A primary care‐led school‐centered model for epilepsy detection and care among children in India

OBJECTIVE: We evaluated whether a primary care-led, school-centered epilepsy detection model, delivered through India's national school health program, Rashtriya Bal Swasthya Karyakram (RBSK), could improve childhood epilepsy detection and the knowledge, attitudes, and practices (KAP) of teachers and primary healthcare providers. METHODS: A hybrid effectiveness-implementation study using the Medical Research Council framework was conducted in Faridkot district, Punjab, India. A multidisciplinary team co-designed a structured epilepsy education program (SEEP) delivered via a three-tier cascade training model, culminating in RBSK Mobile Health Teams training primary healthcare providers (PHCPs), Accredited Social Health Activists (ASHAs), and Anganwadi workers, and government school teachers. Epilepsy detection was compared between pre-intervention (2019-2020) and post-intervention (2022-2023) using RBSK Child Health Registers, with screen-positive children confirmed via EEG/MRI, acknowledging pandemic-related confounding. KAP was assessed using validated questionnaires pre- and post-training; focus group discussions and interviews explored feasibility and acceptability. RESULTS: The intervention reached 1994 teachers (82%) across 398 schools (96% coverage) and PHCPs (ASHAs 88% [399/454]; Anganwadi workers 86% [466/542]). Epilepsy detection rates more than doubled, from 56 to 129 per 100 000 screened children (RR 2.3; 95% CI 1.4-3.8). Against a district prevalence of 35.4 per 10 000, detection efficiency improved from 15.7% to 36.5%. Of 51 confirmed post-intervention cases, 42 (68% more than pre-intervention) were previously undiagnosed. On multivariable logistic regression, post-intervention children were more likely treatment-naive (adjusted OR 2.47; 95% CI 1.32-4.61), consistent with, not proof of, reaching previously missed cases. KAP improved significantly across all groups (p < 0.001). Across 21 qualitative sessions (63 participants), stakeholders endorsed acceptability, effectiveness, and scalability. SIGNIFICANCE: Embedding a structured epilepsy program within a national school health initiative was associated with improved epilepsy detection and care capacity in a low- and middle-income country, without added specialist resources. The approach is scalable, adaptable to resource-limited settings, and aligned with WHO's Intersectoral Global Action Plan on Epilepsy and Other Neurological Disorders (2022-2031), offering a promising model for narrowing the epilepsy treatment gap. PLAIN LANGUAGE SUMMARY: Many children with epilepsy in India go undiagnosed because they lack access to specialist care. We trained school teachers and community health workers through India's existing national school health program to recognize epilepsy, provide first aid, and refer children for treatment. After the program, twice as many children with epilepsy were identified compared to before, and teachers felt more confident managing epilepsy in the classroom. Because this model uses health workers and teachers who are already in place, it could be scaled up across India and adapted for other countries facing similar challenges.