Paediatric epilepsy: The status and challenges of care in Zimbabwe

Abstract

Objectives: To characterize seizure disorders and co-morbidities in children aged one month to 16 years

Study Design: Hospital based, cross-sectional study. Participants: Children aged one month to 16 years referred to the paediatric neurology clinic at Parirenyatwa hospital in Harare, Zimbabwe were consecutively enrolled.

Study Factors: Clinical profile, seizure type, co-morbidities and treatment patterns.

Results: Of the357 children referred with neurological disorders, 252 (76.6%) had seizure disorders with generalized epilepsy the commonest presentation. The median (range) age was 48 (24-96) months and 163 (65%) were males. The majority resided in urban areas 201 (79%) and were more likely to be managed by primary care nurse beforereferral197 (78%). Atotal 152 (60%) children presenting with seizures had co-morbidities: 18 autistic disorder syndrome, 32 attention deficit hyperkinetic disorder, 47 intellectual impairment, 25 sensory impairment, 2 burns, and 64 behavioural and 9 psychiatric conditions. Fifty two children (20%) had drug refractory epilepsy and of these 19 (8%) were on second line anti-epileptic drugs.

Conclusion: The burden of epilepsy among children presenting with neurological conditions was high and the majority were initially managed by nurse practitioners. Sixty percent of the children had co-morbidities associated with epilepsy. There was limited access to second line anti-epileptic drugs with less than one in ten children with drug resistant epilepsy on appropriate therapy. A population based epilepsy survey to estimate the prevalence, management and outcomes of paediatric epilepsy in the Zimbabwe is needed to advocate for further narrowing of the treatment gap in children.