Ramifications of national economic crisis on children with epilepsy at a tertiary care centre, Sri Lanka: A mixed method study.

Introduction: Epilepsy is a common paediatric neurological disorder and management primarily involves anti-epileptic drugs (AEDs) provided mainly by the public sector. The economic crisis in Sri Lanka had a significant toll on public health.
Objectives: To evaluate the impact of the economic crisis on the care given to children with epilepsy.
Method: A mixed method study was conducted among 92 epileptic children aged 1-16 years for six months at the paediatric neurology clinic, Teaching Hospital Kurunegala. Data were collected via an interviewer administered questionnaire. Ten caregivers were randomly selected for the focused group discussion and data were analysed thematically.
Results: The mean age was 8.87 years; 97.9% were from rural areas and 73.9% had a monthly income below 50,000 Sri Lankan rupees (LKR). Learning disability, developmental delay and cerebral palsy were the common comorbidities. The economic crisis negatively affected clinic visits, compliance dropping by 6.5% while the medication compliance remained stable (89.1% vs 88%). Children who were seizure free for over a year declined by 22.1%. Children experiencing monthly or more frequent seizures increased by 17.4%. The mean number of AED types received from public sector declined significantly (p<0.001), and expenditure on AEDs increased significantly by 2,566.42 LKR (p<0.001). The key themes identified in focused group discussion were financial difficulties, compliance issues and social issues. Caregivers maintained strong treatment compliance. Challenges were more profound for children with comorbidities. The caregivers suggested longer intervals between clinic visits and providing medications for an extended period.
Conclusions: The economic crisis significantly impacted epilepsy management. Medication shortage led to increase of breakthrough seizures. Caregivers demonstrated dedication to provide better care for children.