赞比亚癫痫的社会经济影响：一项横断面研究。
The social and economic impact of epilepsy in Zambia: a cross-sectional study.
作者信息
Birbeck Gretchen, Chomba Elwyn, Atadzhanov Masharip, Mbewe Edward, Haworth Alan
机构信息
Michigan State University's International Neurologic and Psychiatric Epidemiology Program, East Lansing, MI 48824-1313, USA.
出版信息
Lancet Neurol. 2007 Jan;6(1):39-44. doi: 10.1016/S1474-4422(06)70629-9.
BACKGROUND
Among the 40 million people with epilepsy worldwide, 80% reside in low-income regions where human and technological resources for care are extremely limited. Qualitative and experiential reports indicate that people with epilepsy in Africa are also disadvantaged socially and economically, but few quantitative systematic data are available. We sought to assess the social and economic effect of living with epilepsy in sub-Saharan Africa.
METHODS
We did a cross-sectional study of people with epilepsy concurrently matched for age, sex, and site of care to individuals with a non-stigmatised chronic medical condition. Verbally administered questionnaires provided comparison data for demographic characteristics, education, employment status, housing and environment quality, food security, healthcare use, personal safety, and perceived stigma.
FINDINGS
People with epilepsy had higher mean perceived stigma scores (1.8 vs 0.4; p<0.0001), poorer employment status (p=0.0001), and less education (7.1 vs 9.4 years; p<0.0001) than did the comparison group. People with epilepsy also had less education than their nearest-age same sex sibling (7.1 vs 9.1 years; p<0.0001), whereas the comparison group did not (9.4 vs 9.6 years; p=0.42). Housing and environmental quality were poorer for people with epilepsy, who had little access to water, were unlikely to have electricity in their home (19%vs 51%; p<0.0001), and who had greater food insecurity than did the control group. During pregnancy, women with epilepsy were more likely to deliver at home rather than in a hospital or clinic (40%vs 15%; p=0.0007). Personal safety for people with epilepsy was also more problematic; rape rates were 20% among women with epilepsy vs 3% in the control group (p=0.004).
INTERPRETATION
People with epilepsy in Zambia have substantially poorer social and economic status than do their peers with non-stigmatised chronic medical conditions. Suboptimum housing quality differentially exposes these individuals to the risk of burns and drowning during a seizure. Vulnerability to physical violence is extreme, especially for women with epilepsy.
背景
在全球4000万癫痫患者中，80%生活在低收入地区，那里护理方面的人力和技术资源极为有限。定性和经验报告表明，非洲的癫痫患者在社会和经济方面也处于不利地位，但几乎没有定量的系统性数据。我们试图评估撒哈拉以南非洲地区癫痫患者的社会和经济影响。
方法
我们对癫痫患者进行了一项横断面研究，同时按照年龄、性别和护理地点与患有无污名化慢性疾病的个体进行匹配。通过口头询问的问卷调查提供了关于人口统计学特征、教育程度、就业状况、住房和环境质量、食品安全、医疗保健使用情况、个人安全以及感知到的污名等方面的比较数据。
研究结果
与对照组相比，癫痫患者感知到的污名平均得分更高（1.8比0.4；p<0.0001），就业状况更差（p=0.0001），受教育程度更低（7.1年与9.4年；p<0.0001）。癫痫患者的受教育程度也低于与其年龄最接近的同性兄弟姐妹（7.1年与9.1年；p<0.0001），而对照组则没有这种情况（9.4年与9.6年；p=0.42）。癫痫患者的住房和环境质量较差，他们很难获得水源，家里不太可能通电（19%对51%；p<0.0001），并且比对照组面临更大的食品安全问题。在孕期，癫痫女性在家分娩的可能性高于在医院或诊所分娩的可能性（40%对15%；p=0.0007）。癫痫患者的个人安全问题也更多；癫痫女性的强奸率为20%，而对照组为3%（p=0.004）。
解读
赞比亚的癫痫患者在社会和经济地位方面比患有无污名化慢性疾病的同龄人差得多。欠佳的住房质量使这些人在癫痫发作时面临烧伤和溺水的风险。遭受身体暴力的脆弱性极高，尤其是癫痫女性。
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