title: Fewer women receive tertiary care for epilepsy in Kerala State, India.
abstract: OBJECTIVE
  The stigma attached to epilepsy often restricts early diagnosis and optimal care, particularly among the underprivileged. We aimed to ascertain any gender bias in the utilization of services for epilepsy in a tertiary and community care facility in Kerala State, India.
  
  
  METHODS
  The R. Madhavan Nayar Center for Comprehensive Epilepsy Care (RMNC) is a leading tertiary care facility in South India. The District Mental Health Program (DMHP) is a community-based care facility that provides medical consultation and anti-epileptic drugs (AED) free of charge. We analyzed the sex ratio (SR) - number of women per one thousand men - of all registrations in these centers according to year of registration, age, religion, income, distance from domicile to the center, and religion.
  
  
  RESULTS
  The SR in the RMNC (1976-2004, n = 12354) was 729. At RMNC, age-specific SR increased up to the 3rd decade (864), and progressively declined beyond 50 years. The SR was lower for those domiciliated at more than 200 km from the center when compared to others. The SR at the DMHP (1999-2004, n = 221) was high (1125). The age-specific SR at DMHP showed two peaks at 21-30 years (1368) and 51-60 years (2333).
  
  
  CONCLUSIONS
  Fewer women with epilepsy (particularly in lower socioeconomic groups) receive tertiary care in this state, in spite of a higher SR in the community (907 for epilepsy and 1058 for all population). The tertiary treatment gap is wider for women over 30 years (particularly over 50 years), when their longer life expectancy is also taken into consideration.
authors.affiliation: R. Madhavan Nayar Center for Comprehensive Epilepsy Care, Sree Chitra Tirunal Institute for Medical Sciences and Technology, India. sanjeev@sctimst.ker.nic.in
authors.forename: Sanjeev V
authors.initials: SV
authors.lastname: Thomas
authors.forename: T D
authors.initials: TD
authors.lastname: Deetha
authors.forename: Prabhachandran
authors.initials: P
authors.lastname: Nair
authors.forename: Sankara P
authors.initials: SP
authors.lastname: Sarma
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D004827:Epilepsy / Q000453:epidemiology / Q000628:therapy*; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D007182:Income; D007194:India / Q000453:epidemiology; D007223:Infant; D008297:Male; D008875:Middle Aged; D012067:Religion; D012737:Sex Factors; D014930:Women