Evaluation of adherence to a convulsion management protocol for children in Rwanda

Area of Science:

• Pediatrics
• Neurology
• Global Health

Background:

• Inappropriate seizure management is linked to increased morbidity and mortality.
• Effective pharmacological management of pediatric seizures is crucial for preventing long-term complications.
• Adherence to national treatment guidelines ensures standardized and optimal patient care.

Purpose of the Study:

• To evaluate the adherence of healthcare professionals in southern Rwanda to the national protocol for the pharmacological management of pediatric seizures.
• To identify specific areas of non-adherence in the initial treatment and subsequent management of prolonged seizures in children.

Main Methods:

• A questionnaire-based assessment was conducted among physicians and nurses in southern Rwanda.
• The questionnaire presented a clinical scenario of a 5-year-old child with generalized prolonged seizures.
• Participants were queried on their choice of initial therapy and management sequence following treatment failure.

Main Results:

• While benzodiazepine was the preferred initial therapy for 93.7% of physicians and 90.9% of nurses, adherence to subsequent management steps was low.
• Only 49.2% of physicians and 41% of nurses would repeat the initial treatment dose upon failure.
• Significant delays in intervention (47% of doctors waiting 30 min) and uncertainty in managing refractory status epilepticus (19% unsure) were observed.

Conclusions:

• Findings indicate suboptimal adherence to the national seizure management protocol among healthcare professionals in southern Rwanda.
• There is a need for targeted education and interventions to improve the consistent application of evidence-based seizure management guidelines.
• Enhancing adherence is essential to reduce morbidity and mortality associated with inadequate seizure control in children.