Seizures: The Perceptions and Frustrations of Healthcare Providers and Traditional Health Practitioners in Namibia

[摘要] ENGLISH ABSTRACT: There are currently no official statistics on the incidence or prevalence of psychogenicnonepileptic seizures (PNES) or epileptic seizures (ES) in Namibia. Furthermore, very little isavailable with respect to diagnostic and treatment guidelines for these disorders. In a developing,resource-poor country such as Namibia, providing services to people with seizures may befraught with difficulties. In addition, providing healthcare in a multicultural setting may presentits own unique challenges and opportunities. This mixed-method research study aimed to explorethe perceptions and frustrations of biomedical and traditional health practitioners in managingmedically explained (MES) and unexplained seizures (MUS) in Namibia. The objectives were todescribe and interpret their conceptualization of seizures, the diagnostic and treatment practicesused in the management of seizures and the challenges encountered in managing seizure patients.A concurrent quantitative and quantitative design was used to investigate both thecontext and the experiences of healthcare providers (HCPs) and traditional health practitioners(THPs) during the diagnosis and treatment of seizures. Quantitative data were collected usingtwo surveys that focused on gathering information on the diagnostic techniques and practicesused by HCPs in the management of MES and MUS. Fifty HCPs completed these surveys anddata were analysed using descriptive statistics. As part of the qualitative phases of the study,thirty healthcare providers participated in semi-structured interviews regarding PNES and ES.Eleven THPs were interviewed as part of the qualitative phase of the study. Thematic analysiswas used to analyse the semi-structured interviews to identify themes and subthemes within thedata. The four systems of the ecological systems theory (Bronfenbrenner, 1977; 1979) were usedto conceptualize the discussion and integration of the findings.The perceptions and frustrations of HCPs and THPs centred on the areas of diagnosis,treatment, patients and awareness. Findings pointed to a lack of knowledge and awarenessregarding seizures, financial constraints that hamper access to specialized services andequipment, lack of collaboration across disciplines and between HPCs and state healthcarefacilities, the recognition that the untapped potential of THPs may play a valuable role inbridging the treatment gap for seizures and a need for increased awareness and trainingopportunities that focus on seizures among both the public and healthcare workers.The unique challenges that a developing country such as Namibia faces were evident insome of the subthemes that highlighted the cultural differences in how seizures areconceptualized and treated. Biomedical practitioners indicated their willingness to engage withTHPs in providing culturally inclusive health services for seizure patients. This may be a firststep in advocating for the formal recognition of THPs in Namibia. This study is but a first for Namibia and opens the way for future studies to build on the findings reported here. The current study can contribute to the goals of the International League against Epilepsy and the International League against Epilepsy Psychogenic Nonepileptic Seizure Task Force by providing information on the diagnostic techniques and treatment modalities used in Namibia for the management of seizures. Secondly, the findings from the multi-layered investigation could guide policy and future research on seizures in Namibia.

[发布机构] Stellenbosch University