A cross-sectional study of healthcare provider perceptions of the management of epilepsy in pregnancy in sub-Saharan Africa

Background: Epilepsy prevalence in sub-Saharan Africa is high with a significant treatment gap. In this context,
epilepsy presents substantial challenges to effective and safe reproductive and maternal healthcare. To improve
this, it is important to understand the views and perceptions of healthcare professionals delivering epilepsy care
to this population.
Methods: This study uses an online questionnaire which asked healthcare professionals (both from nursing and
medical backgrounds) who work in sub-Saharan African countries to rate a set of pre-established options
designed with the feedback of a local focus group of epilepsy experts from countries targeted. The questionnaire
consisted of 21 questions and was a mix of multiple choice and Likert scale questions on managing reproductive
health in women in local settings.
Results: Of 203 healthcare professionals respondents from over 10 countries majority were doctors (48%) or
nurses (36%). The Gambia (28.6%), Nigeria (22.2%), Cameroon (13.3%) and Zambia (9.4%) accounted for
nearly three-quarters of respondents. Over half (54%) felt that they have the necessary training to counsel
women with epilepsy on reproductive health and pregnancy. Only 40% reported they regularly discuss family
planning. Carbamazepine was reported to be the most used anti-seizure medication (ASM) for childbearing age
women. Key challenges outlined were epilepsy awareness among patients and their families, information deficit
on ASMs and pregnancy and access to a sufficient range of ASMs.
Conclusion: Understanding the challenges faced by health professionals in sub-Sharan Africa, provides better
comprehension of the specific “treatment-education gap” in counselling women with epilepsy on ASM risks and
benefits.