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Development
of a community-based programme on identification, management and stigma
removal in epilepsy and psychoses
Technical
Meetings
 Development
of Strategies for Community-Based Neuropsychiatric Services, Report of an Intercountry Consultation, Bangkok, Thailand, 19-22
November 2001 [PDF 120 KB]
Developing
Country Specific Community-Based Strategies for Reduction of Treatment Gap in
Common Neuropsychiatric Conditions – Report of an Intercountry Workshop New Delhi, 18-20 November 2004
[PDF 83 KB]
Intercountry Workshop on Developing Community Mental
Health Services Bangkok, Thailand, 11-14 December 2006 [PDF 236 KB]
Epilepsy
It is estimated that about 1 per
cent of the total population of the Region (i.e. about 15 million persons)
are affected by epilepsy. Unfortunately, it is estimated that less than
100,000 of this 15 million get appropriate treatment. This leads to a huge
amount of morbidity amongst persons affected by epilepsy. Also the stigma
associated with epilepsy prevents patients and families from seeking modern
medical treatment.
As a follow-up of the
inter-country workshop held in Bangkok in November 2001, H&B unit has developed a simple questionnaire
which includes only six questions. If four out of six questions are positive,
it is likely that the person has generalized tonic-clonic type of epilepsy
and needs to be on treatment. This questionnaire has been tested in eight
Member Countries and is ready for implementation in the community on a large
scale. Through this questionnaire, it is anticipated that an additional 8-10
million persons with epilepsy will be identified.
A simple manual
describing the optimum method of treatment with phenobarbital
for such patients has been developed. This easy to use manual can be used by
health care providers even in rural and remote areas. The cost of medication
is extremely low and can either be provided by governments or purchased by
patients at nominal cost.
Because of the stigma related to
epilepsy, a video has been prepared which counters many of the myths and
misconceptions associated with epilepsy. This video can be screened on a
large scale in the community with the objective of making epilepsy being
accepted by the community as a medical condition like any other illness.
Development
of Modules for Identification and Management of Generalized Tonic-Clonic Seizures (Major Fits), Report of an Intercountry Workshop, Yangon, Myanmar, 23-25 September
2002 [PDF 56 KB]
REDUCING THE
TREATMENT GAP FOR EPILEPSY IN NYAUNGDON
TOWNSHIP, MYANMAR.
The project was conducted in Ayeyarwady
division of Nyaungdon township in 2004 with a
population of 239632 (87.5% rural and 12.5% urban). There were 520 health
care providers in the area which included allopathic physicians,
practitioners of indigenous systems of medicine and faith healers.
Before the start of the project, the treatment gap
for epilepsy was 94.6%. Treatment gap was defined as those in need of
treatment but not getting optimum allopathic treatment.
All primary health care system based health workers
were trained in the identification of Generalized Tonic Clonic
Seizures, using technical material developed by SEARO. Training was performed
by experts from the Department of Neurology at Yangon General
Hospital. Medication (phenobarbitone) was provided free of cost to all patients
identified as having epilepsy.
At the end of 1 year of the project, it was shown
that the treatment gap was reduced to zero, i.e. all persons in need of
treatment were getting treatment.
The experts clearly showed that with proper
training of community based health workers, the
treatment gap can be substantially reduced. The limiting factor is the
availability of free medications.
Psychoses
Psychoses is
a group of psychiatric disorders affecting about 0.5% of the population at
any given point of time. These disorders result in severe long-term
disability in the affected individuals and enormous socio-occupational burden
on the families and society, if left untreated. It is unfortunate that
despite the availability of simple, effective treatment, more than two third
patients of psychoses do not receive treatment because of ignorance, stigma
and non-availability of mental health care services.
Experts at a WHO/SEARO meeting at Bangkok in November 2001
recommended that the local health care providers be trained to diagnose
psychoses with the help of a simple questionnaire and manage these patients
with the help of simple management manual after training. Based on these
recommendations, WHO SEARO with the help of its consultants in the field of
mental health and community medicine has developed a questionnaire titled
“Psychoses Identification Questionnaire” (PIQ) and a Psychoses Management Manual
for management of patients of psychoses at community level.
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