dc.description.abstract | Background.
Epilepsy is a common neurological disorder affecting men and women equally. However, its
impact on women involves unique gender issues related to hormone effects on seizure control,
seizure and drug effects on reproductive health, birth control options, and bone mineral density.
Despite publication of guidelines, studies have found the care for Women with Epilepsy to be
suboptimal. Studies have also demonstrated lack of knowledge by both health professionals and
patients in the issues of Women with epilepsy.
Objectives
The objective of the study was to determine the quality of care of women of reproductive age
with epilepsy at the Kenyatta National Hospital, and to assess the knowledge of Residents in
Clinical Medicine and Obstetrics and Gynecology on issues of women with epilepsy.
Study Design and Site.
A cross-sectional descriptive study, at the Neurology Clinic, Kenyatta National Hospital.
Study Participants.
Women of reproductive age, with epilepsy.
Residents in Clinical Medicine and Obstetrics and Gynecology.
Methods.
Each week, a list of female patients booked for the neurology clinic, with a diagnosis of epilepsy
was drawn up by the Principal Investigator. Selected patients had the study explained to them,
and consent obtained. Their prescription patterns of antiepileptic drugs and folic acid were
documented. Their awareness on issues of pregnancy, folate supplementation, contraception and
bone health was also assessed using a study proforma. Residents from the departments of
Clinical Medicine and Obstetrics &Gynecology (University of Nairobi) were asked to complete
the Knowledge of Women‘s Issues and Epilepsy (KOWIE-II) questionnaire.
Results
The study took place between December 2014 and March 2015. One hundred and fourteen
WWE of reproductive age were studied. Majority were on monotherapy (61%), the commonest
drug being carbamazepine at 81%. Of those on polytherapy, dual therapy was the most frequent
at 72%. The commonest polytherapy combination was carbamazepine/ valproic acid at 36 %.
Majority were also on folic acid (60%). The awareness level was low, with only 17% informed
on the need for folic acid, and 14 % on AED/ OCP interaction. Pre-conception counseling and
advice on bone health had been given to only 10% and 6% respectively. The performance
measure based on the AAN quality indicators was at 21%.
One hundred and sixty residents were surveyed from the department of Clinical Medicine and
Obstetrics& Gynecology. Most residents understood the role of folic acid and the need to
continue AEDs during pregnancy (95%). Majority were aware that AEDs decrease efficacy of
OCP (92%).They agreed that AEDs could predispose to osteomalacia (80%). Fewer residents
knew that WWE have increased sexual dysfunction (62.5 %).
Conclusion
The prescription practices were in relative conformity to guideline recommendations, but the
awareness among patients was poor. The residents are knowledgeable in issues of WWE.
Recommendation
We recommend a condensed guideline, specific for W.W.E, to aid in the gaps in care. We also
recommend continuous medical education to guide to best practice with regards to AED
prescriptions and rationalizing polypharmacy. Further studies are needed to assess factors
contributing to limited awareness among patients. | en_US |
dc.description.department | a
Department of Psychiatry, University of Nairobi, ; bDepartment of Mental Health, School of Medicine,
Moi University, Eldoret, Kenya | |