Diagnosis of epileptic seizures by community health workers using a mobile app: A comparison with physicians and a neurologist

Abstract Purpose The World Health Organisation (WHO) strategy for non-physician health workers (NPHWs) to diagnose and manage people with untreated epilepsy depends on them having access to suitable tools. We have devised and validated an app on a tablet computer to diagnose epileptic episodes and now examine how its use by NPHWs compares with diagnosis by local physicians and a neurologist. Methods Fifteen NPHWs at Jan Swasthya Sahyog (JSS) a hospital with community outreach in Chhattisgarh, India were trained in the use of an epilepsy diagnosis app on a tablet computer. They were asked to determine the app scores on patients in their communities with possible epilepsy and then refer them first to their local JSS doctors and then to a visiting neurologist. With the neurologist's opinion as the "gold standard", the misdiagnosis rate from the NPHWs was compared with that of the local physicians. Results There were 96 patients evaluated completely. The NPHWs misdiagnosed eight and the physicians seven. There were more uncertain diagnoses by the NPHWs. In the 22 patients who presented for the first time during the study, the NPHWs misdiagnosed three and the physicians five. Conclusions NPHWs using an app achieved similar misdiagnosis rates to local physicians. Both these rates were well within the range of misdiagnosis in the published literature. These results suggest that task-shifting epilepsy diagnosis and management from physicians to NPHWs, who are enabled with appropriate technology, can be an effective and safe way of reducing the epilepsy treatment gap.