부산대학교 도서관

To purchase or authenticate to the full-text of this article, please visit this link: http://dx.doi.org/10.1111/j.1528-1167.2008.01693.x Byline: Caroline K. Mbuba (*), Anthony K. Ngugi (*), Charles R. Newton (*[dagger][double dagger]), Julie A. Carter (s.) Keywords: Epilepsy; Treatment gap; Anti-epileptic drugs; Adherence; Interventions; Developing countries Abstract: Summary In many developing countries, people with epilepsy do not receive appropriate treatment for their condition, a phenomenon called the treatment gap (TG). We carried out a systematic review to investigate the magnitude, causes, and intervention strategies to improve outcomes in developing countries. We systematically searched MEDLINE, EMBASE, and PsycINFO databases, supplemented by a hand search of references in the key papers. The degree of heterogeneity and a pooled TG estimate were determined using metaanalysis techniques. The estimates were further stratified by continent and location of study (urban, rural). Twenty-seven studies met the inclusion criteria: twelve from Africa, nine from Asia and six from Latin America. We observed a high degree of heterogeneity and inconsistency between studies. The overall estimate of the TG was 56/100 [95% confidence interval (CI) 31.1-100.0]. The variation in estimates could possibly be explained by nonuniform TG estimation methods and the diverse study populations, among other factors. The TG was mainly attributed to inadequate skilled manpower, cost of treatment, cultural beliefs, and unavailability of antiepileptic drugs (AEDs). These factors have been addressed using different intervention strategies, such as education and supply of AEDs. Future research should estimate the TG coherently and develop sustainable interventions that will address the causes. Author Affiliation: (*)The Centre for Geographic Medicine Research (Coast), KEMRI, Kilifi, Kenya ([dagger])Neurosciences Unit, Institute of Child Health, University College London, London, United Kingdom ([double dagger])London School of Hygiene and Tropical Medicine, London, United Kingdom (s.)Centre for International Health and Development, Institute of Child Health, London, United Kingdom Article History: Accepted April 28, 2008; Early View publication June 28, 2008. Article note: Address correspondence to Caroline Kathomi Mbuba, KEMRI-Wellcome Trust Research Programme, P.O. Box 230, Kilifi, Kenya. E-mail: ckathomi@kilifi.kemri-wellcome.org