Epilepsy is a treatable neurological condition that remains underdiagnosed and undertreated in many low- and middle-income countries. The burden in sub-Saharan Africa is amplified by limited access to healthcare, shortages of specialists and diagnostic resources, and widespread sociocultural misconceptions. Access to first-line antiseizure medication (ASM) can enable seizure freedom for most people with epilepsy, often at low annual cost, but large treatment gaps persist. This study quantified the local epilepsy prevalence and measured the treatment gap in two districts of southeastern Ghana to identify barriers that limit access to biomedical care.
The survey was conducted in the Shai-Osudoku (mainly rural and agrarian) and Ningo-Prampram (peri-urban, coastal) districts in the Greater Accra region. Both districts are part of the Dodowa Health and Demographic Surveillance Site (DHDSS), which provided the sampling frame. The districts host a mix of health facilities including a district referral hospital, polyclinic, health centres, CHPS compounds, and private clinics. Ethnically, communities include Ga-Dangme, Ewe, and Akan groups.
Researchers performed a three-stage, population-based, door-to-door cross-sectional survey embedded within the DHDSS. Data collection occurred from April 2023 to December 2023. The survey aimed to estimate epilepsy prevalence, confirm diagnoses, and assess treatment status and barriers. This work formed part of the Epilepsy Pathway Innovation in Africa (EPInA) project, which seeks to improve epilepsy care pathways in sub-Saharan Africa.
The study estimated an epilepsy prevalence of 8.84 per 1,000 people (95% CI: 8.00–9.68) in the surveyed districts. Among individuals with a confirmed diagnosis of epilepsy, only 30% were using antiseizure medication, corresponding to a 70% treatment gap. These findings indicate that the majority of people with epilepsy in these districts were not receiving adequate biomedical treatment despite the availability of low-cost first-line ASM.
Among untreated people with epilepsy, the most commonly reported reason for not receiving biomedical care was lack of diagnostic awareness (37.8%). The study identified several contributing barriers:
These barriers operate at multiple levels — individual knowledge and beliefs, community attitudes, health-system supply and cost factors — and together help explain the high treatment gap observed.
The survey documents both the scale of untreated epilepsy in these two districts and the multifactorial nature of the treatment gap. Lack of diagnostic awareness and entrenched sociocultural misconceptions reduce care-seeking for biomedical services, while economic constraints and ASM supply issues limit sustained treatment even when care is sought. Interventions designed to reduce the treatment gap will therefore need to be multifaceted, combining public health education to address awareness and misconceptions, stigma-reduction strategies, improved availability and affordability of antiseizure medication, and strengthening of diagnostic and service delivery capacity at local health facilities.
The article notes that this study is part of a broader effort to update epidemiological data on epilepsy in southeastern Ghana. Specific methodological details beyond the three-stage, door-to-door approach and the DHDSS sampling frame are provided in the full paper. All relevant data and supporting information are reported within the article and its supporting files. The study was funded by the UK National Institute for Health and Care Research (NIHR) through Official Development Assistance, and the authors declare no competing interests.
In Shai-Osudoku and Ningo-Prampram districts, most people with epilepsy were not receiving biomedical treatment. The quantified treatment gap (70%) reflects major shortfalls in diagnostic awareness, pervasive sociocultural beliefs (including supernatural attributions), stigma, preferences for alternative medicine, costs, and ASM shortages. Targeted public health interventions that address awareness, cultural beliefs, stigma, medication availability, and affordability are required to close the treatment gap and improve epilepsy care and outcomes in these settings.