Nonphysician management of epilepsy in resource‐limited contexts: Roles and responsibilities
2009; Wiley; Volume: 50; Issue: 9 Linguagem: Inglês
10.1111/j.1528-1167.2009.02057.x
ISSN1528-1167
Autores Tópico(s)Child Nutrition and Water Access
ResumoEpilepsiaVolume 50, Issue 9 p. 2167-2168 Free Access Nonphysician management of epilepsy in resource-limited contexts: Roles and responsibilities Alfred K. Njamnshi, Alfred K. Njamnshi Consultant Neurologist & Clinical Neurophysiologist, Head, Neurology Department, Central Hospital Yaoundé, Cameroon; and National Focal Person for Epilepsy, Ministry of Public Cameroonaknjamnshi@yahoo.co.ukSearch for more papers by this author Alfred K. Njamnshi, Alfred K. Njamnshi Consultant Neurologist & Clinical Neurophysiologist, Head, Neurology Department, Central Hospital Yaoundé, Cameroon; and National Focal Person for Epilepsy, Ministry of Public Cameroonaknjamnshi@yahoo.co.ukSearch for more papers by this author First published: 21 August 2009 https://doi.org/10.1111/j.1528-1167.2009.02057.xCitations: 14AboutSectionsPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat In the Gray Matters section of the issue of Epilepsia, Vol. 49, No. 9, 2008, six interesting contributions tackled the increasingly challenging problem of epilepsy management in resource-limited countries, especially in sub-Saharan Africa (SSA). The crucial issue no longer appears to be whether nonphysician personnel should be involved in the management of epilepsy in resource-limited contexts. It now seems to be a question of clarifying roles and responsibilities and enhancing the general health-systems capacity for improving epilepsy care. Kendall-Taylor et al. (2008) clearly describe the important role played by traditional healers in a highly stigmatizing condition such as epilepsy in Kenya. We have reported that at least 25% of our epilepsy patients receive traditional treatment (Dongmo et al., 2003; Njamnshi et al., 2008b, 2009). I agree with Birbeck's (2008) analysis and proposal that "collaborations with traditional healers may offer one effective means of improving access to antiepileptic agents (AEDs) and other medical treatments for people with epilepsy in resource 'poor' regions."Birbeck (2008), and others rightly note that this collaboration faces a lot of challenges. However, although the collaboration is still embryonic in a few countries, it offers a real opportunity that physicians should not miss. Our preliminary findings from a Knowledge, Attitudes and Practices (KAP) survey of traditional healers in rural Cameroon suggest that physician-initiated collaborations with the traditional healers are feasible. Some of the obstacles that must be overcome for successful collaboration may be physician prejudice and limited knowledge of traditional healers and traditional medicine, and of the rich, yet underdeveloped African traditional pharmacopoeia. The role of nonphysician health personnel such as nurses has been nicely reported by Kengne et al. (2008) in Cameroon. As these authors rightly remarked, the sample size was small and the follow-up period was short. However, this may not be the first of such an initiative in Cameroon. Our group has trained nurses and general medical practitioners using a management guide we developed in the Mbam region of Cameroon and has established some nonphysician-run epilepsy clinics in this region (Dongmo et al., 2000; Njamnshi et al., 2005). In these clinics, all initial diagnoses of epilepsy were confirmed by a neurologist from our team. We have shown in one of these clinics (Mbangassina), a 75% improvement in epilepsy (69.6% seizure-free) and 71.2% compliance with treatment (Dongmo et al., 2003). Birbeck (2008) rightly notes that for epilepsy-care services to be delivered primarily by nonphysician health-care workers, appropriate training programs must be developed and the outcomes of such care should be rigorously assessed. In this respect, we are currently assessing one of our physician-established, nurse-run, and neurologist-supervised clinics. The Nyamanga epilepsy clinic has more than 700 patients, 400 of whom have had regular follow-up since the year 2000, and are members of the Cameroon Association of Epilepsy Patients, which is a member of the International Bureau for Epilepsy (IBE) (Njamnshi et al., 2008b). This brings us to the roles of patient-support groups and other members of the community in epilepsy management. An example of the role of epilepsy patient–support groups in the provision of vocational and social rehabilitative support in SSA has been reported by Adamolekun et al. (2000). Our own studies have highlighted the need for general public education and specific professional training on epilepsy, and suggested the role that specific target audiences such as school children may play in the process of transforming attitudes in communities, thereby reducing stigma and hopefully the treatment gap (Njamnshi et al., 2008a, 2008b, 2009). The role of policymakers in putting into place appropriate drug policies has been highlighted by Birbeck (2008). The role of African governments in improving epilepsy care is outlined in the African Declaration on Epilepsy (2001). However, the development and implementation of national plans for epilepsy control will happen only when leaders rise in (1) academia to provide research evidence that will lead to policy, (2) the decision-making machinery to produce and implement evidence-informed policies, and (3) the civil society to build networks and coalitions that will result in public–private partnerships and collaborations. An example of this model has been reported in diabetes care (Njamnshi et al., 2006) and we hope to build epilepsy care on that basis. During the recent Pan African Association of Neurological Sciences 18th Biennial Congress, the importance of community mobilization and collaboration with national, regional, and international institutions for epilepsy care improvement was highlighted (Akinyemi et al., 2008). Therefore, the clarification of roles and responsibilities, the promotion of collaborations, and the enhancement of the general capacity of health-care systems will go a long way in reducing stigma in epilepsy and the treatment gap in SSA. Disclosure Conflict of interest: I confirm that I have read the Journal's position on issues involved in ethical publication and affirm that this report is consistent with those guidelines. The author has no conflict of interest to disclose. References Adamolekun B, Mielke J, Ball D, Mundanda T. (2000) An evaluation of the management of epilepsy by primary health care nurses in Chitungwiza, Zimbabwe. Epilepsy Res 39: 177– 181. CrossrefCASPubMedWeb of Science®Google Scholar African Declaration on Epilepsy. (2001) Afr J Neurol Sci 20. [Available at http://www.ajns.paans.org]. Google Scholar Akinyemi R, Yepnjio F, Njamnshi AK. (2008) Neuroscience in Africa: raising the next generation and changing attitudes towards epilepsy: IBRO brain campaign funds Pre-PAANS congress 2008, Yaounde, Cameroon. Available at http://www.braincampaign.org/Pub/Pub_Main_Display.asp?LC_Docs_ID=3740 (accessed December 5, 2008). Google Scholar Birbeck GL. (2008) The health care workforce for epilepsy in resource-poor settings: what will work? What is realistic? Epilepsia 49: 1642– 1643. Wiley Online LibraryPubMedWeb of Science®Google Scholar Dongmo L, Mbonda E, Njamnshi AK, Ndongo E, Ndo D. (2000) Bien Soigner l'Epilepsie: A l'usage des personnels médicaux et para-médicaux. Séminaire de prise en charge des épileptiques. Bafia, 9-13 Octobre 2000 (Monographe). Google Scholar Dongmo L, Echouffo B, Njamnshi AK, Sini V, Pepouomi MN, Kamdem P. (2003) Difficulties faced in the management of epilepsy in rural Cameroon: the case of Mbangassina locality. Afr J Neurol Sci 22. [Available at: http://www.ajns.paans.org] (Accessed December 5, 2008). Google Scholar Kendall-Taylor N, Muba C, Rimba K, Newton C. (2008) Traditional healers and epilepsy treatment on the Kenyan coast. Epilepsia 49: 1638– 1639. Wiley Online LibraryCASPubMedWeb of Science®Google Scholar Kengne A, Fezeu L, Awah P, Sobngwi E, Dongmo S, Mbanya JC. (2008) Nurse-led care for epilepsy at primary level in a rural health district in Cameroon. Epilepsia 49: 1639– 1642. Wiley Online LibraryCASPubMedWeb of Science®Google Scholar Njamnshi AK, Dongmo L, Sini V, Echouffo B, Pepouomi MN, Kamdem P, Ndo D, Atchou G. (2005) Epilepsy in rural Cameroon: the alarming prevalence rates in the Mbam valley. J Neurol Sci 238(suppl 1):S136. Google Scholar Njamnshi A, Bella Hiag A, Mbanya J-C. (2006) From research to policy: the development of a national diabetes programme in Cameroon. Diabetes Voice 51: 18– 21. Google Scholar Njamnshi AK, Angwafor SA, Baumann F, Angwafo F III, Jallon P, Muna WFT. (2008a) Knowledge, attitudes and practice of Cameroonian medical students and graduating physicians towards epilepsy. Epilepsia, in press. Web of Science®Google Scholar Njamnshi AK, Angwafor SA, Jallon P, Muna WFT. (2008b) Secondary school students' knowledge, attitudes and practice towards epilepsy in the Batibo Health District—Cameroon. Epilepsia doi: DOI: 10.1111/j.1528-1167.2008.01809.x. Wiley Online LibraryWeb of Science®Google Scholar Njamnshi AK, Angwafor SA, Tabah EN, Jallon P, Muna WFT. (2009) General public knowledge, attitudes and practice towards epilepsy in the Batibo Health District, Cameroon. Epilepsy Behav 14: 83– 88. 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