title: The epilepsy treatment gap in rural Tanzania: A community-based study in adults.
abstract: OBJECTIVE
  Most people with epilepsy (PWE) in low-income countries are not treated. We identified risk factors for the epilepsy treatment gap in rural Tanzania.
  
  
  METHODS
  We identified adult PWE in a community-based prevalence study. Factors associated with failure to access or default from medical care were identified using logistic regression modelling.
  
  
  RESULTS
  A total of 291 PWE were included, of whom 253 (86.9%) had presented to medical services. Failure to present was positively associated with using alcohol (odds ratio (OR) 4.20; 95% confidence interval (CI) 1.63 to 10.82) or attending traditional healers (OR 2.62; CI 1.00 to 6.83) and inversely associated with having completed primary education (OR 0.33; CI 0.11 to 0.96). Default from treatment was associated with being male (OR 3.35; CI 1.39 to 8.09), having a seizure-related injury (OR 2.64; CI 1.12 to 6.19), believing in a supernatural cause for epilepsy (OR 5.44; CI 1.48 to 19.94) or having no expressed knowledge of cause (OR 5.29; CI 1.60 to 17.52). Cases less likely to default had a duration of epilepsy greater than 10 years (OR 0.28; CI 0.09 to 0.90) or had previously received a seizure-related diagnosis (OR 0.25; CI 0.09 to 0.65). Of all 291 PWE included, 118 denied taking AEDs; the epilepsy treatment gap in this population was therefore 40.5% (95% CI 34.9 to 46.2).
  
  
  CONCLUSIONS
  Interventions to improve access to education and to support formal diagnoses may promote access to, and retention under, medical care for PWE in rural Tanzania and in other low-income countries.
authors.affiliation: Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK. Electronic address: ewanh7@gmail.com.
authors.forename: Ewan
authors.initials: E
authors.lastname: Hunter
authors.affiliation: Kilimanjaro Christian Medical University College, PO Box 2240, Moshi, Tanzania.
authors.forename: Jane
authors.initials: J
authors.lastname: Rogathi
authors.affiliation: Oxford University Department of International Development, Queen Elizabeth House, 3 Mansfield Road, Oxford OX1 3TB, UK.
authors.forename: Simukai
authors.initials: S
authors.lastname: Chigudu
authors.affiliation: Department of Radiology, Kilimanjaro Christian Medical Centre, PO Box 3010, Moshi, Tanzania.
authors.forename: Ahmed
authors.initials: A
authors.lastname: Jusabani
authors.affiliation: Department of Neurology and Neurophysiology, Royal Victoria Infirmary, Newcastle NE1 4LP, UK.
authors.forename: Margaret
authors.initials: M
authors.lastname: Jackson
authors.affiliation: Department of Neurology and Neurophysiology, Royal Victoria Infirmary, Newcastle NE1 4LP, UK.
authors.forename: Roger G
authors.initials: RG
authors.lastname: Whittaker
authors.affiliation: North Tyneside General Hospital, Rake Lane, North Shields, NE29 8NH, UK.
authors.forename: William
authors.initials: W
authors.lastname: Gray
authors.affiliation: Institute of Health & Society, Newcastle University, Newcastle NE2 4AX, UK.
authors.forename: Richard J Q
authors.initials: RJQ
authors.lastname: McNally
authors.affiliation: Muhimbili National Hospital, PO Box 65000, Dar es Salaam, Tanzania.
authors.forename: Eric
authors.initials: E
authors.lastname: Aris
authors.affiliation: Kilimanjaro Christian Medical University College, PO Box 2240, Moshi, Tanzania.
authors.forename: Declare
authors.initials: D
authors.lastname: Mushi
authors.affiliation: North Tyneside General Hospital, Rake Lane, North Shields, NE29 8NH, UK; Institute of Health & Society, Newcastle University, Newcastle NE2 4AX, UK.
authors.forename: Richard
authors.initials: R
authors.lastname: Walker
mesh_terms: D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D000927:Anticonvulsants / Q000600:supply & distribution / Q000627:therapeutic use; D004827:Epilepsy / Q000453:epidemiology* / Q000628:therapy*; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D012044:Regression Analysis; D012189:Retrospective Studies; D012307:Risk Factors; D012424:Rural Population / Q000706:statistics & numerical data*; D013636:Tanzania / Q000453:epidemiology; D055815:Young Adult
chemical_list: D000927:Anticonvulsants
keywords: Africa; Epidemiology; Risk-factors