Przynależność do ludów tubylczych jako wskaźnik szczególnego ryzyka u osób z epilepsją: badanie przekrojowe z Indii Środkowej
Tribal ethnicity also identifies particularly vulnerable persons with epilepsy: A cross-sectional study from Central India
W skrócie
Badacze przebadali 534 osoby z epilepsją w wiejskich regionach Indii i odkryli, że aż 61% z nich nie otrzymywała leczenia lekami przeciwpadaczkowymi. Osoby należące do ludów tubylczych miały znacznie mniejsze szanse na otrzymanie leczenia w porównaniu z osobami spoza tych grup, podczas gdy szanse na leczenie były wyższe u osób młodszych, lepiej wykształconych, ubezpieczonych i z wyższymi dochodami. Wyniki wskazują, że osoby z ludów tubylczych stanowią szczególnie zagrożoną grupę i powinny być priorytetowo objęte programami zdrowotnym w niedofinansowanych regionach.
Oryginalny abstract (angielski)
OBJECTIVE: In regions facing high epilepsy treatment gaps, it is essential to identify Particularly Vulnerable Persons with Epilepsy (PVPWE) to ensure equitable resource allocation. This study sought to identify these individuals and determine the specific attributes that increase the risk of remaining untreated within severely underserved communities in Central India. METHODS: This cross-sectional study was nested within an implementation research project in two rural blocks (Nagri and Ambagarh Chowki) of Chhattisgarh, India. The analysis included 534 consenting persons with epilepsy (PWE) who were diagnosed with active epilepsy during six community outreach clinics. Participants were classified as "Untreated" or "On treatment" based on their antiseizure medication status at the time of the clinic. Multivariable logistic regression was utilized to determine independent factors associated with treatment status. RESULTS: Of the 534 PWE attending these outreach clinics, 324 (61%) were classified as "Untreated" and 210 (39%) as "On treatment". Multivariable analysis indicated that individuals of tribal ethnicity had significantly lower odds of being on treatment compared to non-tribal individuals (AOR 0.45, p < 0.001). Conversely, increased odds of receiving treatment were independently associated with younger age at epilepsy onset (p = 0.003), middle-income status (p = 0.01), higher educational attainment (p = 0.04), Ayushman Bharat health insurance beneficiary status (p = 0.01), and the location of the outreach clinic (p = 0.04). SIGNIFICANCE: Among PWE attending these outreach clinics, approximately 60% were not receiving prescribed ASM treatment at the time of assessment. Tribal ethnicity serves as a significant marker for heightened vulnerability, defining a distinct group of PVPWE. Prioritizing these particularly vulnerable populations is crucial for policy development and the equitable triage of limited health resources to effectively reach underserved communities.