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Published on: September 20, 2024
Surgical Candidacy, Barriers, and Facilitators of Pediatric Epilepsy Surgery at St. Francis Hospital Nsambya: A Mixed
Bisilikirwa Hope Walube1, Tracy Tushabe Namata1, Emmanuel Wegoye2
1Department of Paediatrics and Child Health, St.Francis Hospital Nsambya, Kampala, Uganda.
Insights
Nearly 40% of Ugandan children with epilepsy are candidates for surgery. Addressing misinformation and improving healthcare capacity are key to increasing access to this life-changing treatment.
Area of Science:
- Pediatric Neurology
- Neurosurgery
- Public Health
Background:
- Epilepsy is a prevalent neurological disorder in children.
- Epilepsy surgery offers significant benefits but is underutilized in Uganda.
- This study investigated surgical candidacy, barriers, and facilitators in Ugandan children with epilepsy.
Purpose of the Study:
- Determine the proportion of pediatric epilepsy surgery candidates in Uganda.
- Identify barriers hindering epilepsy surgery uptake.
- Explore facilitators that could promote epilepsy surgery.
Main Methods:
- A sequential explanatory mixed-methods study was conducted.
- Quantitative phase: analyzed records of 110 children (aged 2-18) with epilepsy.
- Qualitative phase: in-depth interviews with caregivers and health workers.
Main Results:
- 38.2% of children were identified as potential epilepsy surgery candidates.
- Common barriers included lack of information, financial constraints, and cultural beliefs.
- Facilitators involved accurate information, empathy, and shared experiences.
Conclusions:
- Approximately 4 in 10 children with epilepsy in Uganda may be eligible for surgery.
- Enhancing community engagement and health system capacity is crucial.
- Addressing knowledge gaps is essential for optimizing pediatric epilepsy surgery outcomes.
Background:
Epilepsy is the most common neurological disorder among children. Despite evidence showing that epilepsy surgery improves seizure control, quality of life, and cognitive outcomes, it remains severely underutilized in Uganda. This study aimed to determine the proportion of children who are epilepsy surgery candidates and to explore its barriers and facilitators.
Methods:
A sequential explanatory mixed-methods study was conducted at St. Francis Hospital Nsambya. Consecutive records of 110 children aged 2-18 years with confirmed epilepsy provided data for the quantitative phase. Surgical candidacy was defined by concordant magnetic resonance imaging and electroencephalography abnormalities; generalized epilepsies were excluded. Qualitative data was obtained by purposive in-depth interviews with four caregivers of operated and five caregivers of non-operated children as well as four health workers. Quantitative data were analyzed using STATA 17 and qualitative data thematically.
Results:
Of the 110 children enrolled, majority (77; 70%) were aged 2-9 years and 58 (52.7%) were males. Overall, 42 (38.2%) (95% confidence interval: 29.5%-47.7%) were eligible candidates for epilepsy surgery. Hemiparesis and use of multiple anti-seizure medications were more common among surgical candidates. Major barriers included information gaps, misinformation, fear of surgical risk, financial limitations, negative cultural or religious beliefs, and discouragement from social circles. Facilitators included accurate information, empathy, and shared caregiver experiences, hope, faith in God, pivotal health events such as intensive care unit admission.
Conclusions:
Four in ten children with epilepsy are potential surgical candidates. Strengthening community engagement, addressing knowledge gaps, and building health system capacity are essential in optimizing pediatric epilepsy surgery in Uganda.
