Abstract
BACKGROUND: In Mali, the screening, diagnosis, and treatment of epilepsy face significant challenges due to a shortage of qualified health workers in rural areas, limited access to health services, and cultural barriers. This study assessed how mHealth platforms can support task shifting to community health workers (Relais) to screen and treat epilepsy at the community level. METHODS: We conducted a cohort study involving persons with epilepsy (PWE) and Relais in 17 villages in the Nonkon health area of the Kolokani Health District, approximately 105 km northwest of Bamako, the capital city of Mali. Relais collected data using mobile phones equipped with an "Epi-Collect" application specifically designed for epilepsy management, enabling Relais to record patient information digitally. All collected data was securely stored in "telesante.ml," a telemedicine platform utilized by healthcare professionals. RESULTS: Out of 64 patients suspected of having epilepsy by the Relais and indexed on the platform, 61 patients were confirmed by the neurologist through remote evaluation, resulting in a confirmation rate of 95%. After an 18-month follow-up, the patient retention rate was 86.89% (53 out of 61). At baseline, 98.36% (60 out of the 61) experienced at least one seizure per month. However, after six months of treatment, 89.28% (50 out of 56 at month six) PWE had no seizures in the last month (p < 0.0001). CONCLUSION: This study demonstrates the insightful effectiveness of leveraging an mHealth platform to empower community Relais to manage epilepsy in rural Mali. The Relais demonstrated a high capacity for screening, with neurologists confirming most suspected cases they identified. This innovative approach resulted in excellent patient outcomes, including a high retention rate over the follow-up period and statistically significant reduction in seizures. While challenges such as mobile network coverage and varying literacy levels among Relais were encountered, the findings strongly support this mHealth strategy as a viable solution to bridge the healthcare gap, significantly improving access to and management of epilepsy for remote and hard-to-reach populations.