Evaluation of Adherence to a Convulsion management Protocol for Children in Rwanda

Inappropriate seizure management may result in high morbidity and mortality. We assessed the adherence
of health professionals in southern Rwanda to a national protocol for pharmacological management
of seizures in children. A questionnaire featuring a 5-year-old child with generalized prolonged seizures
was administered. The questions focused on the choice of initial treatment and the sequence of management
following failure of the initial treatment choice. Benzodiazepine was chosen as initial therapy by
93.7% of physicians and 90.9% of nurses. Only 49.2% of physicians and 41% of nurses would repeat the
initial treatment in case of failure of the first dose and 47% of doctors would wait 30 min to intervene. In
case of refractory status epilepticus, 34% of physicians would give three doses of benzodiazepine, whereas
19% did not know what to do. These results suggest poor adherence to national protocol.