Abstracts

Rationale: Epilepsy is one of the most common neurological disease world-wide. More than 80% of world's epilepsy population resides in the developing countries with prevalence reported to be the highest in sub-Saharan Africa.1 A clear understanding of gender-based prevalence and nature of disease can support future research and advocacy efforts to develop interventions and improve care outcomes. The purpose of this abstract is to highlight the gender-based differences for epilepsy patients in comparison to other neurology patients seeking care at Moi Teaching and Referral Hospital (MTRH), Eldoret, Kenya. Methods: We conducted a 3-month prevalence study (from 03/01/2019 to 05/31/2019) to describe the neurological patients seen (adult and pediatric /inpatient and outpatient) at MTRH. MTRH is the second largest National Referral Hospital in the country serving a patient population of approximately 24 million people throughout western Kenya, parts of Eastern Uganda, and Southern Sudan. MTRH provides care to more than 400,000 inpatients and outpatients annually and serves as the major teaching hospital for Moi University.Data were collected by three research assistants who reviewed daily admissions from hospital records and conducted daily ward rounds, and by attending weekly outpatient clinic and reviewing each outpatient neurology patient record. Prevalence data and a short survey to describe nature of the disease and patient characteristics were collected from medical records and one-time face-face patient inquiry. Data were collected using mobile software – Research Electronic Data Capture (RedCap) and analyzed using SPSS. The statistical methods include descriptive statistics, chi-square tests and Mann-Whitney U.  Results: A total of N=1,357 neurology patients was seen at MTRH during the study period, n=800 (59%) were males and 557 (41%) were females, mean age (SD) was 30.51 years (24.59). Table 1 describes gender-based comparison of adult patients with epilepsy/seizure disorder and in comparison to other neurology patients seen at MTRH during the study period. Table 2 describes pediatric population with epilepsy/seizure disorder in comparison to other neurology patient.There was a statistically significant difference in the residence type of male pediatric (p=.001) and female pediatric patients (p=.001). There was a statistically significant difference in the distance to MTRH for pediatric epilepsy patients (male: p=.001); (female: p=.001) suggesting that comparing to other neurological diseases people from closer distance come to MTRH for epilepsy/seizure care. There are statistically significant findings for both adult and pediatric epilepsy patient’s adherence to biomedical treatment, the attributing factors to non-adherence/irregular to biomedical treatment, included treatment costs, distance to medical facility, complexity of scheduling, and preference for traditional healing methods. Two adult patients from rural setting, who had discontinued treatment were admitted with consequences such as burns and fracture.Table 1: Adult epilepsy patientsDescription of numbers: Adult epilepsy patients/total number of adult neurology patients in that category (percentage or significance level)Item                                            Male                                       FemaleN=199/869                              n=73/526                                   n=61/343Age (in years )                     32.67 (SD 18.47)                34.33 (SD 19.78)Educational Status  No formal education                8/59                                     4/42Primary education                 23/208                                23/148Secondary education            33/197                                33/133Diploma/Degree                   8/59                                     0/131Residence  Rural                                  44/391     (p=.240)                    32/261(p=.288)Peri-urban                        29/135                                        29/82Distance to MTRH (km)   383/401.7 (p=.517)                 246/ 278.6  (p=.134)Visit type  Inpatient                      27/428                                            21/219Outpatient                 46/98                                               40/124Patient on biomedical treatment at the time of admission/clinic visitYes                           59/156                                             52/181No                         14/370                                                     9/162Adherence to biomedical treatment                                                                                                                              Regular                                 52                                    48Irregular                                 7           p=.001*               4                               p=.001*Had stopped treatment          2                                      3*statistically significant valueTable 2: Pediatric epilepsy patientsDescription of numbers: Pediatric epilepsy patients/total number of neurology patients in that category (percentage or significance level) Item                                        Male                                      FemaleN=345/481                           n=190/274                            n=155/207Age (in years)                     6.53 (SD 4.22)                      6.42 (SD 4.58)Educational Status  No formal education          89/150 (59.3%)                     85/114 (74.6%)Primary                             100/122 (82%)                       69/90 (76.7%)Secondary                        1/2 (50%)                                 1/2 (50%)Residence   Rural                                93/145(p=.001)*                    71/99(p =.001)*Peri-urban                       97/129                                    84/108Distance to MTRH (km)   278.5/437.7  (p=.001)*       180.1/311  (p=.001)*Visit Type  Inpatient                           21/83 (22.5%)                     24/64 (37.5%)Outpatient                        169/191 (88.5%)                    131/143 (89%)Patient on biomedical treatment at the time of admission/clinic visitYes                                     175/199                               129/63No                                    15/75                                    26/144Adherence to biomedical treatment     Regular                               170                                              124                                                           p=.001*                                                       p=.001*Irregular                                3                                             4Had stopped biomedical treatment   2                                1*statistically significant value  Conclusions: Compared to other neurological diseases seen at MTRH, findings from this 3 month prevalence study, indicates that pediatric epilepsy patients from closer distance, irrespective of gender come to MTRH for epilepsy/seizure care. In addition, irrespective of age, more male rural based patients as compared to their female counterparts, receive epilepsy/seizure care at MTRH. Nevertheless, no apparent gender based difference exists within the peri-urban setting.  Funding: The Enhanced Mentoring Program with Opportunities for Ways to Excel in Research (EMPOWER) , Indiana University-Purdue University, Indianapolis