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Open Access Research article

Is insufficient knowledge of epilepsy the reason for low levels of healthcare in the Lao PDR?

Aina Harimanana1234, Phetvongsinh Chivorakul1234, Vimalay Souvong1, Pierre-Marie Preux234 and Hubert Barennes1567*

Author Affiliations

1 Institut Francophone pour la Médecine Tropicale (IFMT), BP 9519, Vientiane, Lao PDR, Laos

2 INSERM UMR 1094, Tropical Neuro epidemiology, Limoges, France

3 School of Medicine, Institute of Tropical Neurology, Univ. Limoges, Limoges, France

4 CHU Limoges, Limoges, France

5 ISPED, Centre INSERM U897-Epidemiologie-Biostatistique, Univ. Bordeaux, F-33000, Bordeaux, France

6 INSERM, ISPED, Centre INSERM U897-Epidemiologie-Biostatistique, F-33000, Bordeaux, France

7 ANRS BP 983, Phnom Penh, Cambodia

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BMC Health Services Research 2013, 13:41  doi:10.1186/1472-6963-13-41

Published: 4 February 2013

Abstract

Background

The treatment gap for epilepsy is considerable in low and middle-income countries. In the Lao PDR it is estimated at over 90%. Health workers play a significant role in bridging the gap between people with epilepsy (PWE) and access to epilepsy care. In a national survey we assessed: 1) the knowledge and practices of health workers in the Lao PDR towards the disease, and, 2) patient attendance at health facilities.

Methods

We conducted a random three-stage sampling of health workers at the provincial, district and health center levels in 2009.

Results

Overall, 284 health workers were enrolled in 50 health facilities of 11 provinces: health centers 24.7%; district hospitals 23.2%; and province hospitals 52.1%. Only a minority of these (2.5%) recalled ever having received training or seeking information on epilepsy. Our survey showed a lack of knowledge in diagnosing and prescribing drugs for epilepsy, including phenobarbital, the first-line of treatment. The majority of respondents (59.9%) was unaware of the availability of antiepileptic drugs in health facilities. Only 10 (20%) health facilities, and no health centres, received people with epilepsy. It was estimated that one PWE per month receives medical attention. Traditional beliefs about PWE were common; such as the idea that epilepsy could be transmitted through saliva (63.2%). A higher attendance of PWE was observed in province hospitals where the knowledge of epilepsy care was higher. Global acceptance of people with epilepsy was low.

Conclusions

The low level of knowledge of epilepsy on the part of health workers may be contributing to the wide treatment gap in the Lao PDR. Improving knowledge of this disease and increasing the availability of antiepileptic drugs will reduce misconceptions about epilepsy, thus encouraging more PWE to seek treatment. Community-based educational programs and extensive advocacy for people with epilepsy only began in 2009.

Keywords:
Epilepsy; Treatment gap; Knowledge; Medical staff; Nurse; Interventions