Challenges of epidemiological research on epilepsy in resource-poor countries.

in addressing health needs. The purpose of this text is to highlight some of the methodological challenges faced when conducting epidemiological research on epilepsy in resource-poor settings. An acute resource constraint is a dominant underlying feature of health services in developing countries. The treatment gap is huge (reaching more than 90%) in most places. As only a small fraction of PWE benefit from treatment, health services are of limited value to conduct epidemiological research on this condition. Typically, beneficiaries of treatment originate from urban areas and belong to the economically advantaged section of the population, which does not represent the majority in need. Therefore, community-based studies are inevitable to correctly assess the living conditions and needs of PWE. However, community-based epidemiological studies are challenging. Exact and reliable census data are rarely available, and denominators needed to calculate population prevalence or incidence rates are often crude estimations because they are too resource-consuming to be determined properly. Door-to-door surveys produce an accurate account of denominators; however, migratory effects and other population dynamic elements cannot be easily captured by this technique. Passive case finding of PWE underestimates the actual number. Those most affected often do not come forward. Stigma, misconceptions and beliefs attached to this condition influence the open presentation of affected individuals in public meetings. Hence, active case detection