Singh, Balveen;
Mahajan, Nitika;
Singh, Gagandeep;
Sander, Josemir W;
(2022)
Temporal trends in the epilepsy treatment gap in low- and low-middle-income countries: A meta-analysis.
Journal of Neurological Sciences
, 434
, Article 120174. 10.1016/j.jns.2022.120174.
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Abstract
INTRODUCTION: Earlier systematic reviews estimated the epilepsy treatment gap in low- and low-middle-income countries to be above 75%. Reduction in the gap since then due to healthcare improvements and socio-economic changes is plausible but unproven. AIM: To review the epilepsy treatment gap evidence and determine if it has decreased over time. METHODS: We identified articles in English reporting estimates of the treatment gap in community samples from low- and low-middle-income countries from 1980 onwards. We performed meta-proportion analyses to determine the treatment gap's pooled estimates and meta-regression analyses to determine time trends for all countries and separately for African and Asian countries. RESULTS: The analysis included 58 full studies and 12 abstracts covering 31 countries. We retrieved a single report for 18 countries. The pooled estimate for treatment gap for all countries was 71% (95% Confidence Intervals: 65%, 77%; I2: 98.4%), for Africa, 73% (95% CIs: 66%, 80%; I2: 97.9%) and for Asia, 69% (95% CIs: 58%, 79%; I2: 98.8%). We found wide between studies variance and observed a trend towards reduction in the pooled gap from all countries. The reduction was significant for African countries (Regression Coefficient: -0.025; 95% CI, -0.048 to -0.0005; P = 0.045) but not for Asia (Regression Coefficient: -0.0008; 95% CI, -0.023 to 0.007; P = 0.26). CONCLUSIONS: Despite limitations of large variances, small sizes of individual studies, limited or no data from many countries, there is progress in reduction of the epilepsy treatment gap in low- and low-middle-income countries. This progress is considerable in Africa compared to Asia.
| Type: | Article |
|---|---|
| Title: | Temporal trends in the epilepsy treatment gap in low- and low-middle-income countries: A meta-analysis |
| Location: | Netherlands |
| Open access status: | An open access version is available from UCL Discovery |
| DOI: | 10.1016/j.jns.2022.120174 |
| Publisher version: | https://doi.org/10.1016/j.jns.2022.120174 |
| Language: | English |
| Additional information: | This version is the author accepted manuscript. For information on re-use, please refer to the publisher’s terms and conditions. |
| Keywords: | DALYs, disability adjusted life years, LMICslow- and low-middle income countries, ASMs, antiseizure medications |
| UCL classification: | UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences > UCL Queen Square Institute of Neurology > Clinical and Experimental Epilepsy UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences UCL UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences > UCL Queen Square Institute of Neurology |
| URI: | https://discovery.ucl.ac.uk/id/eprint/10143847 |
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