Disparities in Epilepsy Knowledge, Beliefs and Cost-Effectiveness: A Comparative Analysis of Rural Healthcare Facilities in Bhakkar Hard- to-Reach District in South Punjab- Pakistan

Abstract

ABSTRACT

Background: Although 80% of the 50million people with epilepsy reside in resource poor, developing countries. Epilepsy care in these regions remains limited and the majority of epilepsy patients go untreated due to various modifiable and non-modifiable factors.

Objective: Comparing the effectiveness of volunteer specialist intervention versus autonomous epilepsy treatment to optimize care strategies and improve patient well-being in rural areas of Bhakkar, Punjab, Pakistan.

Material and Methods: An observational study comparing treatment gap and expenses between two cohorts: one being supported and treated at Rukhsana Shafqat Medical Centre, and their counterpart’s getting treatment from other facilities with spending out of their pocket was carried out June 01, 2023 to January 01, 2024 at RSMC Bhakkar, Punjab.

Results: A comparison of 100 epilepsy cases each from a major medical center (RSMC) and rural healthcare facilities shows demographic and clinical differences. RSMC patients are younger, with different gender ratios and education levels. RSMC reports 31% idiopathic epilepsy, 61% symptomatic, and 8% cryptogenic, contrasting rural centers' 14%, 78%, and 8%. Co morbidities vary, with 49 individuals having none in RSMC and 60 in rural centers. Treatment duration and disease knowledge also differ, with RSMC demonstrating better knowledge (64.57% good knowledge) compared to rural centers (52.63%). Misconceptions are higher in rural areas (50.4%) than at RSMC (36%). Monthly costs are predominantly below 5000 PKR at RSMC (87%) and in 72% of cases in rural centers, with 28% spending more than 5000 PKR.

Conclusion: The community-based rehabilitation model of care can offer an alternative approach to epilepsy care and address the reality of most people with epilepsy living in such areas of poor developing countries.