Tribal ethnicity also identifies particularly vulnerable persons with epilepsy: A cross-sectional study from Central India.

OBJECTIVE

In regions facing high epilepsy treatment gaps, it is essential to identify Particularly Vulnerable Persons with Epilepsy (PVPWE) to ensure equitable resource allocation. This study sought to identify these individuals and determine the specific attributes that increase the risk of remaining untreated within severely underserved communities in Central India.

METHODS

This cross-sectional study was nested within an implementation research project in two rural blocks (Nagri and Ambagarh Chowki) of Chhattisgarh, India. The analysis included 534 consenting persons with epilepsy (PWE) who were diagnosed with active epilepsy during six community outreach clinics. Participants were classified as "Untreated" or "On treatment" based on their antiseizure medication status at the time of the clinic. Multivariable logistic regression was utilized to determine independent factors associated with treatment status.

RESULTS

Of the 534 PWE attending these outreach clinics, 324 (61%) were classified as "Untreated" and 210 (39%) as "On treatment". Multivariable analysis indicated that individuals of tribal ethnicity had significantly lower odds of being on treatment compared to non-tribal individuals (AOR 0.45, p < 0.001). Conversely, increased odds of receiving treatment were independently associated with younger age at epilepsy onset (p = 0.003), middle-income status (p = 0.01), higher educational attainment (p = 0.04), Ayushman Bharat health insurance beneficiary status (p = 0.01), and the location of the outreach clinic (p = 0.04).

SIGNIFICANCE: Among PWE attending these outreach clinics, approximately 60% were not receiving prescribed ASM treatment at the time of assessment. Tribal ethnicity serves as a significant marker for heightened vulnerability, defining a distinct group of PVPWE. Prioritizing these particularly vulnerable populations is crucial for policy development and the equitable triage of limited health resources to effectively reach underserved communities.