Replacing hospital based epilepsy clinics with rural epilepsy clinics and education in Uganda: impact on attendance

Christopher Harris, Bwambale George, Unity Harris, Mary Munyagwa, Anne Greenough

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    Abstract

    Background: A high proportion of the Ugandan population with epilepsy receive no treatment.
    Aim: To determine whether introduction of an agreed multidisciplinary guideline and establishment of a local clinic outside the hospital and four rural satellite clinics improved attendance and follow-up by children with epilepsy in Western Uganda.
    Methods: A multidisciplinary team from Kagando Hospital, Kasese, south-west Uganda created a guideline for the management of epilepsy. A clinic local to the hospital and rural satellite clinics were established. Attendance and follow-up were audited for three months before the intervention. Attendance, follow-up and the cost of the hospital, local and rural clinics were audited 6 months and 5 years post intervention.
    Results: Pre-intervention, one patient a month attended the free Kagando Hospital epilepsy clinic. Post-intervention, a median of eight patients (range 2–12) attended the local clinic and 100% attended booked follow-up appointments; the cost per clinic was £15 (£1.88 per patient, range 1.25–7.50). A median of 42 (range 15–56) patients per clinic attended the rural clinics and 70% of patients attended follow-up appointments; the cost per clinic was £34 (£0.81 per patient, range 0.61–2.23). Rural clinic attendance was higher than in the hospital clinic (p=0.007) and in the local clinic (p=0.004). Five years post-intervention, the attendance was 44 patients (range 25–85) per rural clinic and the cost per clinic was £34.
    Conclusions: Rural epilepsy clinics were associated with higher attendance than the hospital or local clinic and the attendance rate remained higher 5 years post-intervention.
    Original languageEnglish
    Article numberdoi: 10.1080/20469047.2018.1544803
    Pages (from-to)1-4
    Number of pages4
    JournalPaediatrics and International Child Health
    Early online date27 Nov 2018
    DOIs
    Publication statusE-pub ahead of print - 27 Nov 2018

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