An evaluation of the management of epilepsy by primary health care nurses in Chitungwiza, Zimbabwe

Abstract

In order to design an effective training program for nurses on the management of epilepsy in Zimbabwe, the drug management of epilepsy by community health nurses without prior training in epilepsy management was evaluated. Epilepsy patients in Chitungwiza, a high density suburb of Harare, were routinely managed at four health clinics run by nurses. The patients also attended a monthly epilepsy support group (ESG) program that provided them with vocational and social rehabilitative support. The drug therapy of all patients attending this support group program was evaluated by neurologists over a 2-year period. The specialist interventions required for drug therapy in patients with inadequate seizure control or drug side effects were noted. One-hundred and fourteen epilepsy patients (age range, 8–56 years, M:F = 1:1.2) were seen; 84.2% had generalized seizures; 40.3% of patients had been seizure free for at least 6 months; 71.9% of patients were on phenobarbitone, while 59.6% were on monotherapy. No drug intervention was required to ongoing drug therapy in 43% of patient consultations. The most important intervention in patients with inadequate seizure control was an increase in drug dose, required in 29% of consultations. Fifty-eight percent of serum drug level estimations in clinically indicated cases were below the therapeutic ranges. This tendency to subtherapeutic dosing with an antiepileptic drug (AED) among nurses suggested that a written AED drug therapy protocol specifying optimal maintenance doses and dose increment schedules may be beneficial to the community-based nursing management of epilepsy.