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. 2012;7(8):e44469.
doi: 10.1371/journal.pone.0044469. Epub 2012 Aug 31.

Results of an action-research on epilepsy in rural Mali

Elisa Bruno  1 , Karamoko Nimaga, Ibrahima Foba, Philippe Vignoles, Pierre Genton, Ogobara Doumbo, Daniel Gérard, Pierre-Marie Preux, Guy Farnarier
Affiliations

Results of an action-research on epilepsy in rural Mali

Elisa Bruno et al. PLoS One. 2012.

Abstract

Purpose: 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.

Key findings: 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.

Significance: 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.

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Conflict of interest statement

Competing Interests: This work was supported by Sanofi-Aventis within the project “RARE: Réseau Action-Recherche sur l’Epilepsie” coordinated by the NGO Santé-Sud. This does not alter the authors' adherence to all the PLoS ONE policies on sharing data and materials. Dr. Karamoko Nimaga and Dr. Ibrahima Foba are affiliated to the "Association des Médecins de Campagne/RARE Network". Dr. Pierre Genton, Dr. Ogobara Doumbo and Dr. Guy Farnarier declare to be affiliated to the nongovernmental organization "Santé-Sud". Dr. Daniel Gérard declares to be employed for Sanofi-Aventis. These above-mentioned affiliations do not alter the authors' adherence to all the PLoS ONE policies on sharing data and materials.

Figures

Figure 1
Figure 1. Patients enrollment and treatments underwent.
Figure 2
Figure 2. Kaplan-Meier plots illustrating time to withdrawal for any cause for the groups of convulsive and non-convulsive seizures.
Figure 3
Figure 3. Time to first seizure.
Kaplan-Meier analysis for cumulative event rates during the first year follow-up for the groups of convulsive and non-convulsive seizures.
See this image and copyright information in PMC

References

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