Title : Clinical impact of neurological consultation in management of epilepsy in rural area, case of Rwanda
Abstract:
Introduction: Epilepsy is the most common neurological disorder in Rwanda with a prevalence of 4.9 percent. Similar to other low-income countries, there is a shortage of healthcare providers in Rwanda with less than ten neurologists countrywide in a population of more than 13 million. Remote areas are the most affected as most neurologists work in the capital city of Kigali.
Methods: Since 2022 through Partners in Health (PIH) /Rwanda and its three supporting hospitals Butaro District Hospital (north province), Rwinkwavu and Kirehe district Hospitals (Eastern province), a regular neurological consultation with focus on epilepsy was introduced. Patients seen in our consultation are from health centers located in our catchment area. For each visit there was a full neurological assessment, laboratory investigations, a plan for neurophysiology (EEG) and imaging (Brain CT scan /MRI) exams alongside treatment management. We added family education and psychosocial intervention in the community by having healthcare provider home visits to most vulnerable patients for assessment of good adherence on ongoing treatment and a support of food package is provided. Within two years, 100 new and follow up patients were reviewed on a monthly basis within the catchment area of the three hospitals. There was a significant raise in community awareness of epilepsy as a brain illness compared to held cultural beliefs and misconception that previously considered Epilepsy as taboo to affected persons and their families.
Results: This intervention faced multiple challenges including stigma around epilepsy, low socio-economic status of families limited patients’ access to healthcare services and lack of diagnostic tools such as imaging and neurophysiology at place as well as availability of medication supplies. On the other hand, it brought opportunities with a team of sponsors funding the support for vulnerable patients with Partners in Health Rwanda and Rwanda Biomedical Center (RBC) through the Ministry of Health. EEG machines are now available at each site with an operating CT scan in Butaro hospital. Patients are no long traveling long to have access to Electroencephalograms (EEG) exam and multiple antiepileptic medications are made available for continuity of care and stable clinical outcome. Today patients understood their condition and were more compliant to medications.
Conclusion: A lot needs to be done to bridge the gap in managing epilepsy in low-income countries and it becomes crucially important in remote and rural areas. Involvement of stakeholders coupled with community care increased access to services and medications alongside strong government policy, capacity building programs can help with a positive step forward in addressing the needs of the most vulnerable populations.
