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Interventional programs to improve therapeutic management of people with epilepsy in low- and middle-income countries

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dc.contributor.author Jost, Jeremy
dc.contributor.author Moyano, Luz Maria
dc.contributor.author Auditeau, Emilie
dc.contributor.author Boumediene, Farid
dc.contributor.author Ratsimbazafy, Voa
dc.contributor.author Preux, Pierre-Marie
dc.date.accessioned 2018-11-30T17:17:14Z
dc.date.available 2018-11-30T17:17:14Z
dc.date.issued 2018
dc.identifier.uri https://hdl.handle.net/20.500.12866/4104
dc.description.abstract OBJECTIVE: To assess the current status of initiatives carried out in developing countries to improve therapeutic management of people with epilepsy. METHODS: A literature review was performed in 2015 to identify and analyze interventional programs carried out in countries with low- and middle-income economies. Electronic databases were reviewed with no time restriction. Each intervention was categorized according to the level of evidence achieved (A: blind randomized controlled trial, B: randomized controlled trial, C1: randomized trial, C2: controlled trial, D: prospective cohort, E: retrospective evaluation). RESULTS: A total of 46 intervention projects were identified, 13 with no quantitative assessment. The 31 remaining projects were carried out in 18 countries, 52% (16) in Africa, 42% (13) in Asia, and 6% (2) in Latin America. Among those, 13% (4) were level B, 3% (1) C1, 6% (2) C2, 74% (23) D, and 3% (1) were level E. The effectiveness of the intervention, assessed by the efficacy of antiepileptic drugs, was the primary objective in 81% (25). People with epilepsy were on average seizure-free in 44.6%±14.4% of cases at one year, ranging from 25.0% to 78.4%. At two years, on average 50.9%±29.7% are seizure-free, ranging from 4.6 to 92.7%. The median compliance was 79.3% with a minimum of 21.6% and a maximum of 100.0%. DISCUSSION: No blind randomized controlled trial has been used to assess the efficacy of a program to improve access to antiepileptic drugs (AEDs) in developing countries, and the level of evidence was globally low. Phenobarbital remains the AED predominantly used in programs. Adherence to treatment management has been pointed out to be a key element in the success of a program, sometimes not sufficiently considered. Monthly supply of AEDs, at specific and community level, reducing the costs and time spent traveling, appeared to be the most effective strategies. Homogenization and standardization of evaluation practices of programs to improve the management of epilepsy in resource-limited settings would lead to comparison and meta-analysis which would ultimately improve strategies of support for not only epilepsy but also other noncommunicable diseases in developing countries. en_US
dc.language.iso eng
dc.publisher Elsevier
dc.relation.ispartofseries Epilepsy and Behavior
dc.rights info:eu-repo/semantics/restrictedAccess
dc.rights.uri https://creativecommons.org/licenses/by-nc-nd/4.0/deed.es
dc.subject Interventional programs en_US
dc.subject epilepsy en_US
dc.subject low-income countries en_US
dc.subject middle-income countries en_US
dc.title Interventional programs to improve therapeutic management of people with epilepsy in low- and middle-income countries en_US
dc.type info:eu-repo/semantics/article
dc.identifier.doi https://doi.org/10.1016/j.yebeh.2018.01.011
dc.subject.ocde https://purl.org/pe-repo/ocde/ford#3.02.25
dc.relation.issn 1525-5069


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