Muhammad Akbar Malik, Arshad Rafique, Ahmad Omar Virk.
Empowerment of primary health care in an Outreach resource-limited district in Punjab: a strategy for improving adherence to Antiepileptic drug treatment in children with Epilepsy..
Pak J Neurological Sci Jan ;14(4):6-12.

Introduction: There is wide acknowledgement of the need for community involvement in the optimal management of children with epilepsy (CWE) in outreach financially constrained districts of the developing countries, but there is scarce data on comprehensive community-based childhood epilepsy treatment programs assessment. OBJECTIVES: The objective of this study is to weigh impact of local primary care empowerment upon anti-epileptic drugs (AEDs) adherence assessed by self-reporting method in an outreach financially constrained district: Bhakhar in Pakistan. Methods: During this snap-shot study, 240 children with epilepsy aged 4months to 18years, on treatment with AED(s) at least 3 months prior to the camp dates, were selected for data collection. Of the total, 160 were being managed in the empowered private charity primary health care while 80 had the first contact and were taken as control. The three parts of the data were:1) demography of the study population 2) AEDs adherence profile assessed by the “Morisky Medication Adherence Scale-8” (MMAS-8) and 3) usefulness of multimodal strategy of the “Community Childhood Epilepsy Center” (CCEC) on antiepileptic drug adherence. Ethical approvals were attained from the institutional ethics committee. RESULTS: Age ranged from 04 months - 18 yrs with female to male ratio of 1: 1.26. AED(s) self-report adherence was 85% (in 2014 it was 42% without support and intervention) amongst the patients treated at community childhood epilepsy center with the provision of free consultations and AEDs, whereas adherence was 40% amongst the patients not intervened by the community center: without any gender preference in either group. Unaffordability of childhood epilepsy treatment cost was the most important cause of non-adherence to AEDs among the study population. CONCLUSION: Marked improvement in AEDs adherence (85% VS 40%) was documented after empowering the local community with the help of visiting the consultant pediatric neurologists from the cosmopolitan city to an outreach resource-constrained district in Pakistan.

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