Epilepsy care delivery during COVID-19 in resource limited countries: A survey in collaboration with International Epilepsy Equity Group

Abstract

Background: The impact of the pandemic has had worse effects in countries with already stretched healthcare resources. The study aim was to explore changes in epilepsy care delivery in resource-limited countries during and since the acute phase of the COVID-19 pandemic. Method: A cross-sectional survey was conducted in 22 countries among health care providers (HCPs) caring for persons with epilepsy (PWE), in collaboration with newly formed global collaborators, the International Epilepsy Equity Group. Findings were compared based on World Bank Ranking (WBR) and HCPs’ practice type. Data were analyzed using Chi-square tests (α= 0.05) and pairwise multiple comparisons with α= 0.017 (Bonferroni adjustment). Open-ended responses were analyzed using thematic analysis. Findings: A total of 241 HCPs participated in the study. Of these, 8.30%, 65.98%, and 21.99% were from high-income (HIC), upper-middle-income (UMIC), and lower-middle-income countries (LMICs), respectively. Among HCPs, 31.12% were adult specialists, and 43.98% were pediatric specialists. During the acute phase of the pandemic, HCPs reported that the major barrier for PWE was difficulty reaching physicians/healthcare providers. Except for difficulty reaching physicians/healthcare providers (WBR P=0.01 HIC<LMIC), no other significant differences in barriers during the acute phase were observed. Since the acute phase of the pandemic, the major concern for PWE was fear of getting infected with the SARS CoV-2 virus. Significant differences in concerns since the acute phase included lockdowns (WBR: P= 0.03 UMIC<LMIC), fiscal difficulties (WBR: P<0.001 UMICs<LMICs, UMICs<HIC; practice type: P= 0.006 adult<others, pediatrics < others), clinic closure (WBR: P=0.003 UMIC<HIC; practice type: P= <0.001 adult<others, pediatric<others), and long waiting times (WBR: P=0.005, LMIC<UMIC, LMIC<HIC; practice type: P=0.006 pediatric<adults). Diagnostic services, including EEG, MRI, CT (practice type: P<0.001, adult<others; pediatric<others), and lab work (WBR: P=0.01 UMIC<HIC), were restricted. The telephone was the most reported teleconsultation method used. Except for SMS/texting (WBR P= 0.02 UMIC<LMIC), there were no significant differences in teleconsultation methods used. Discussion: There is a high probability that the initial wave and consequent reduction of in-person care, restriction of health services, and fiscal difficulties affecting all involved in care deliver, led to disruption of epilepsy care. Additional supports are needed in resource-limited countries to cope with future pandemics.