Treatment Gap Issues in Community Sample of People with Epilepsy

Abstract

Aim of the study was to identification of the factors leading to treatment gap in a community sample of persons with epilepsy in north India. Sample: A population of semi-urban slum area of Ludhiana city N=15750 was surveyed in an ICMR study, out of this 114 cases were found screened positive with active epilepsy. Details were obtained from database of community study. Active epilepsy cases were provided free medicines on monthly basis in the community itself. A total number of 67 patients were not on follow ups and 47 were on follow ups in the community. All 67 patients were contacted door to door by the author. Only 24 patients were traced and interviewed. The first group n=47 named follow up group and second group n=24 formed treatment gap group. Measures: Screening questionnaire for epilepsy validated on epilepsy patients and controls, Socio-economic scale (Modified) by Udai Pareek and Semi structured interview schedule to assess issues related to treatment gap was specifically developed which also includes Socio-demographic and clinical details of the patients. Results: two groups were significantly different in respect to type of seizures frequency of seizures episodes. Occupation of the patient and mother’s educational level were also found to be significantly different in both the groups. In the study of factors related to treatment gap, indirect cost- in the form of absence from the work lead to daily income loss in labor class was significant factor in 29% patients; dissatisfaction with the treatment was noted in the 63 % people with epilepsy, 58.33% of the patients do not have adequate knowledge of right treatment of this condition, 29% of the patients did not believe in the anti-epileptic treatment, they were following the faith healers advice, 20 % patients were not seeking the treatment because of stigma, co-morbidity of mental retardation and psychosis was found in 8.5% and 14.28 % patients could not receive treatment because of family conflict. Conclusion: dissatisfaction with the treatment and lack of adequate knowledge were the main factors found in this study which were related to the treatment gap in this study.