Determinants of the Epilepsy Treatment Gap in a Resource Limited Setting: A Study in a Rural Community in South India (P1.082)

Objective: To determine the determinants of the epilepsy treatment gap in a rural community Background: The epilepsy treatment gap in resource-limited setting is about 80[percnt], however determinants associated with this treatment gap have not been well studied. Methods: Treatment gap and the possible determinants were studied in a cohort of 462 prevalent people with active epilepsy (PWE) in Comprehensive Rural Epilepsy Study in South India (CRESSI). Treatment gap was defined as the number of people with active epilepsy not on treatment or on inadequate treatment expressed as a percentage of total number of people with active epilepsy. A person was considered to have active epilepsy if the person had two or more unprovoked seizures in the 12 months immediate to identification. The possible determinants studied included: health care resources, cultural believes, treatment seeking behaviour, antiepileptic drug (AED) prescription patterns by the medical community, reasons for poor drug adherence, and purchasing capacity. Results: The epilepsy treatment gap in this cohort was 82[percnt], 16[percnt] on traditional medicines. For the study population of 74,086 in 22 villages, the health care resources were: 3 primary- and 8 sub-health centers, 4 medical graduates and 11 medical dispensaries with only 7 with AED availability. often erratic. AED prescription was in sub-therapeutic doses in 78[percnt] prescription. Knowledge and attitude study in the community findings were: 64[percnt] believed in allopathic medication and 35[percnt] in ayurvedic medicine. Drug adherence was very poor, only in 22[percnt] and the common reason was poor purchasing capacity. The annual family income was INR 2,300 (US$103). Average annual cost of AED therapy was INR 1917.7 (US$41.6), 7.8[percnt] of per capita GNP Conclusion: This study showed a very high epilepsy treatment gap. The main reasons include poor purchasing power of the people and also poor health care resources. Disclosure: Dr. Murthy has nothing to disclose. Dr. Vijay has nothing to disclose.