Risk factors and etiologies of epilepsy and the predictors of long-term healthcare attendance and treatment adherence in urban and rural Rwanda.

Epilepsy is one of the most common chronic brain disorders. Up to 85% of persons living with epilepsy (PwE) live in the developing world. In sub-Saharan Africa, Rwanda has one of the highest prevalence rates (5%). Higher prevalence in low-and middle-income countries (LMICs) can partly be attributed to differences in risk factors for epilepsy of which a great number are preventable. Expanding knowledge on risk factors and etiologies of epilepsy in Rwanda can lower the portion of preventable epilepsies and decrease the high number of Rwandan PwE. In addition, 75% of PwE in LMICs are not appropriately treated. The epilepsy treatment gap (ETG) in Rwanda is 91.5%. Knowledge on modifiable contributors to the ETG will lead to targeted interventions closing the gap and reducing morbidity caused by seizures. Adherence, which also implies behavior such as seeking medical attention and attending follow-up appointments, has a dynamic behavior. Identifying differential patterns of healthcare attendance and treatment adherence during follow-up is important to determine subgroups at the highest risk of nonadherence, critical periods for adherence intervention and minimal adherence thresholds to optimize treatment efficacy. This project will investigate: (1) risk factors and etiologies of epilepsy in Rwanda using a nationwide approach; and (2) patterns of long-term healthcare attendance and treatment adherence of PwE in a tertiary reference center, including predictors of these patterns.