Review
Introduction
World Health Organization Mental Health Gap Action Programme guideline development
High-income countries | Low-income and middle-income countries | |
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Gross national income per capita | High ≥US$9,386; upper middle US$3,036 to $9,385 | Low ≤US$765 or lower; middle US$766 to $3,035 |
Access to health care | Initial access usually through primary care with established referral networks, which may include high indirect costs | Limited to very basic primary care especially in rural areas and/or established referral networks, which invariably include high indirect costs |
Healthcare funding | National programs, private insurance, out-of-pocket expenses | Often ill-funded, may rely on donors/volunteering services. Indirect costs and informal payments can represent major barriers to care |
Common epilepsy etiologies | Neoplastic, cerebrovascular | (Post-)infectious, antenatal, post-traumatic |
HIV prevalence | Low | Can be moderate to high |
Cultural perception of seizures | Biomedical model | Traditional medicine, spiritual approach; contagion beliefs common |
Socio-cultural attitudes towards epilepsy | Neutral public perception or at least social presentation of neutrality | Overt negative public perception, stigmatization, and discrimination common |
Reality | Requirement |
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Care is largely provided by non-physician healthcare workers with very basic or no neurological training | Clear case definition of epileptic seizures and simple algorithms tailored for the local circumstances |
Limited access to medication | Guidelines recommending those medications that can be accessed |
Indirect costs as a barrier to care-seeking and adherence | Priority for inexpensive affordable drugs delivered as close to the patient's residence as possible |
High prevalence of infectious causes | Incorporate into guidelines testing/treating of common conditions such as HIV, neurotuberculosis, and parasitosis. Refer to existing treatment guidelines whenever possible unless comorbid conditions require care that differs from national guidelines |