Burden, causes, and outcomes of people with epilepsy admitted to a rural hospital in Kenya

Epilepsy is a common neurologic disorder directly affecting about 70 million people in the world, with about 90% residing in lower‐and middle‐income countries.1 The treatment gap for epilepsy is large (up to 90%) in these areas, and this is in part due to negative attitudes toward biomedical services, cost of accessing diagnosis and treatment, and traditional beliefs about the cause of epilepsy.2, 3 People with epilepsy (PWE) are thought to have more hospital admissions than those with other chronic neurologic disorders,4 and is the third most common after stroke and spinal cord injuries in sub‐Saharan Africa (SSA).5 Epilepsy‐related hospital admissions are increasing in high‐income countries; for example, the rate of hospital use increased from 66 to 68/100,000 persons/year over 10 years in England and Wales,4 and by 27% over 12 years in the United States.6 In the American study, epilepsy accounted for more than half of all hospital stays among admissions of PWE, with respiratory‐related complications being the most common causes for admission.6 The hospital admission rates would be expected to be higher in SSA compared to the West because of the higher prevalence of epilepsy7 and the larger treatment gap.3 In addition, epilepsy in Africa is associated with increased complications such as status epilepticus, burns, and head injuries,8 which often require treatment at the hospital. Nevertheless, there are few published studies that document the burden, causes, and duration of hospitalization in PWE in SSA, where epilepsy may add a considerable burden on the health system. In Zambia PWE had a poorer socioeconomic status compared to their peers with other medical conditions,9 but the focus of this study was not to examine the burden of hospitalization due to epilepsy. This study estimates the incidence of admissions with epilepsy, the associated disability‐adjusted life years (DALYs) and determines the important causes and risk factors of admission to a rural hospital among PWE. We further examined the risk factors associated with the major outcomes (duration of hospitalization and mortality) among PWE.