Antiepileptic Drug Treatment in Rural Africa: Involving the Community

The vast majority of patients with epilepsy in developing countries do not receive adequate medical treatment and an estimated percentage of 80–90% are without any treatment. Poor infrastructure, insufficient availability of drugs and scarcity of trained medical personnel are relevant factors for this situation. Traditional concepts about epilepsy may also affect acceptance and compliance to modern treatment. We report our experience with anti-epileptic drug (AED) treatment in a rural African community with a high prevalence of epilepsy. After identification of the patients during a prevalence survey on epilepsy, the input of the medical service of the district to the treatment scheme was reduced to a 6-monthly medical visit to the area and long-term provision of AED to the patients. Members of the community were integrated as assistants in the distribution of the drugs and community participation was gradually enhanced over the first year of the programme. A cost-sharing system for the financing of the community assistants was introduced and a self-help committee of epilepsy patients and their families was founded. Within the first 20 months the patients showed good compliance as indicated by a growing number of patients presenting for treatment and a low rate of discontinuation of the treatment. A marked improvement could be observed for most of the patients treated with phenobarbitone in terms of reduction of seizure frequency although complete seizure control was achieved in only a few.