Health care delivery model in epilepsy to reduce treatment gap: World Health Organization study from a rural tribal population of India.
OBJECTIVE
To design and develop an effective health care delivery model in epilepsy to reduce the treatment gap in a rural tribal community in India.


METHODS
This study was conducted in tribal dominated Namkum Block (114,068 population) of Ranchi, Ranchi District, Jharkhand state, India and carried out as four-staged program-first stage consisted of separate training programs (to 6 volunteer health workers, traditional practitioners of community including 267 faith healers and qualified practitioners), second stage consisted of awareness campaign programs, third stage consisted of diagnosis, treatment delivery and follow-up in once a month camps with free medication and final stage consisted of continued follow-up after the end of study by local practitioners.


RESULTS
Health volunteers identified 787 probable cases in the community, 453 attended the camps, and 318 were diagnosed and treated for epilepsy in the camp. Treatment gap was 95% on the initial assessment. 213 epileptic patients enrolled in the study completed 12 months treatment and more than 75% were seizure free at the end of the study. Eighty percent of patients' care-givers and their family members were satisfied with the care provided. At the end of study, local medical practitioners continued to do the follow-up of study participants to ensure continuity of care although results of further follow-up are not included in the present study.


CONCLUSIONS
A four-staged program in epilepsy treatment delivery model was successful. Voluntary health workers from the community can be effectively trained to identify cases and persuade them to seek treatment. The delivery model should include intensive health awareness campaign, training of doctors and other health care providers, free supply of AEDs (Antiepileptic drugs), continuous follow-up for compliance and side-effects of the drug and tactful dealing with indigenous practitioners and faith healers without antagonising them.
Nizamie
S Haque
SH
Central Institute of Psychiatry, Kanke, Ranchi, Jharkhand 834006, India.
Akthar
Sayeed
S
Banerjee
Indrajeet
I
Goyal
Nishant
N
D000293:Adolescent; D000328:Adult; D000927:Anticonvulsants; D002648:Child; D003695:Delivery of Health Care / Q000379:methods*; D004827:Epilepsy / Q000453:epidemiology* / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006282:Health Personnel; D006303:Health Services, Indigenous; D006801:Humans; D007194:India / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D012424:Rural Population; D014944:World Health Organization; D055815:Young Adult
D000927:Anticonvulsants