Community-based management of epilepsy in Southeast Asia: two intervention strategies in Lao PDR and Cambodia

Background: Epilepsy affects more than 50 million people worldwide, 80% of whom live in low- and middle-income countries (LMICs). In Southeast Asia, the prevalence is moderate (6 per thousand), and the main public health challenge is reducing the treatment gap, which reaches more than 90% in rural areas. Methods: This 12-month comparative study (intervention vs. control areas) assessed the community effectiveness of two different strategies for the identification and home follow-up of people with epilepsy by Domestic Health Visitors for epilepsy (DHVes). In Lao PDR, DHVes were health center staff covering several villages via monthly visits; in Cambodia, DHVes were health volunteers living in the villages. Findings: At baseline, the treatment gap was >95% in Lao PDR and 100% in Cambodia. After 12 months, the treatment gap in Lao PDR decreased by 5.5% (range: 4.0-12.2) in the intervention area and 0.5% (range: 0.4-0.8) in the control area (p<0.0001). In Cambodia, the treatment gap decreased by 34.9% (range: 29.0-44.1) in the intervention area and 8.1% (range: 6.7-10.2) in the control area (p<0.0001). Among the PWEs followed at home by the DHVes, the proportion adhering to drug treatment was 85.2% in Lao PDR and 78.1% in Cambodia. The cost associated with strategy implemented in Cambodia, compared with the control area, was lower than the cost associated with strategy implemented in Lao PDR." Interpretation: The treatment gap was significantly reduced with both intervention strategies, but the effect was larger in Cambodia. The results of this cost analysis pave the way for scaling-up in rural areas of Lao PDR and Cambodia, and experimental adaptation in other LMICs. Funding: The study was funded by the Global Health Department of Sanofi and Grand Challenges Canada (grant number 0325-04).