© 1998 Oxford University Press
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Comparison of key informant and survey methods for ascertainment of childhood epilepsy in West Bengal, India
aNeurosciences Unit, Institute of Child Health, University College London, London WCIN 2AP and Child-in-Need Institute vill Daulutpur, 24 Pgs (S), West Bengal 743512
bSANCHAR-AROD. vill and P0 Pailan 24 Pgs (S). West Bengal 743512
Reprint requests: Dr DK Pal, Neurosciences Unit, Institute of Child Health, University College London Medical School, The Wolfson Centre, Mecklenburgh Square, London WCIN 2AP. UK
BACKGROUND: This study aimed to compare efficacy and cost of key informants and survey for ascertainment of childhood epilepsy within a treatment context in rural India.
METHODS: The study was set in a non-governmental, community programme for the functional and socioeconomic rehabilitation of children with disabilities in rural West Bengal, India. Ascertainment was by two methods: house-to-house survey of 15 000 households and also by 430 key informants including village leaders, health workers and 670 schoolchildren. Methods were compared for positive predictive value, and sensitivity by capture-recapture technique. Ninety four children were enrolled into treatment. Predictors of treatment success were determined by multiple logistic regression analysis, giving adjusted odds ratios for remission. The costs of identifying one case and one treatment success were measured by costing personnel, materials and overheads.
RESULTS: The survey was four times as sensitive as key informants although the positive predictive values were similar (36% 40%). The survey had an absolute sensitivity of only 59%. Identification by key informants strongly predicted successful treatment outcome (odds ratio [OR] 4.74, 95% confidence interval [CI] : 1.19–18.85). The cost of finding one case was US$11 and US$14, and of finding one successful treatment outcome US$35 and US$67 for informants and survey respectively. Key informants were essential in attaining longer term programme objectives.
CONCLUSIONS: In the context of a treatment programme, key informants were the more cost effective method, but community involvement was traded against low sensitivity in the short term. Overall ascertainment costs were significant in the context of primary health care in India.
Keywords Epilepsy, India, ascertainment, costs, key informant, children
Accepted 5 November 1997
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