Introduction and Situation Analysis
Senegal is a West-African country that covers a territory of 69,700 km² and has a population of 10 million.
Of the population 45% are less than 15 years of age, 54% are female and 55% live in rural areas. The health system is structured as a pyramid, constituted from the base to the top by: health posts (villages and rural community), health centres (cities), regional hospitals and (2) university hospitals. There is a wide disparity of medical personnel: 90% of specialised doctors are concentrated in Dakar. More than 50% of the countries medical doctors, pharmacies, nurses and midwives are based in the Dakar region.
The mean national prevalence rate of epilepsy in Senegal is estimated to be 8.3%. Different epidemiological research projects have emphasised the important differences from one region to another. In the suburban area Pikine, characterised by promiscuity and problems of hygiene and water supply, the prevalence raises to 12%.
The Pikine Health District is a poor suburb of Dakar with a population of 480,000 of whom 57% are younger than 20 years of age. Pikine is a conglomerate of traditional villages, resettlement houses and squatters homes. Some limited primary maternal and infant health plans exist.
- to decrease the treatment gap
- to develop a model of epilepsy care in terms of identification, treatment, prevention, education, training and research
- to evaluate knowledge, attitude and practice about epilepsy
- to assess local cultural beliefs and health seeking strategies
- to develop epilepsy training modules
- to strengthen health personnel capacity to detect and manage epilepsy
- to ameliorate access to and availability of antiepileptic drugs
- to assess current management practices and to promote their improvement
- to improve the prevention of epilepsy
- to ameliorate epilepsy knowledge and required attitudes of teachers
- to ascertain education on epilepsy to patients and their families
- to promote general awareness about epilepsy and to fight the stigma surrounding the condition
- to set up local support groups
- to reduce the social, economic and professional burden faced by people with epilepsy
Methodology – Epidemiological survey
A multi-disciplinary and multi-dimensional approach was used to establish services for epilepsy and to ensure that these would be integrated into the national health service. The strategy consisted of:
- preparation phase
- national intervention
- pilot intervention studies
This Demonstration Project consisted of a survey of people with epilepsy in the project site. This was followed by training and educational interventions. Finally a second survey to evaluate their expected impacts on awareness, treatment gap, knowledge and services was performed.
The interventions consisted of the distribution of training materials for health professionals, leaflets specifically for people with epilepsy and information for the general public .A television documentary and advertising message were developed with the participation of the First lady, the Ministry of Health, the National Wrestling Champion and a Music Celebrity and, finally, weekly broadcasting on epilepsy.
A Drug Bank providing Phenobarbital was set up. Training Seminars were organized for:
- Primary school teachers
- Students from 5 primary and 2 secondary schools
- Doctors and health personnel from public and private enterprises
Later, weekly specialised consultations for epilepsy were organized.
The Demonstration Project in Pikine revealed that the public health methodology applied was effective, despite the difficulties related to the context, and could be extended to the rest of Senegal. The methodology could also be proposed as a model that could be suitably adapted for use by other countries of the Region, taking into account local specificity.
Organizational Context and Management Structure
The Ministry of Health had been instructed by the Prime Minister of the country to initiate a Demonstration Project. A co-ordination team was set up consisting of the Director of Health of the Ministry of Health and the Executive Board of the Senegalese League Against Epilepsy (SLAE).
Training, research and care activities were co-ordinated by the SLAE Research and Training Commission. Education, information and social activities were managed by the SLAE Socio-Educative Commission. The project was supported by the Service of Health Education of the Ministries of Health and of Social Affairs, Woman and Child.
The Project was facilitated and monitored on behalf of the Global Campaign Secretariat by Prof Ley Sander, the scientific project leader of the Campaign, and by Prof Harry Meinardi. The project was facilitated and monitored by members of the Campaign Secretariat (Dr Leonid Prilipko and Hanneke M de Boer).