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Journal of Neurology and Clinical Neuroscience | Volume: 03
8th International Conference on
NEUROLOGICAL DISORDERS,
CENTRAL NERVOUS SYSTEM AND STROKE
&
International Conference on
NEUROLOGY AND NEUROSURGERY
December 04-05, Dubai, UAE
Joint event on J Neurol Clin Neurosci, Volume: 03
Experience of implementing integrated services for children with Epilepsy in primary
health care and primary health nurse role in an outreach financially - constrained
district in Pakistan
Muhammad Akbar Malik
The Brain Associates Lahore, Pakistan
Introduction: Of the 35 million people with epilepsy
who live in developing countries, around 85% receive no
treatment at all. Cost-effective, sustainable epilepsy care
services, delivering uninterrupted Antiepileptic Drugs
(AEDs) through established primary health care facilities,
are needed to decrease these treatment gaps.
Objectives: The aim of this study was efficacy assessment
of integration of childhood epilepsy in primary health with
help of primary health nurse and local paediatrician to
narrow the treatment gap among Children With Epilepsy
(CWE) in an outreach financially-constrained district in
Pakistan.
Methods : The data about Childhood Epilepsy Treatment
Gap (CETG) and impact of integration of childhood epilepsy
in primary health care in improving it was collected in free
paediatric neurology camps on 7th and 8th December
2018. We evaluated 240 CWE (160 fully supported and 80
as control), in whom treatment was initiated with AEDs at
least 3 months prior the study date. Data was collected by
a questionnaire divided into three parts 1) demographical
information about patients, 2) information about childhood
epilepsy treatment and AED(s) medication adherence
profile using the Morisky Medication Adherence Scale-8
(MMAS-8) and 3) data on intervention-effectiveness of the
Community Childhood Epilepsy Center (CCEC) on bridging
the treatment gap in comparison with cohort not being
intervened by this center.
Ethical approval was obtained from the institutional ethics
committee.
Results: Age ranged from 04 months - 18 years with male to
female ratio of 1.26:1. AED(s) adherence by self-report was
85% (was 42% in 2014 without community intervention)
among the supported CWE and was 40% among the control:
withoutanygenderpreferenceineithergroup.Aftertwoyears
of intervention by Top-Down-Bottom-up-Childhood-Epilepsy-
Program–Center (TDBUCEPC), CETG dropped to 20% (was
≥90% in 2014without local community support), however still
it was 82.5%without any support. Nonaffordability treatment
cost was themost important cause of non-adherence to AEDs
among CWE; however other less important caused were lack
of trained personals, parent’s negligence and misbelieve. The
most effective cause of adherence promotion and bridging
the wide treatment gap was integration of childhood epilepsy
services in free local primary health care.
Conclusion: Our experiences showed that strengthening of
the local primary health care service along with training
or primary nurse and local pediatrician is an efficient
approach in bridging the huge treatment gap among CWE
in financially poor settings. This experience may be of
value for other resource-poor settings.
Biography
Muhammad Akbar Malik was born in a very small village, on the
eastern brim of River Chinab, just 5 Km from Maralah Barrage,
without any barrier between the purest natural water the river and
his village. After initial education in Open Air High School Kulluwal,
got his Medical Education from Lahore, was trained in Lahore. He got
highest qualification in the field of pediatrics. He went to Ireland and
passed his MRCPI in the field of paediatric. Then he moved to UK and
was trained in Pediatric Neurology and pediatric neurophysiology. He
established the first teaching pediatric neurology and neurophysiology
department in Children’s Hospital Lahore. He is currently working as
the Chairperson charity program Top-Down-Bottom-Up-Childhood-
Epilepsy-Program with aspiration to bridge the treatment gap of
childhood epilepsy in outreach and financially constrained communities
in Pakistan, in addition to his voluntary services of visiting consultant
paediatric neurologist in Shaukat Khanum Memorial Cancer Hospital
and Research Centre Lahore. His interest in Neurology began medical
school. Neurology cases were like solving a puzzle when he was trying
to localize the lesion. Later on, he learned that Neurology and sorting
out this in financially constrained settings.
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