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

In order to design an effective training program for nurses on the manageme nt of epilepsy in Zimbabwe, the drug management of epilepsy by community he alth nurses without prior training in epilepsy management was evaluated. Ep ilepsy patients in Chitungwiza, a high-density suburb of Harare, were routi nely managed at four health clinics run by nurses. The patients also attend ed a monthly epilepsy support group (ESG) program, which provided them with vocational and social rehabilitative support. Neurologists evaluated the d rug therapy of ail patients attending this support group program over a 2-y ear period. The specialist interventions required to drug therapy in patien ts with inadequate seizure control or drug side effects were noted. A total of 114 epilepsy patients (age range 8-56 years, M:F = 1:1.2) were seen, of these 84.2% had generalized seizures, 40.3% of patients had been seizure-f ree for at least 6 months, 71.9% of patients were on phenobarbitone, while 59.6% were on monotherapy. No drug intervention was required to on-going dr ug 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. Of serum drug level estimations in clinic ally indicated cases, 58% were below the therapeutic ranges. This tendency to sub-therapeutic dosing with AED amongst nurses implied that a written AE D drug therapy protocol specifying optimal maintenance doses and dose incre ment schedules may be beneficial to the community-based nursing management of epilepsy. (C) 2000 Elsevier Science B.V. All rights reserved.