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VIGH study seeks to expand epilepsy care efforts in Africa

Oct. 10, 2019, 10:24 AM

 

by Holly Fletcher

The Vanderbilt Institute for Global Health (VIGH), with Aminu Kano Teaching Hospital (AKTH), will conduct a randomized clinical trial in three cities in northern Nigeria to determine the efficacy of shifting childhood epilepsy care to epilepsy-trained community health extension workers — a recommendation from the World Health Organization.

Epilepsy is the most common severe neurological disorder among children, most of whom can live normal lives with treatment.

Yet among the world’s children living with epilepsy, about 80% reside in low- and middle-income countries and 60-90% of them do not receive treatment.

This phenomenon is known as the childhood epilepsy treatment gap.

WHO recommends delegating epilepsy diagnosis and treatment to community health extension workers who receive additional training in epilepsy and who work in primary health care centers, but evidence of efficacy for task-shifted epilepsy care is lacking, and large-scale task-shifted epilepsy care has not been implemented.

The 60-site cluster study is funded with a five-year $5.9 million federal grant, “Bridging the Childhood Epilepsy Treatment Gap in Africa (BRIDGE),” from the National Institute of Neurological Disorders and Stroke of the National Institutes of Health.

VIGH’s BRIDGE project previously developed an epilepsy training program for community health workers, developed tools to assist community health workers who make epilepsy diagnoses, and piloted a protocol for epilepsy treatment used by community health workers in resource limited environments.

“The BRIDGE clinical trial will test a method of epilepsy diagnosis and treatment that has the potential to bring epilepsy care to about half of the world’s children with epilepsy, who currently are without treatment,” said Edwin Trevathan, MD, MPH, BRIDGE principal investigator and the Amos Christie Chair, professor of Pediatrics and Neurology and director of the Vanderbilt Institute for Global Health at Vanderbilt University Medical Center.

“This is a pivotal step toward improving the quality and longevity of life through treatments that are available in other parts of the world.”

This first NIH-funded randomized clinical trial of task-shifted epilepsy care will compare outcomes of children with epilepsy who will be diagnosed and treated by more than 120 epilepsy-trained community health workers with routine physician care for children with epilepsy.

Outcome measures will include seizure reduction, time to next seizure and accuracy of diagnosis and classification. The BRIDGE project will also study the implementation of this task-shifted method of epilepsy care, and the economic impact of task-shifted epilepsy care in northern Nigeria.

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