Community-based rehabilitation offers cost-effective epilepsy treatment in rural Guinea-Bissau.

Treatment of epilepsy in low-income countries is a challenge considering the lack of resources, availability of antiepileptic drugs, and cultural beliefs. We used a community-based rehabilitation (CBR) service for the detection, monitoring, and treatment of epilepsy. A local network of trained community volunteers provided education, good quality antiepileptic drugs, and clinical follow-up for people with epilepsy (PWE). In a period of 2years, approximately 22,500 people were screened in central Guinea-Bissau, and 112 PWE were identified and registered. Monthly check-ups were offered to monitor treatment effect and increase compliance. Retrospective analysis on 81 records of patients under treatment in June 2016 showed a decrease of seizure frequency in 88.8% after treatment initiation and was maintained throughout the clinical follow-up of 15months. A conservative estimation of the treatment and monitoring of a single person with epilepsy revealed a daily cost of $0.73. Despite acknowledging epilepsy as a neglected condition by the World Health Organization (WHO), most PWE still lack appropriate treatment. Although CBR service has been suggested as efficient strategy to reduce the treatment gap, little information is available on the efficacy of the programs. Our experiences show that CBR service is a cost-effective approach to monitor treatment and increase compliance in PWE. This experience may be of value for other resource-poor settings.

Evaluating community ED crowding: the Community ED Overcrowding Scale study.

OBJECTIVES: The goals of this study were to (1) identify valid variables that correlate with emergency department (ED) crowding and (2) determine a model that could be used to accurately reflect the degree of ED crowding. METHODS: A site sampling form was applied to convenience sampling of 13 community hospitals in California between April 6, 2011, and May 1, 2011. The outcome variable was average perception of crowding by the ED physician and charge nurse on a 100-mm visual analog scale. We focused on 20 candidate predictor variables that represented counts and times in the ED that were collected every 4 hours. A prediction model was developed using multivariable linear regression to determine the measures that predicted ED crowding. A parsimonious model was developed to allow for a clinical useful tool that that explained a significant amount of variability predicted by the full ED crowding model. RESULTS: A total of 2006 data sets were collected for each of the participating hospitals. A total of 1628 time entries for the hospitals were included in the study. Hospital EDs had censuses ranging from 18 000 to 98 000. Full evaluation was completed on 1489 data sets. Twenty variables were considered for the full model with 7 removed due to multicollinearity. The remaining 13 variables constituted the full model and explained 50.5% of the variability in the outcome variable. Five predictors were found to represent 92% of the variability represented by the full model. CONCLUSIONS: Five variables were highly correlated with community ED crowding and could be used to model the full set of all variables in explaining ED crowding.

Cultural beliefs among people with epilepsy or physical impairment in Guinea-Bissau: Differences and similarities.

People living with a disability in sub-Saharan Africa have poorer health outcomes, lower educational successes, less economic participation, and higher levels of poverty than people without disability. Disability-inclusive development promotes the involvement of people with disabilities in programs that reduce these inequalities. This requires a good understanding of how individuals with disability perceive their condition. In this study, we identified cultural beliefs among 31 individuals with epilepsy or physical impairment, known to a community-based rehabilitation service in Guinea-Bissau, using face-to-face interviews. We related these beliefs to religious background and type of disability. We found poor knowledge of and attitudes towards disability among persons with epilepsy and physical impairment. Cultural beliefs were significantly shaped by religious background. Islamic respondents were more positive about their disability as compared to Christians and traditional believers. A better understanding of cultural beliefs among people with disabilities may help to launch and adapt disability-inclusive community-based rehabilitation services.

Understanding of and attitudes towards people with epilepsy among community-based rehabilitation volunteers in Guinea-Bissau.

BACKGROUND: Community-based epilepsy care programs improve access to epilepsy treatment in resource-poor settings. Community volunteers are important to these services. Most studies on familiarity with, understanding of, and attitudes towards people with epilepsy (PWE), however, ignore these volunteers. METHODS: We explored these issues among 15 community volunteers involved in a community-based rehabilitation child epilepsy service recently initiated in Guinea-Bissau using face-to-face interviews. RESULTS: We found that the volunteers had a reasonable understanding of epilepsy, moderate attitudes towards PWE, and a good understanding of difficulties PWE encounter in society. CONCLUSION: Evaluation of understanding and attitudes of community volunteers may be useful to improve low-cost community-based epilepsy programs. A correct understanding of epilepsy among community volunteers may increase effective treatment of and support to children with epilepsy through community-based epilepsy programs.

The power of language: Functional brain network topology of deaf and hearing in relation to sign language experience.

Prolonged auditory sensory deprivation leads to brain reorganization. This is indicated by functional enhancement in remaining sensory systems and known as cross-modal plasticity. In this study we investigated differences in functional brain network topology between deaf and hearing individuals. We also studied altered functional network responses between deaf and hearing individuals with a recording paradigm containing an eyes-closed and eyes-open condition. Electroencephalography activity was recorded in a group of sign language-trained deaf (N = 71) and hearing people (N = 122) living in rural Africa. Functional brain networks were constructed from the functional connectivity between fourteen electrodes distributed over the scalp. Functional connectivity was quantified with the phase lag index based on bandpass filtered epochs of brain signal. We studied the functional connectivity between the auditory, somatosensory and visual cortex and performed whole-brain minimum spanning tree analysis to capture network backbone characteristics. Functional connectivity between different regions involved in sensory information processing tended to be stronger in deaf people during the eyes-closed condition in both the alpha and beta frequency band. Furthermore, we found differences in functional backbone topology between deaf and hearing individuals. The backbone topology altered during transition from the eyes-closed to eyes-open condition irrespective of deafness, but was more pronounced in deaf individuals. The transition of backbone strength was different between individuals with congenital, pre-lingual or post-lingual deafness. Functional backbone characteristics correlated with the experience of sign language. Overall, our study revealed more insights in functional network reorganization caused by auditory deprivation and cross-modal plasticity. It further supports the idea of a brain plasticity potential in deaf and hearing people. The association between network organization and acquired sign language experience reflects the ability of ongoing brain adaptation in people with hearing disabilities.

Comparison of knowledge and accessibility to information sources of HIV/AIDS between blind and sighted populations in Nigeria.

The aim of this study was to compare the HIV/AIDS knowledge and accessibility to HIV/AIDS information between blind and sighted individuals in Nigeria. A cross-sectional survey was undertaken among rural and urban blind (57) and sighted (62) adolescents in 2006. A structured questionnaire was used to collect data about HIV/AIDS symptoms, transmission and prevention knowledge, as well as accessibility to sources of HIV/AIDS information. Binary logistic regression and chi-square statistics were applied to compare responses between the two populations. Blindness was found to be associated with diminished knowledge of HIV/AIDS transmission, prevention and symptoms. At the same time, the blind rely on different sources of HIV/AIDS information than sighted respondents. A lack of knowledge and limited accessibility to proper sources of information causes the blind disabled to be more vulnerable. It is necessary to supply them with proper information and increase their HIV/AIDS knowledge.

Evaluation of HIV/AIDS secondary school peer education in rural Nigeria.

In this study, we assessed whether peer education is an effective method of HIV/AIDS awareness, in terms of knowledge, misconception and behavior, among adolescents in the rural area of Nigeria. A comparative case series (n = 250), cross-sectional structured survey (n = 135) and focus group discussions (n = 80) were undertaken among adolescents. In both the case series and structured survey, a questionnaire was used which addresses the following issues: socio-demography, knowledge on transmission and prevention of HIV/AIDS, accessibility to different sources of HIV/AIDS information, stigmatization and sexual behavior. Binary logistic regression was applied to compare responses from the peer-educated and not peer-educated populations. The model was adjusted for confounders. We demonstrated increased knowledge and decreased misconception and sexual risk behavior in adolescents receiving peer education as compared to adolescents not receiving peer education. These differences are apparent both over time (2005-2007) and cross-sectional (2007). In conclusion, peer education in rural areas can be effective in HIV/AIDS prevention. Knowledge and behavior can be influenced positively.