Comparing characteristics of epilepsy treatment providers on the Kenyan coast: implications for treatment-seeking and intervention

Introduction: Existing studies have identified demographic and resource-related barriers to treatment-seeking and have focused on treatment seekers in exploring and modeling decision-making. While the treatment-seeking literature acknowledges the role of the characteristics of treatment providers, few studies have adopted an explicit focus on these determinants, nor have they approached the study of treatment-seeking with an in-depth ethnographic focus on the providers themselves. The following article analyzes the structural aspects of treatment provision as one influence on how families in Kilifi, Kenya seek care for a child with chronic epilepsy. While not a comprehensive decision model, the study examines the ways in which treatment-seeking may be facilitated or deterred by the characteristics of available treatment options. Methods: Ethnographic methods were applied, including interviews, participant observations and surveys, to examine factors that may affect the choice of families on the coast of Kenya between traditional healing and biomedical care for epilepsy. Results: Traditional healers were found to have a profound influence in the treatment of epilepsy in Kilifi. Their treatments differ from those available at health facilities in the following key dimensions: explanations of causation, communication styles, social roles, referral practices, location and systems of payment. Conclusions: The article identified key differences between biomedical and traditional treatments that may help to explain the existence of the biomedical treatment gap in Kilifi. This study suggests that comparing data on treatment providers reveals barriers to obtaining biomedical care, thereby offering an important tool in intervention design research.