Treatment with phenobarbital and monitoring of epileptic patients in rural Mali.
OBJECTIVE
To assess the efficacy of phenobarbital treatment for epileptic patients in rural Mali.


METHODS
Epileptic patients were treated at home with phenobarbital at daily dosages ranging from 50 mg for children to 200 mg for adults and their condition was monitored. Advice was given to patients, their families, and the village authorities in order to achieve compliance. An uninterrupted supply of generic phenobarbital was provided and a rural physician made two follow-up visits to each village to ensure that the drug was taken in the correct doses. The physician gave information to the population, distributed the phenobarbital in sufficient quantities to cover the periods between visits, and monitored the patients' responses to treatment. During the first year the physician visited the patients every two months. The frequency of visits was subsequently reduced to once every four months.


RESULTS
In the six months preceding treatment the average rate of seizures among patients exceeded four per month. After a year of treatment, 80.2% of the patients experienced no seizures for at least five months. A total of 15.7% of patients experienced a reduction in seizures. In many cases no further seizures occurred and there were improvements in physical health, mental health and social status. There were very few side-effects and no cases of poisoning were reported. The cost of treatment per patient per year was 7 US dollars for generic phenobarbital and 8.4 US dollars for logistics.


CONCLUSIONS
Low doses of phenobarbital were very effective against epilepsy. However, there is an urgent need for programmes involving increased numbers of physicians in rural areas and, at the national level, for the inclusion of epilepsy treatment in the activities of health care facilities. Internationally, an epilepsy control programme providing free treatment should be developed.
Nimaga
K
K
Santé Sud, Bamako, Mali.
Desplats
D
D
Doumbo
O
O
Farnarier
G
G
D000293:Adolescent; D000328:Adult; D000359:Aftercare / Q000458:organization & administration; D000368:Aged; D000927:Anticonvulsants / Q000191:economics / Q000627:therapeutic use*; D019090:Case Management / Q000458:organization & administration; D002648:Child; D002675:Child, Preschool; D016527:Drug Costs / Q000706:statistics & numerical data; D016903:Drug Monitoring / Q000706:statistics & numerical data*; D017723:Drug Utilization Review; D004827:Epilepsy / Q000188:drug therapy*; D005260:Female; D006302:Health Services Research; D006801:Humans; D008297:Male; D008302:Mali; D008875:Middle Aged; D020380:Needs Assessment; D010634:Phenobarbital / Q000191:economics / Q000627:therapeutic use*; D015397:Program Evaluation; D019035:Rural Health Services / Q000458:organization & administration*; D016896:Treatment Outcome
D000927:Anticonvulsants; D010634:Phenobarbital