title: Results of an action-research on epilepsy in rural Mali.
abstract: OBJECTIVE
  To evaluate the RARE (Réseau Action-Recherche sur l'Epilepsie) program, a model of managing and treating people with epilepsy (PWE) at a primary health-care level in rural areas of Mali, we assessed treatment efficacy and compliance of patients who underwent the first year follow-up.
  
  
  METHODS
  A network of rural general practitioners (GPs) settled in six rural districts of the regions of Koulikoro, Segou and Sikasso, was involved in the diagnosis, evaluation and monitoring of all the identified PWE and in the distribution of phenobarbital (PB). All the participants were included in a prospective database and followed-up by GPs at 4 months intervals during the first year. Seizure frequency, treatment doses and appearance of adverse events (AEs) were systematically recorded. Efficacy was evaluated in terms of reduction of seizures frequency while noncompliance in terms of time to study withdrawal for any cause.
  
  
  RESULTS
  596 patients treated with PB were included in the analysis. Of these, 74.0% completed the first year follow-up. At the final visit, 59.6% were seizure-free: 31.0% for 12 months, 10.2% for 8 months and 18.4% for 4 months. Adults and patients with convulsive seizures were the most drug-resistant (p<0.002). Few AEs were recorded. The multivariate analysis showed that being a woman, presenting convulsive seizures, having more than 5 seizures/month and had never be treated were predictors of withdrawal (p ≤ 0.05) at 12 months.
  
  
  CONCLUSIONS
  This study showed a good response and compliance to the treatment and allowed the identification of some factors associated with failure of management in a setting very near to clinical practice. Awareness campaigns are needed to assure a broader accessibility to treatment and to improve the compliance and continuity with treatment programs.
authors.affiliation: Institut National de la Santé et de la Recherche Médicale (INSERM) U1094, Tropical Neuroepidemiology, University of Limoges, School of Medicine, Institute of Tropical Neurology, Centre Hospitalier Universitaire (CHU), Limoges, France.
authors.forename: Elisa
authors.initials: E
authors.lastname: Bruno
authors.forename: Karamoko
authors.initials: K
authors.lastname: Nimaga
authors.forename: Ibrahima
authors.initials: I
authors.lastname: Foba
authors.forename: Philippe
authors.initials: P
authors.lastname: Vignoles
authors.forename: Pierre
authors.initials: P
authors.lastname: Genton
authors.forename: Ogobara
authors.initials: O
authors.lastname: Doumbo
authors.forename: Daniel
authors.initials: D
authors.lastname: Gérard
authors.forename: Pierre-Marie
authors.initials: PM
authors.lastname: Preux
authors.forename: Guy
authors.initials: G
authors.lastname: Farnarier
mesh_terms: D000293:Adolescent; D000328:Adult; D000927:Anticonvulsants / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D018572:Disease-Free Survival; D004827:Epilepsy / Q000628:therapy*; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008302:Mali; D015999:Multivariate Analysis; D010634:Phenobarbital / Q000627:therapeutic use*; D016016:Proportional Hazards Models; D019035:Rural Health Services; D012424:Rural Population; D016896:Treatment Outcome; D028761:Withholding Treatment; D055815:Young Adult
chemical_list: D000927:Anticonvulsants; D010634:Phenobarbital