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Harimanana A.,Institute Francophone pour la Medecine Tropicale IFMT | Harimanana A.,French Institute of Health and Medical Research | Harimanana A.,University of Limoges | Harimanana A.,Limoges University Hospital Center | And 11 more authors.
BMC Health Services Research | Year: 2013

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. © 2013 Harimanana et al; licensee BioMed Central Ltd. Source


Barennes H.,Institute Francophone pour la Medecine Tropicale IFMT | Harimanana A.N.,Institute Francophone pour la Medecine Tropicale IFMT | Vorachit S.,Institute Francophone pour la Medecine Tropicale IFMT | Chivorakoun P.,Institute Francophone pour la Medecine Tropicale IFMT
Neurology Asia | Year: 2011

In Lao PDR research conducted over the last 7 years has highlighted the difficult challenges that the 52,000 patients living with epilepsy (PWE) have to face. Mortality and morbidity is high among untreated patients. The treatment gap is 90% or more. The highly traditional and poor knowledge of the disease and its treatment, low trust in modern treatment, restricted access to anti-epileptic drugs (phenobarbital is the first line drug), and ignorance of requirement for long term treatment explain the high treatment gap. Stigma, misconceptions, and fear of the disease are common. Knowledge of medical staffs regarding epilepsy diagnosis and treatment is poor. The neurology investigational facilities are basic and mainly concentrated in the capital city. Using lessons from program of neighboring countries, the authors have been developing a step-by-step treatment intervention project since 2009. The intervention was adapted to the local constraints and a limited budget, which demanded regular feedbacks, analysis and reorientation of the activities. Source

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