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School of Public Health
College of Health Sciences, Makerere University

Barriers to biomedical care for people with epilepsy in Uganda: A cross-sectional study

Abstract
Objective
Epilepsy, a neurological disorder with effective biomedical treatment, remains largely untreated in Uganda. Potential reasons for this treatment gap (TG) include limited access to trained providers and clinics, social stigmata of seizures, cultural beliefs, or lack of public understanding of epilepsy as a treatable condition. The current study aimed to formally evaluate barriers faced by people with epilepsy (PWE) in Uganda when seeking biomedical care.
Methods
In a cross-sectional study, 435 participants drawn from a community prevalence study were enrolled. We included participants reporting a history of recurrent seizures suggestive of epilepsy, who completed a survey about barriers to obtaining care for their symptoms. Principal axis factor analysis (PFA) using a promax rotation was conducted for data reduction. Frequencies of barrier factors were compared across those who did not seek care for epilepsy ( n  = 228), those who sought care from biomedical facilities ( n  = 166), and those who sought care from a traditional or pastoral healer ( n  = 41).
Results
The PFA yielded a five-factor solution: 1) logistical and actual costs; 2) treatment effectiveness; 3) influence of the opinion of others; 4) doctors' care; and 5) contextual factors impacting decision-making. Variables related to logistical and actual costs were most endorsed. Comparison of groups by care sought did not reveal a difference in endorsement of factors, with the exception that those who sought biomedical care were more likely to endorse factors related to doctors' care compared with those that sought care from traditional or pastoral healers (P  = .005).
Conclusions
People with repetitive seizures in Uganda report several barriers to obtaining biomedical care in Uganda, with those related to practical and actual costs endorsed the most. It is imperative that interventions developed to reduce the TG in Uganda consider these practical issues to improve access to effective epilepsy care.
This article is part of the Special Issue “The Intersection of Culture, Resources, and Disease: Epilepsy Care in Uganda
Keywords
Epilepsy
Barriers to treatment
Cost
Uganda
Notes
Year of Publication
2021
Journal
Epilepsy & Behavior
Volume
114
Date Published
September 20, 2020
Type of Article
RESEARCH ARTICLE
Publisher
ISBN Number
1525-5050
URL
https://doi.org/10.1016/j.yebeh.2020.107349
DOI
doi: 10.1016/j.yebeh.2020.107349