{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,11]],"date-time":"2026-08-11T18:28:53Z","timestamp":1786472933824,"version":"build-2736575974"},"reference-count":32,"publisher":"Public Library of Science (PLoS)","issue":"8","license":[{"start":{"date-parts":[[2026,8,11]],"date-time":"2026-08-11T00:00:00Z","timestamp":1786406400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100013373","name":"NIHR Oxford Biomedical Research Centre","doi-asserted-by":"publisher","award":["200134"],"award-info":[{"award-number":["200134"]}],"id":[{"id":"10.13039\/501100013373","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Epilepsy is an easily treatable condition, but a substantial treatment gap persists, particularly in low- and middle-income countries. We quantified the epilepsy treatment gap in Ghana.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Materials and methods<\/jats:title>\n                    <jats:p>We conducted a three-stage population-based study in the Shai Osudoku and Ningo-Prampram districts, embedded within the Dodowa Health and Demographic Surveillance System to estimate prevalence and assess treatment barriers from April 2023 to December 2023.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>We found an epilepsy prevalence of 8.84 per 1,000 people (95% CI: 8.00\u20139.68). A 70% treatment gap was identified, with only 30% of those with a confirmed diagnosis using antiseizure medication. Among untreated people, the most common reason was a lack of diagnostic awareness (37.8%). Barriers to treatment included sociocultural beliefs and misconceptions, stigma, preference for alternative medicine, cost, and antiseizure medication shortages. Significant knowledge gaps were evident, with 36.8% of respondents attributing epilepsy to witchcraft or supernatural causes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Most people with epilepsy in the area were not receiving adequate biomedical care. The observed treatment gap was associated with multiple factors, including gaps in awareness, sociocultural misconceptions, and economic barriers, suggesting the need for targeted public health interventions to improve epilepsy care and management.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0355854","type":"journal-article","created":{"date-parts":[[2026,8,11]],"date-time":"2026-08-11T17:30:50Z","timestamp":1786469450000},"page":"e0355854","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Barriers to epilepsy care: Measuring the treatment gap in rural and peri-urban districts in Ghana"],"prefix":"10.1371","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-3260-4482","authenticated-orcid":true,"given":"Emmanuel Kwame","family":"Darkwa","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patrick","family":"Adjei","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sabina","family":"Asiamah","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elizabeth","family":"Awini","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cynthia","family":"Sottie","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7892-4495","authenticated-orcid":true,"given":"Anthony","family":"Godi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John E.","family":"Williams","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frank","family":"Atuguba","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fuseini","family":"Sataru","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander","family":"Adjei","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arjune","family":"Sen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charles R.","family":"Newton","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anthony","family":"Danso-Appiah","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J. Helen","family":"Cross","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Josemir W.","family":"Sander","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4802-9852","authenticated-orcid":true,"given":"Albert","family":"Akpalu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"on behalf of the EPInA investigators","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,8,11]]},"reference":[{"issue":"6","key":"pone.0355854.ref001","doi-asserted-by":"crossref","first-page":"962","DOI":"10.1111\/j.1528-1167.2012.03446.x","article-title":"Mapping the availability, price, and affordability of antiepileptic drugs in 46 countries","volume":"53","author":"A Cameron","year":"2012","journal-title":"Epilepsia"},{"issue":"4","key":"pone.0355854.ref002","doi-asserted-by":"crossref","first-page":"837","DOI":"10.1016\/j.ncl.2016.06.015","article-title":"The epidemiology of global epilepsy","volume":"34","author":"A Singh","year":"2016","journal-title":"Neurol Clin"},{"issue":"4","key":"pone.0355854.ref003","doi-asserted-by":"crossref","first-page":"1127","DOI":"10.3171\/2018.3.JNS171722","article-title":"An estimation of global volume of surgically treatable epilepsy based on a systematic review and meta-analysis of epilepsy","volume":"130","author":"KA Vaughan","year":"2018","journal-title":"J Neurosurg"},{"key":"pone.0355854.ref004","volume-title":"Epilepsy in Adults","author":"F Facts","year":"2023"},{"issue":"1","key":"pone.0355854.ref005","doi-asserted-by":"crossref","first-page":"136","DOI":"10.1046\/j.1528-1157.2001.32800.x","article-title":"The treatment gap in epilepsy: the current situation and ways forward","volume":"42","author":"H Meinardi","year":"2001","journal-title":"Epilepsia"},{"key":"pone.0355854.ref006","volume-title":"WHO information kit on epilepsy: What you can do","author":"WH World Health Organization","year":"2015"},{"issue":"9","key":"pone.0355854.ref007","doi-asserted-by":"crossref","first-page":"1491","DOI":"10.1111\/j.1528-1167.2008.01693.x","article-title":"The epilepsy treatment gap in developing countries: a systematic review of the magnitude, causes, and intervention strategies","volume":"49","author":"CK Mbuba","year":"2008","journal-title":"Epilepsia"},{"issue":"4","key":"pone.0355854.ref008","doi-asserted-by":"crossref","first-page":"260","DOI":"10.2471\/BLT.09.064147","article-title":"Global disparities in the epilepsy treatment gap: a systematic review","volume":"88","author":"A-C Meyer","year":"2010","journal-title":"Bull World Health Organ"},{"issue":"9848","key":"pone.0355854.ref009","doi-asserted-by":"crossref","first-page":"1193","DOI":"10.1016\/S0140-6736(12)61381-6","article-title":"Epilepsy in poor regions of the world","volume":"380","author":"CR Newton","year":"2012","journal-title":"Lancet"},{"issue":"4","key":"pone.0355854.ref010","doi-asserted-by":"crossref","first-page":"475","DOI":"10.1111\/epi.12550","article-title":"ILAE official report: a practical clinical definition of epilepsy","volume":"55","author":"RS Fisher","year":"2014","journal-title":"Epilepsia"},{"key":"pone.0355854.ref011","doi-asserted-by":"crossref","first-page":"283","DOI":"10.1016\/j.yebeh.2014.06.013","article-title":"Social determinants of health in epilepsy","volume":"41","author":"M Szaflarski","year":"2014","journal-title":"Epilepsy Behav"},{"issue":"3","key":"pone.0355854.ref012","article-title":"Epilepsy in Ghana: challenges, possibilities, future directions","volume":"9","author":"R Klevor","year":"2020","journal-title":"African & Middle East Epilepsy Journal"},{"key":"pone.0355854.ref013","unstructured":"Siriba RM. The experiences of people living with epilepsy in Nzhelele, Limpopo Province. 2014."},{"key":"pone.0355854.ref014","doi-asserted-by":"crossref","first-page":"1230336","DOI":"10.3389\/fneur.2023.1230336","article-title":"Perceived causes and management of epilepsy among rural community dwellers in Ghana: a qualitative synthesis","volume":"14","author":"D Gyaase","year":"2023","journal-title":"Front Neurol"},{"key":"pone.0355854.ref015","first-page":"29","article-title":"Prevalence and risk factors for Active Convulsive Epilepsy in Kintampo, Ghana","volume":"21","author":"KA Ae-Ngibise","year":"2015","journal-title":"Pan Afr Med J"},{"issue":"9","key":"pone.0355854.ref016","doi-asserted-by":"crossref","first-page":"4529","DOI":"10.1007\/s10072-024-07456-1","article-title":"Gaps in treatment of epileptic seizures in a Zambian rural area","volume":"45","author":"R Mambo","year":"2024","journal-title":"Neurol Sci"},{"issue":"1","key":"pone.0355854.ref017","first-page":"22","article-title":"Factors associated with treatment gap in children and adolescents with epilepsy in a rural Nigerian community","volume":"41","author":"E Eseigbe","year":"2013","journal-title":"Nig J Paed"},{"issue":"1","key":"pone.0355854.ref018","doi-asserted-by":"crossref","first-page":"131","DOI":"10.1186\/s12936-023-04561-y","article-title":"Prevalence, trends and associated factors of malaria in the Shai-Osudoku District Hospital, Ghana","volume":"22","author":"JA Tetteh","year":"2023","journal-title":"Malar J"},{"issue":"6","key":"pone.0355854.ref019","doi-asserted-by":"crossref","first-page":"1686","DOI":"10.1093\/ije\/dyt197","article-title":"Profile: the Dodowa HDSS","volume":"42","author":"M Gyapong","year":"2013","journal-title":"Int J Epidemiol"},{"key":"pone.0355854.ref020","doi-asserted-by":"crossref","first-page":"25543","DOI":"10.3402\/gha.v7.25543","article-title":"Estimating cause of adult (15+ years) death using InterVA-4 in a rural district of southern Ghana","volume":"7","author":"E Awini","year":"2014","journal-title":"Glob Health Action"},{"issue":"1","key":"pone.0355854.ref021","doi-asserted-by":"crossref","first-page":"160","DOI":"10.1186\/s12884-016-0956-2","article-title":"Socioeconomic and demographic determinants of birth weight in southern rural Ghana: evidence from Dodowa Health and Demographic Surveillance System","volume":"16","author":"AK Manyeh","year":"2016","journal-title":"BMC Pregnancy Childbirth"},{"key":"pone.0355854.ref022","article-title":"The prevalence and determinants of epilepsy in Ghana: a population-based study in two districts using a three-stage approach","author":"EK Darkwa","year":"2026","journal-title":"Epilepsia"},{"issue":"1","key":"pone.0355854.ref023","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0303735","article-title":"Translation, adaptation and validation of an epilepsy screening instrument in two Ghanaian languages","volume":"20","author":"EK Darkwa","year":"2025","journal-title":"PLoS One"},{"issue":"6","key":"pone.0355854.ref024","doi-asserted-by":"crossref","first-page":"48","DOI":"10.1007\/s11910-017-0758-6","article-title":"The new classification of seizures by the international league against epilepsy 2017","volume":"17","author":"RS Fisher","year":"2017","journal-title":"Curr Neurol Neurosci Rep"},{"issue":"3","key":"pone.0355854.ref025","doi-asserted-by":"crossref","first-page":"253","DOI":"10.1016\/S1474-4422(13)70003-6","article-title":"Prevalence of active convulsive epilepsy in sub-Saharan Africa and associated risk factors: cross-sectional and case-control studies","volume":"12","author":"AK Ngugi","year":"2013","journal-title":"Lancet Neurol"},{"issue":"8","key":"pone.0355854.ref026","doi-asserted-by":"crossref","first-page":"688","DOI":"10.1016\/S1474-4422(12)70155-2","article-title":"Risk factors associated with the epilepsy treatment gap in Kilifi, Kenya: a cross-sectional study","volume":"11","author":"CK Mbuba","year":"2012","journal-title":"Lancet Neurol"},{"issue":"4","key":"pone.0355854.ref027","doi-asserted-by":"crossref","first-page":"527","DOI":"10.4103\/1119-3077.151789","article-title":"Epidemiology of active epilepsy in a suburban community in Southeast Nigeria: a door-to-door survey","volume":"18","author":"PO Nwani","year":"2015","journal-title":"Niger J Clin Pract"},{"issue":"2","key":"pone.0355854.ref028","doi-asserted-by":"crossref","first-page":"188","DOI":"10.1002\/epi4.12048","article-title":"Adverse perinatal events, treatment gap, and positive family history linked to the high burden of active convulsive epilepsy in Uganda: a population-based study","volume":"2","author":"A Kakooza-Mwesige","year":"2017","journal-title":"Epilepsia Open"},{"key":"pone.0355854.ref029","doi-asserted-by":"crossref","first-page":"976039","DOI":"10.3389\/fepid.2022.976039","article-title":"Treatment gaps in epilepsy","volume":"2","author":"J Pellinen","year":"2022","journal-title":"Front Epidemiol"},{"key":"pone.0355854.ref030","volume-title":"Mental health gap action programme (mhGAP) guideline for mental, neurological and substance use disorders","author":"WH Organization","year":"2023"},{"key":"pone.0355854.ref031","volume-title":"Intersectoral global action plan on epilepsy and other neurological disorders 2022\u20132031","author":"WH Organization","year":"2023"},{"key":"pone.0355854.ref032","article-title":"Epilepsy prevalence, treatment gap, and stigma in western Kenya (I14. 008)","volume":"86","author":"D Sokhi","year":"2016","journal-title":"Neurology"}],"container-title":["PLOS One"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0355854","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,11]],"date-time":"2026-08-11T17:30:59Z","timestamp":1786469459000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0355854"}},"subtitle":[],"editor":[{"given":"Hiroki","family":"Annaka","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2026,8,11]]},"references-count":32,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2026,8,11]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0355854","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,11]]}}}