Utilization and Therapeutic Choices after a First Seizure: A Mixed- Methods Analysis of Determinants in a Malian Cohort

Background The therapeutic pathway options of people living with epilepsy (PWE) in Sub-Saharan Africa (SSA), especially in Mali are influenced by sociocultural, anthropological, and economic factors. Our study aimed to analyze the determinants of healthcare-seeking behavior and therapeutic choices after an inaugural epileptic seizure. Methods We focused on analyzing the choice of care pathway after an inaugural epileptic seizure in an environment characterized by the coexistence of conventional medicine (CM) and traditional medicine (TM). We hypothesized that a mixed approach, combining classical biomedical methods (qualitative and quantitative) with constructivist approaches, would allow for a deeper understanding of the issue. This study was conducted in urban and rural referral centers for the management of PWE. Patients with clinically and EEG-confirmed epilepsy were consecutively enrolled in outpatient consultations at the two sites during the study period, and data were collected through direct and semi-structured interviews. Descriptive statistics and linear regressions were used to analyze the generated data. Results A total of 87 patients met the inclusion criteria and participated in the interviews (patients or caregivers). The mean age was 20 ± 14 years, and were predominantly men (50/87, 57%). Epilepsy was mainly symptomatic, linked to complications from abnormal childbirth, head trauma, stroke, and cerebral malaria. Following the inaugural seizure, patients consulted conventional healthcare facilities (48%), traditional practitioners (49%) and pastor (2%). The high cost of antiepileptic drugs in conventional medicine emerged as a limiting factor. The multivariate model showed that male sex and higher levels of education were associated with significantly more robust odds ratios for consulting a physician. Conversely, a greater distance from a healthcare facility was associated with a significantly lower likelihood of consulting a physician. Conclusion The diagnosis and treatment of epilepsy remain major public health challenges in sub-Saharan Africa, particularly in Mali. This study highlights the central role of traditional medicine as a primary therapeutic option following an inaugural seizure, often favored due to the high cost of medication and, significantly, the challenges surrounding the accessibility and availability of conventional healthcare facilities. In this context, the implementation of the Universal Health Insurance Plan (RAMU) is essential to mitigate the prohibitive cost of anti-seizure medications and ensure financial accessibility for the most vulnerable populations. Researchers and policymakers must implement innovative strategies aimed at: (1) improving access to healthcare facilities, especially in rural areas; (2) promoting collaboration between traditional and conventional medicines; and (3) developing information and education campaigns to foster positive behavioral changes. Our work represents an initial step toward adapting epilepsy care to local sociocultural and economic realities—a prerequisite for reducing the burden of this pathology in Mali and throughout sub-Saharan Africa.