The problem of epilepsy and its care in rural Ethiopia.

BACKGROUND Jimma University Hospital (JUH) in south west Ethiopia has been running an integrated rural chronic disease programme since 1999, focusing on treatment of epilepsy, diabetes and heart disease. OBJECTIVE The purpose of this review is to compare clinical data of the epilepsy patients with those previously published from a similar programme in Gondar university, in the north west of the country. METHOD In November 2005, we identified a total of 1,250 patients with epilepsy from the JUH study with case records for analysis. Clinical data are documented in the case records using a structured questionnaire and follow-up chart. We entered the data into SPSS software and performed descriptive analyses. RESULTS The age of the patients was weighted towards teenage years and young adult life, very similar to that seen in Gondar. The majority of those presenting to the clinic were male (M:F = 1.6:1) and educational level in rural communities was poor. The seizure history was very similar to that observed in Gondar. The average age at onset of unprovoked seizures was 13 years, and only 35% of patients presented within six months of their first seizure. A family history was found in 8% compared with 24% in Gondar. Other risk factors for epilepsy such as previous intracranial infection, head injury and perinatal factors were reported more frequently by patients from Jimma. Status epilepticus was reported by 2.7% in Jimma and 2.0% in Gondar. 10% in both Jimma and Gondar had received burns as a result of seizures. The psychosocial impact of epilepsy was substantial; 24-47% of patients were affected in some way. Default from follow-up was high in both Jimma (40%) and Gondar (62%). CONCLUSION The JUH data show good general agreement with Gondar university, suggesting that the areas have comparable populations of people with epilepsy. Despite the large number of patients registered at the health centres, there is still a considerable gap between those who suffer from the condition and those who actually get treatment with phenobarbitone. Future work will need to address this shortfall and increase the availability of this inexpensive and effective treatment.