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A community health workers to improve adherence to anti-epileptic drugs in rural sub-Saharan Africa: Is it cost-effective?
Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
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(Engelska)Artikel i tidskrift (Refereegranskat) Submitted
Nationell ämneskategori
Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi Hälso- och sjukvårdsorganisation, hälsopolitik och hälsoekonomi
Identifikatorer
URN: urn:nbn:se:umu:diva-120156OAI: oai:DiVA.org:umu-120156DiVA, id: diva2:926898
Tillgänglig från: 2016-05-10 Skapad: 2016-05-10 Senast uppdaterad: 2018-06-07
Ingår i avhandling
1. The Burden of Epilepsy: using population-based data to define the burden and model a cost-effective intervention for the treatment of epilepsy in rural South Africa
Öppna denna publikation i ny flik eller fönster >>The Burden of Epilepsy: using population-based data to define the burden and model a cost-effective intervention for the treatment of epilepsy in rural South Africa
2016 (Engelska)Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
Abstract [en]

Rationale Epilepsy is a common, chronic, neurological condition that disproportionately affects individuals living in low- and middle- income countries, including much of sub-Saharan Africa. Epilepsy is treatable, with the majority of individuals who take anti-epileptic drugs experiencing a reduction, or elimination, of seizures. Yet the number of individuals taking and adhering to medication in Africa is low and interventions aimed at improving treatment are lacking.

Aims To define the epidemiology of convulsive epilepsy in rural South Africa in terms of incidence, mortality and disability-adjusted life years; to determine outpatient, out-of-pocket costs resulting from epilepsy treatment; to establish the level of adherence to anti-epileptic drugs amongst people with epilepsy; and, to determine whether the introduction of routine visits to people with epilepsy by community health workers is a cost-effective intervention for improving adherence to anti-epileptic drugs.

Methods Nested within the Agincourt Health and Demographic Surveillance System, this work utilized a cohort of individuals diagnosed with convulsive epilepsy in 2008 to determine health care utilization and out-of-pocket costs due to care sought for epilepsy. Additionally, using blood samples from the cohort, anti-epileptic drug adherence was measured and, following the cohort, mortality rates were determined. Using these collected epidemiological parameters, disability-adjusted life years due to convulsive epilepsy were determined. Finally, combining the epidemiological and cost parameters, a community health worker intervention was modeled to determine its incremental cost-effectiveness ratio.

Key Findings The burden of convulsive epilepsy is lower in rural South Africa than other parts of Africa, likely due to lower levels of known risk factors. Yet the burden, especially in terms of mortality, remains high, as does the treatment gap and health care utilization. Findings from the economic evaluation found the introduction of a community health worker to be highly cost-effective and would likely lower the burden of epilepsy in rural South Africa.

Implications Epilepsy contributes to the burden of disease in rural South Africa, with high levels of mortality and a substantial treatment gap. The introduction of a community-health worker is likely to be one cost-effective, community based intervention that would lower the burden of epilepsy by improving adherence to anti-epileptic drugs. Implementing this intervention, based on these findings, is a justified and important next step.

Ort, förlag, år, upplaga, sidor
Umeå: Umeå University, 2016. s. 94
Serie
Umeå University medical dissertations, ISSN 0346-6612 ; 1814
Nyckelord
Africa, epilepsy, incidence, mortality, cause of death, disability-adjusted life years, out-of-pocket, costs, health care utilization, treatment cascade, adherence, intervention, economic evaluation, community health worker
Nationell ämneskategori
Övrig annan medicin och hälsovetenskap Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi Neurologi
Identifikatorer
urn:nbn:se:umu:diva-120163 (URN)978-91-7601-494-3 (ISBN)
Disputation
2016-06-02, Sal 135 Allmänmedicin, Norrlands Universitetssjukhus, Umeå, 09:00 (Engelska)
Opponent
Handledare
Tillgänglig från: 2016-05-12 Skapad: 2016-05-10 Senast uppdaterad: 2018-06-07Bibliografiskt granskad

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Wagner, RyanNorström, FredrikForsgren, LarsLindholm, Lars

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Wagner, RyanNorström, FredrikForsgren, LarsLindholm, Lars
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Epidemiologi och global hälsaKlinisk neurovetenskap
Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologiHälso- och sjukvårdsorganisation, hälsopolitik och hälsoekonomi

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