Barriers to epilepsy care: Measuring the treatment gap in rural and peri-urban districts in Ghana

Abstract

Background Epilepsy is an easily treatable condition, but a substantial treatment gap persists, particularly in low- and middle-income countries. We quantified the epilepsy treatment gap in Ghana. Materials and methods We conducted a three-stage population-based study in the Shai Osudoku and Ningo-Prampram districts, embedded within the Dodowa Health and Demographic Surveillance System to estimate prevalence and assess treatment barriers from April 2023 to December 2023. Results We found an epilepsy prevalence of 8.84 per 1,000 people (95% CI: 8.00–9.68). A 70% treatment gap was identified, with only 30% of those with a confirmed diagnosis using antiseizure medication. Among untreated people, the most common reason was a lack of diagnostic awareness (37.8%). Barriers to treatment included sociocultural beliefs and misconceptions, stigma, preference for alternative medicine, cost, and antiseizure medication shortages. Significant knowledge gaps were evident, with 36.8% of respondents attributing epilepsy to witchcraft or supernatural causes. Conclusion Most people with epilepsy in the area were not receiving adequate biomedical care. The observed treatment gap was associated with multiple factors, including gaps in awareness, sociocultural misconceptions, and economic barriers, suggesting the need for targeted public health interventions to improve epilepsy care and management.