Difficultes de la Prise en Charge de L\'epilepsie en Milieu Rural Camerounais: le Cas de la Localite de Mbangassina Difficulties Faced in the Management of Epilepsy in Rural Cameroon: The Case of Mbangassina Locality (Francais)

Introduction Epilepsy is frequent in Africa and most of the patients live in the rural areas where anti-epileptic drugs (AED) are difficult to find and even when available, might not even be accepted. Objective The aim of this study is to employ « proximity » medical practice to evaluate the difficulties faced in the management of epileptic patients in their natural environment. Patients and Methods Epileptic patients diagnosed using the WHO/IENT criteria in the Mbangassina area of Cameroon, were followed-up monthly for 15 months from June 1999 to September 2000 in an out-patient consultation. Proposed medical prescriptions, compliance, response to treatment, the main side-effects, reasons for non-compliance were examined. A management algorithm was constructed. Results During the study period, 125 patients were followed-up. Out of these, 25.6% had been on traditional treatment before. The AED used were : phenobarbital (75.2%), carbamazepine (15.2%), phenytoines (3.2%). Compliance rate was 71.2%. The main reason for non-compliance was lack of finances. The main side effect was somnolence. Complete remission of seizures was observed in 69.6% of cases, partial improvement in 16% and failure of treatment in 14.4%. The average cost of treatment per patient was 30.58 CFA/day. The medical team involved was voluntary. Conclusion The management of epileptic patients in rural areas at affordable cost is possible. The results are excellent. However, this involves an organisation that has to take into consideration the cost of moving the supervising team. Resume Introduction L\'epilepsie est frequente en Afrique et la majorite des malades vivent en milieu rural ou l\'acces aux medicaments est difficile , et leur acceptabilite encore inconnue. Objectif Le but de ce travail est d\'utiliser une medecine de proximite pour evaluer les difficultes de prise en charge des malades epileptiques dans leur milieu naturel. Methodologie Des epileptiques diagnostiques a l\'aide des criteres OMS/IENT dans la localite de Mbangassina (Cameroun) , ont ete suivis en consultations mensuelles pendant 15 mois de Juin 1999 a Aout 2000.Les prescriptions conseillees, la regularite des prises, la reponse therapeutique, les principaux effets secondaires, les raisons de non compliance, ont ete notes. Un algorithme de prise en charge a ete construit. Resultats 125 malades ont ete suivis pendant la duree d\'etude. 25,6% avaient suivi un traitement traditionnel auparavant. Les medicaments utilises etaient : le phenobarbital (75,2%),la carbamazepine (15,2%), les phenytoines (3,2%). Le taux de compliance etait de 71,2%. La raison de non compliance etait financiere. Le principal effet secondaire etait la somnolence. La remission complete des crises etait observee dans 69,6% des cas, une amelioration partielle dans 16%, et un echec dans 14,4%. Le cout moyen du traitement etait de 30,58 CFA/jour. L\'activite du personnel medical etait benevole. Conclusion La prise en charge des epileptiques en milieu rural est possible a cout abordable. Les resultats sont excellents. Il s\'agit cependant d\'une organisation qui doit prendre en compte les couts de deplacement du personnel d\'encadrement. (Af. J. of Neurological Sciences: 2003 22(1))