IMPROVING MANAGEMENT IN EPILEPSY:
COMMUNITY BASED MANAGEMENT PROGRAMME
INVOLVING THE VILLAGE HEALTH WORKER
 
 
 
Vidya Dev Sharma
 
 
A Thesis Submitted in Partial Fulfillment of the Requirements
for the Degree of Master of Public Health
Health Systems Development Programme
College of Public Health
Chulalongkorn University
Academic Year 1998-99
ISBN: 974-331-305-2
Ó College of Public Health, Chulalongkorn University.
  Thesis Title Improving Management in Epilepsy: Community Based Management Programme involving Village Health Workers By Vidya Dev Sharma
Program Master of Public Health, (Health Systems Development) College of Public Health
Thesis Advisor Sathirakorn Pongpanich M.A., Ph.D.

_____________________________________________________________________

 

Accepted by College of Public Health Chulalongkorn University in Partial Fulfillment of the Requirement for the Master's Degree

 
, Dean of the College of Public Health

(Professor Chitr Sitthi-Amorn, M.D., Ph. D.)
 

THESIS COMMITTEE

, Chairperson
(Assoc. Prof. Wattana S Janjaroen, Ph.D.)
 

, Thesis advisor
(Sathirakorn Pongpanch, M.A., Ph.D.)
 

, Member
(Stephen King, M. Med. Sci., DR. P. H.)

 
., Member
(Edgar J. Love, M.D., Ph.D.)
 

TABLE OF CONTENTS

ABSTRACT
ACKNOWLEDGEMENTS
TABLE OF CONTENTS
LIST OF TABLES
LIST OF FIGURES

CHAPTER I

INTRODUCTION

CHAPTER II

IMPROVING MANAGEMENT IN EPILEPSY: COMMUNITY BASED MANAGEMENT PROGRAM INVOLVING VILLAGE HEALTH WORKER

2.1    Introduction
2.2    Why is epilepsy a public health problem in Nepal ?
2.3    Problem situation
2.4    What are the causes, consequences and remedy of the problem
        2.4.1 Non behavioral factors
        2.4.2 Behavioral factors
        2.4.3 Predisposing factors
        2.4.4 Reinforcing factors
        2.4.5 Enabling factors
        2.4.6 Treatment failure
        2.4.7 Consequence of the problem
        2.4.8.Treatment
2.5  Problem in relation to Nepal
2.6  What could be done to improve the situation and how would they bring improvement ?
        2.6.1 Increase community awareness
        2.6.2 Sensitization of the community
        2.6.3 Increment of social pressure
        2.6.4 Involvement of the community
        2.6.5 Involvement of other healing systems
        2.6.6 Strengthening active case-finding
        2.6.7 Strengthening the health post system
        2.6.8 Development of support systems for patients and families
2.7   Chosen intervention to be used
2.8   How does it work
        2.8.1 Human factor
        2.8.2 Health service factor
2.9   Village health worker (VHW) as agent of change
2.10  Motivation for the VHW to take on the role
2.11  How to implement it 34
2.12  References 35
 
CHAPTER III

EMPOWERMENT AND MOBILIZATION OF VILLAGE HEALTH WORKERS IN THE USE OF PHENOBARBITONE TO BRING ABOUT BETTER COVERAGE AND QUALITY CARE OF EPILEPTICS IN KERABARI HEALTH POST OF MORANG DISTRICT OF NEPAL.

3.1   Introduction
3.2   Purpose of the study
3.3   Objective
       3.3.1 General objective
       3.3.2 Specific objective
3.4   Strategy of implementation
3.5   Study design
3.6   Study site
3.7   Pre training groundwork
       3.7.1 Development of curriculum
       3.7.2 Diagnostic and screening guidelines
       3.7.3 Treatment protocol
       3.7.4 Teaching learning material
3.8  Training activities
       3.8.1 Training of VHWs
       3.8.2 Refresher training
3.9  Supervision and monitoring
3.10 Evaluation
       3.10.1 Process
       3.10.2 Outcome
       3.10.3 Impact
3.11 Expected outcome
3.12 Activity plan
3.13 Anticipated hurdles
3.14 Budget
       3.14.1 VHW training
       3.14.2 Refresher training
       3.14.3 Material development
       3.14.4 Seed money for Community Drug Fund
       3.14.5 Transportation and communication
       3.14.6 Salary
       3.14.7 Contingency
3.15 Human resource and technical requirement
3.16 Information and recording system
3.17 Sustainability
3.18 Ethical issues
3.19 Supportive activities

CHAPTER IV

A CROSS SECTIONAL SURVEY OF QUALITY OF LIFE OF EPILEPTIC PATIENTS

4.1 Introduction
4.2 Objective
4.3 Methodology
4.4 Results
4.5 Discussion
4.6 Limitations
4.7 In-depth interview
4.8 Lessons learned
4.9 References

CHAPTER V

PRESENTATION

CHAPTER VI

BIBLIOGRAPHY

APPENDIX

I.      Map of Nepal showing study site
II.    Training schedule of VHW
III.   Flip chart
IV.   Brochure
V.    Pre / Post test Questionnaire
VI.   Patient record card
VII.  Patient follow up card
VIII. Questionnaire for data exercise
X.     Duke Health Profile Questionnaire
XI.    Thai version of Duke Health Profile Questionnaire
 
LIST OF TABLES

1.1 Classification of epilepsy
1.2 Anti epileptic drug of choice
3.1 Manpower situation of Kerabari health post.
3.2 Diagnostic guidelines of epilepsy
3.3 Activity plan
3.4 Budget at a glance
4.1 QOL scores in different domains of the two groups
4.2 Correlation between QOL scores in different domains among themselves in normal population
4.3 Correlation between QOL scores in different domains among themselves and the measures of
      dysfunction in patient population
4.4 Correlation between illness profile and different domains and measures of dysfunction in patient
      population
4.5 Descriptive characteristics of the patient population

LIST OF FIGURES

2.1 Causal web of under utilization of services in relation to epilepsy.
2.2 Determinants of health service utilization in relation to epilepsy services.
2.3 Determinants of health seeking behavior.
2.4 Different roles of VHWs in the proposed program.
3.1 The total number of epilepsy cases attending the different health posts in Morang district
3.2 Study design