Limited Care Offered to People with Epilepsy in Mwanza, Tanzania: Need for Intervention

Abstract Background Epilepsy is one of the most common neurological disorder worldwide. It is associated with high socioeconomic burden. Epilepsy successful treatment depends on appropriate diagnosis, correct choice of anti-epileptic drugs (AEDs) and adherence to the prescribed AEDs. While up to 90% of PWE in developing countries don’t get appropriate treatment, there is limited information about care offered to people with epilepsy (PWE) in Tanzania. Therefore, this study aimed to describe available care offered to PWE in Mwanza.Methods This was a cross sectional descriptive study which enrolled health Care workers (HCWs) who regularly treated PWE in five selected hospitals of Mwanza region. It aslo enrolled PWE (or their caretakers) attending outpatient clinic in these hospitals. HCWs completed self-administered questionnaires while PWE or caretakers were interviewed using structured Swahili translated questionnaires. Coded data were analyzed using SPSS.Results A total of 18 HCWs and 218 PWE (or their care takers) participated in this study. Among 18 HCWs who routinely diagnosed and treated PWE, nurses were majority and none was a neurologist. Only 2/18 (11.1%) HCWs reported to use investigations to confirm epilepsy diagnosis or explore its causes. 10/18 (55.6%) of HCWs reported that counseling was given to patients. However, counseling information was largely inadequate regarding the use of AEDs. The AEDs prescriptions were mainly dictated by drug availability and affordability to patients, rather than seizure types. 27/218 (12.4%) patients were given subtherapeutic and 109/218 (50.0%) sub-optimal doses, despite some had one or more seizures in the last 30 days. No follow-up investigation was done to any of the 218 participant patients. Ten (55.6%) HCWs did not stop AEDs medication to their patients while the rest stopped medication after varying periods of seizure free.Conclusion Most PWE in Mwanza were diagnosed and treated by nurses. Patients were not thoroughly investigated, counseled and followed-up, and had limited choice and accessibility to AEDs. Some patients particularly in district hospitals were under-medicated despite of seizure recurrence. There was discrepancy between hospitals and practitioners regarding withdraw of AEDs. We recommend short-course training about epilepsy management to the HCWs who diagnose and treat PWE regularly.