Replacing hospital-based epilepsy clinics with rural epilepsy clinics and education in Uganda: impact on attendance

Background: A high proportion of the Ugandan population with epilepsy receive no treatment. Aim: To determine whether introduction of an agreed multidisciplinary guideline and establishment of a local clinic outside the hospital and four rural satellite clinics improved attendance and follow-up by children with epilepsy in Western Uganda. Methods: A multidisciplinary team from Kagando Hospital, Kasese, south-west Uganda created a guideline for the management of epilepsy. A clinic local to the hospital and rural satellite clinics were established.Attendance and follow-up were audited for three months before the intervention. Attendance, follow-up and the cost of the hospital, local and rural clinics were audited 6 months and 5 years post intervention. Results: Pre-intervention, one patient a month attended the free Kagando Hospital epilepsy clinic. Post-intervention, a median of eight patients (range 2-12) attended the local clinic and 100% attended booked follow-up appointments; the cost per clinic was £15 (£1.88 per patient, range 1.25-7.50). A median of 42 (range 15-56) patients per clinic attended the rural clinics and 70% of patients attended follow-up appointments; the cost per clinic was £34 (£0.81 per patient, range 0.61-2.23). Rural clinic attendance was higher than in the hospital clinic (p = 0.007) and in the local clinic (p = 0.004). Five years post-intervention, the attendance was 44 patients (range 25-85) per rural clinic and the cost per clinic was £34. Conclusions: Rural epilepsy clinics were associated with higher attendance than the hospital or local clinic and the attendance rate remained higher 5 years post-intervention.