Vol 7 No 1 (2026)

Epilepsy remains a major public health challenge in sub-Saharan Africa, where treatment options are often limited to older, low-cost enzyme-inducing antiseizure medications such as phenobarbital, carbamazepine, and phenytoin. Although these medications are essential for seizure control in resource-constrained settings, prolonged use may accelerate vitamin D metabolism and contribute to hypovitaminosis D, impaired bone mineralization, reduced bone mineral density, osteomalacia, and increased fracture risk. Despite these potential complications, vitamin D assessment is rarely integrated into epilepsy care in the region, and evidence regarding the burden of deficiency among people with epilepsy remains limited. This paper proposes a pragmatic framework for risk-based vitamin D supplementation in epilepsy care adapted to sub-Saharan African contexts. Given the limited availability and affordability of serum 25-hydroxyvitamin D testing, routine laboratory-guided screening is often not feasible. We therefore advocate for a clinically oriented risk-stratification approach prioritizing preventive supplementation among patients at highest risk of deficiency and skeletal complications. High-risk groups may include individuals receiving long-term enzyme-inducing antiseizure medications, children and adolescents, older adults, pregnant women, and patients with malnutrition, reduced sunlight exposure, or physical disability. The framework emphasizes integration of low-cost empirical vitamin D supplementation into routine epilepsy services, particularly at the primary-care level. It also highlights the need for context-adapted clinical algorithms, healthcare provider awareness, patient education, and implementation research to evaluate feasibility, safety, and cost-effectiveness in African settings. Integrating bone health into epilepsy management may represent a feasible and scalable strategy to reduce preventable morbidity and improve long-term outcomes among people living with epilepsy in sub-Saharan Africa.

Atopic dermatitis in children is a common presentation within the primary care setting. Atopic dermatitis has general symptoms, but presentation may vary among individuals. A systematic approach of treatment for atopic dermatitis is explored- topical emollients, corticosteroids and calcineurin inhibitors, as well as phototherapy, immunosuppression and immunotherapy. Owing to limited dermatological experience and condition-specific expertise, primary care doctors are reluctant to use specific treatments, particularly when it comes to children. The first stage of atopic dermatitis management is its diagnosis. Following this, comes treatment. Recognising and having familiarity with the condition in both these aspects is essential. It is a lifelong condition, hence optimising its management should be a priority. All recommended treatments show great efficacy when it comes to management. Knowing when to use what treatment, depending on circumstance and severity is essential for improving its overall prognosis. An area with growing research in particular is the use of immunotherapy for its management, with studies proving its significant improvements on patient outcomes.