Family in Guinea-Bissau

van Diessen E, van der Maas F, Cabral V, Otte WM. Epilepsy & Behavior 79 (2018): 23-25


Epilepsy is a neglected condition in many low- and middle-income countries. This study presents data on a potential strategy for treating people with epilepsy who live in sub-Saharan African regions, such as rural Guinea-Bissau, where treatment is lacking due to limited resources, high costs, and the presence of a cultural stigma towards epilepsy.

Description of Study

  • The authors of this study implemented a community-based rehabilitation, or CBR, strategy to detect, monitor, and treat people with epilepsy who live in rural Guinea-Bissau.
  • By employing local resources, the researchers believe the CBR strategy addresses four major contributions to the disparity of epilepsy treatment:
    1. Inadequate skilled healthcare manpower
    2. High treatment costs
    3. Limited or no antiepileptic drug access
    4. Unfavorable cultural beliefs
  • The study was conducted in the rural state of Oio. It has been reported that epilepsy was one of the leading disabilities in this region. The researchers “closely collaborated with the local disability organization of Bissora, a centrally located town.”
  • The study implemented a 3-stage approach that also included awareness campaigns and epidemiological characterization in the community:
    1. Door-to-door surveys were conducted in rural villages to register people with epilepsy.
    2. The medical history was recorded of individuals with epilepsy who were also asked to keep a calendar log of their seizures.
    3. A potential person with epilepsy was to visit the CBR center for the next 3 months and diagnosis and treatment of epilepsy was started by an experienced senior nurse.

Summary of Study Findings

  • About 22,500 people were screened over two years. 112 people were registered with epilepsy, successfully kept a seizure diary, and showed up consistently.
  • 81 of the 112 people were treated with phenobarbital, a medication typically used to treat epilepsy in developing countries.
  • The study’s data shows an 88.8% of people that received treatment had a significant drop in the number of seizures after starting treatment.
  • Prior to CBR implementation, the median seizure load was around 5.5 per month. After treatment, the median dropped to 0 seizures per month. This remained after 6, 12, and 15 months after treatment.
  • Although the study does not provide hard data on addressing epilepsy stigma, they do report that “spontaneous show up of people at the CBR center, asking for diagnosis and treatment of epilepsy, indicated increased awareness in the community.”
  • The total cost for the CBR service in 2015 was $21,500. Thus, effective treatment and monitoring of 81 people with epilepsy amounted to $0.73 per person per day. If initial start-up costs are excluded, the cost drops to $0.38 per person per day.

What does this mean?

  • Although the study authors do not compare their approach with other strategies that might have been used to treat people with epilepsy in rural regions of sub-Saharan Africa, their results are an important step in the right direction.
  • The study makes this claim: “With this field data from Guinea-Bissau, we show the importance of BFR for the identification and monitoring of [people with epilepsy] in rural areas of low-middle income countries. Addressing epilepsy with CBR is cost-effective and effectively tackles stigma and negative community barriers. Furthermore, start of antiepileptic drug treatment was successful for most [people with epilepsy] and compliance increased compared with our previous experiences.”
  • Although approximately 65 million people worldwide are directly affected by epilepsy, there is a higher prevalence in developing countries. This study demonstrates that the use of local resources and a CBR strategy can provide cost-effective and life-altering treatment for people with epilepsy in low- and middle-income countries like Guinea-Bissau.

Article published in Epilepsy & Behavior, February 2018.

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Authored By: 
Dara Farhadi MS
Authored Date: 
Reviewed By: 
Joseph I. Sirven MD
Friday, March 16, 2018