Tribal ethnicity also identifies particularly vulnerable persons with epilepsy: A cross-sectional study from Central India

Background Large epilepsy treatment gaps persist in low- and middle-income countries, including India. Even within underserved communities, some persons with epilepsy (PWE) remain disproportionately more likely to be untreated. Identifying such particularly vulnerable persons with epilepsy (PVPWE) is essential for designing equitable, primary care–oriented interventions. Methods We conducted a cross-sectional study nested within an ongoing implementation research programme evaluating epilepsy care strengthening at the primary care level in rural Chhattisgarh, Central India. Six neurologist-led outreach epilepsy clinics were held between September 2023 and January 2025 in two rural blocks. Factors associated with treatment status were analysed using univariate comparisons and multivariate logistic regression. Results Of 534 PWE included, 324 (60.7%) were untreated at the time of clinic presentation. Untreated PWE were older, had a later age of epilepsy onset, and had lower household incomes. Tribal ethnicity was strongly associated with untreated epilepsy, with 70% of tribal PWE untreated compared to 53% of non-tribal PWE (p < 0.001). In multivariate analysis, tribal ethnicity remained independently associated with lower odds of being on treatment (adjusted OR 0.45; 95% CI 0.28–0.70). Conclusions Within high treatment-gap rural settings, tribal ethnicity identifies a subgroup of PWE who are particularly vulnerable to remaining untreated. Primary care–based epilepsy programmes should explicitly recognise and prioritise tribal PWE through targeted outreach, community engagement, and continuity-of-care strategies to reduce inequities in epilepsy treatment access.