Decentralized, primary-care delivered epilepsy services in Burera District, Rwanda: Service use, feasibility, and treatment
Beatha Nyirandagijimana, Alphonse Nshimyiryo, Hildegarde Mukasakindi, Jackline Odhiambo, Eugenie Uwimana, Valerie Mukamurenzi, Robert Bienvenu, Jean Sauveur Ndikubwimana, Clemence Uwamaliya, Priya Kundu, Paul H Park, Tharcisse Mpunga, Giuseppe J Raviola, Fredrick Kateera, Christian Rusangwa, Stephanie L Smith
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Background Integrating epilepsy care into primary care settings could reduce the global burden of illness attributable to epilepsy. Since 2012, the Rwandan Ministry of Health and the international nonprofit Partners In Health have collaboratively used a multi-faceted implementation program- MESH MH—to integrate and scale-up care for epilepsy and mental disorders within rural primary care settings in Burera district, Rwanda. We here describe demographics, service use and treatment patterns for patients with epilepsy seeking care at MESH-MH supported primary care health centers. Methods and findings This was a retrospective cohort study using routinely collected data from fifteen health centers in Burera district, from January 2015 to December 2016. 286 patients with epilepsy completed 3307 visits at MESH-MH participating health centers over a two year period (Jan 1st 2015 to Dec 31st 2016). Men were over twice as likely to be diagnosed with epilepsy than women (OR 2.38, CI [1.77–3.19]), and children under 10 were thirteen times as likely to be diagnosed with epilepsy as those 10 and older (OR 13.27, CI [7.18–24.51]). Carbamazepine monotherapy was prescribed most frequently (34% of patients). Conclusion Task-sharing of epilepsy care to primary care via implementation programs such as MESH-MH has the potential to reduce the global burden of illness attributable to epilepsy.