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Hospital-based epilepsy care in Uganda: A prospective study of three major public referral hospitals
Anthony T Fuller1, Alysa Almojuela2, Martin N Kaddumukasa3
1Duke Division of Global Neurosurgery and Neurology, Department of Neurosurgery, Box 3807 Duke University Medical Center, Durham, NC 27705, USA; Duke Global Health Institute, 310 Trent Dr, Durham, NC 27710, USA; Duke University, School of Medicine, Durham, NC, USA.
Insights
This study describes epilepsy demographics and treatment in Ugandan hospitals. Findings show severe epilepsy cases and a positive trend in seizure management with antiepileptic drugs (AEDs).
Area of Science:
- Neurology
- Public Health
- Epidemiology
Background:
- Epilepsy care in low-income countries presents unique challenges.
- Understanding the demographics and treatment practices of people with epilepsy (PWE) in Uganda is crucial for improving healthcare.
- Hospital-based care is a key access point for PWE in Uganda.
Purpose of the Study:
- To describe the current demographics of people with epilepsy (PWE) in Uganda.
- To outline epilepsy treatment practices in three major Ugandan public referral hospitals.
- To assess trends in epilepsy severity and quality of life over a six-month follow-up period.
Main Methods:
- A six-month prospective cohort study involving 626 children and adults with epilepsy.
- Data collection through questionnaires at baseline and at 3 weeks, 3 months, and 6 months.
- Detailed data on patient demographics, clinical characteristics, epilepsy severity, and antiepileptic drug (AED) treatment.
Main Results:
- Nearly equal gender distribution (50.8% female) with no significant age or gender differences between hospitals.
- Majority of PWE had primary education; over 90% experienced loss of consciousness during seizures.
- Most patients received 1-2 AEDs, with carbamazepine being most common; a trend towards improved seizure severity was observed.
Conclusions:
- People with epilepsy in Ugandan hospitals often have severe forms requiring AED management.
- Current hospital practices indicate a positive trend in reducing seizure burden and improving quality of life.
- Further interventions are needed to enhance access to biomedical care for all PWE in Uganda.
Objective:
This study sets out to describe the current demographics of people with epilepsy (PWE) attending hospital-based care in Uganda and the epilepsy treatment practices within three of the largest Ugandan public referral hospitals.
Methods:
In a six-month prospective cohort study, 626 children and adults attending epilepsy clinics at Mulago National Referral Hospital, Butabika National Referral Mental Hospital and Mbarara Regional Referral Hospital were enrolled. Using a study questionnaire, data were collected at baseline and at 3 weeks, 3 months, and 6 months following enrollment. Specific data surrounding individual patient demographics, clinical characteristics and severity of epilepsy, and treatment of epilepsy with antiepileptic drugs (AEDs) were collected.
Results:
Female patients totaled to 50.8%, with a nearly equal gender distribution at each hospital. There was no statistical difference in gender or age between sites. The majority of PWE had completed primary school, with less than 15% of patients completing more than a secondary education. Seizure severity was high, with most patients having multiple seizures per week at the initial onset of epilepsy, and greater than 90% of patients reporting a loss of consciousness with seizures. The majority of patients (54.95%) also reported a developmental or learning delay. Most patients were on 1 AED (46.01%) or 2 AEDs (36.90%), with carbamazepine being the most frequently prescribed AED. There was a trend towards improved seizure severity over the follow-up period, as assessed by the corresponding Personal Impact of Epilepsy Scale (PIES) subscale.
Conclusions:
People with epilepsy attending hospital-based care in Uganda tend to have severe forms of epilepsy requiring management with AEDs. Current hospital-based practices show a positive trend for seizure burden and quality of life of PWE in Uganda. Further interventions to improve overall access to biomedical care are required to continue to advance the management of PWE across all communities. This article is part of the Special Issue "The Intersection of Culture, Resources, and Disease: Epilepsy Care in Uganda".
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