Quality of care in women of reproductive age with epilepsy and knowledge of residents on women’s issues in epilepsy at the Kenyatta National Hospital.

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.