Healthcare Provider Education to Reduce Epilepsy Care Disparities in Uganda (2020-2021)

Background

Epilepsy is one of the most common neurological disorders in world, affecting over 50 million people. While it is highly treatable, three out of four people with epilepsy in low- and middle-income countries do not receive care for this neurologic condition. In East Africa, there are strong beliefs in supernatural or witchcraft-based causes and treatments, and a concurrent lack of personnel resources for biomedical care. Supernatural or spiritual attributions for illness and the use of traditional healers employing herbal or spiritual interventions also exert influence on care seeking and provision.

In Uganda, there are five neurologists and approximately 35 psychiatrists in the public sector treating all neurologic and psychiatric conditions in a country of 44.3 million people, over half of whom rely on the public healthcare system. Non-specialty-level healthcare providers include general practice physicians and residents, medical and psychiatric clinical officers and nurses, all with variable exposure to epilepsy treatment curricula. There is significant misinformation and stigma about epilepsy, with almost one in five people believing it to be contagious. Less than a third of people know how to respond to a person having seizures.

Project Description

In order to address these barriers, a multiyear Bass Connections project has designed interventions that include collaboration between biomedical healthcare providers and traditional healers, awareness building and the development of additional medical infrastructure to address medication stockouts. The 2020-2021 team will expand on this work and help strengthen healthcare provider mastery of epilepsy treatment paradigms in culturally sensitive and relevant manners.

Team members will draw from the data from earlier phases of this work to tailor provider education, and use broad medical, psychological and sociocultural perspectives and methodologies to solve this problem. The project will focus on the World Health Organization’s mhGAP Intervention Guide, which contains a module on epilepsy diagnosis and treatment designed for frontline healthcare physicians, nurses and officers. However, in its current form, the guide’s epilepsy module lacks specificity at the level of differential diagnosis and longitudinal care management that is specific to the medicine, diagnostic tools and cultural setting of Uganda.

With the collected data, team members will adapt the module to meet the specific needs and resources of Uganda. The epilepsy curriculum will be reviewed for modification and approval by neurologists and psychiatrists in Uganda. Once approved, it will be piloted in Mbarara, Uganda. Outcomes will be demonstrated using a pre-post examination of epilepsy “Knowledge, Attitudes and Practice” survey.

Anticipated Outputs

Epilepsy treatment curriculum for Uganda; posters; presentations; manuscripts; data for use in student projects

Timing

Fall 2020 – Summer 2021

  • Fall 2020: Modify World Health Organization mhGAP 2.0 Intervention Guide; review collaborative partners’ edits; prepare and submit IRB
  • Spring 2021: Implement specialized healthcare provider education; conduct pre- and post-test of Knowledge, Attitudes and Practice survey; begin post-implementation tracking
  • Summer 2021: Travel to Uganda; analyze data; disseminate results

See earlier related team, Cultural and Practical Barriers to Epilepsy Care in Uganda (2018-2019).

 

Image: Christopher Komakech demonstrates how to place electrodes for an EEG exam, from Fighting Epilepsy in Uganda with Tools and Teamwork, Duke Global Health Institute website 

EEG exam demonstration.

Team Leaders

  • Deborah Attix, School of Medicine-Psychiatry and Behavioral Sciences;Neurology
  • Neil Prose, School of Medicine-Dermatology

/graduate Team Members

  • Antoinette Charles, Medicine-MD

/undergraduate Team Members

  • Michael Gildea
  • Tyler Johnson, Psychology (AB)
  • Pratamesh Ramasubramanian
  • Olivia Ratliff, Computer Science (BS)

/yfaculty/staff Team Members

  • Anthony Fuller, School of Medicine-Neurosurgery
  • Michael Haglund, Duke Global Health Institute|School of Medicine-Neurosurgery

/zcommunity Team Members

  • Mark Kaddumukasa, Department of Medicine, Makerere University
  • Martin Kaddumukasa, Department of Medicine, Makerere University
  • Angelina Kakooza, Department of Medicine, Makerere University
  • Colby Newson