From Traditional Medicine to Physicians: Dynamics and Determinants of Healthcare- Seeking Behavior Following an Inaugural Epileptic Seizure in Mali

Background In sub-Saharan Africa, over 80% of the population relies on traditional medicine (TM) as their primary healthcare resource. Following our team's previous work establishing broad healthcare-seeking patterns, this study investigates the specific clinical window immediately following an inaugural epileptic seizure in Mali, analyzing the behavioral and socioeconomic determinants driving choices between TM and conventional medicine (CM). Methods We employed a prospective, sequential exploratory mixed methods design across two interconnected urban and rural referral facilities in Mali. Qualitative thematic findings informed the cultural adaptation of a structured quantitative questionnaire administered to 87 patients with confirmed epilepsy according to International League Against Epilepsy (ILAE) criteria. Predictors of primary physician utilization were isolated using univariable and multivariable logistic regression. Results The study population were young with a mean age of 20 (SD = 14) years. Following the inaugural seizure, primary consultations were evenly split between traditional practitioners (49.4%) and conventional physicians (48.3%). Conversely, secondary consultations marked a definitive therapeutic shift, with 100% returning patients transitioning to physicians. In the final multivariable model, male sex (Adjusted Odds Ratio [AOR] = 3.89, p = 0.03), primary education (AOR = 4.84, p = 0.03), and higher education (AOR = 33.47, p = 0.02) were robust predictors of primary physician utilization. Conversely, rural residency in Koulikoro (AOR = 0.13, p = 0.002) or Sikasso (AOR = 0.07, p = 0.04) significantly hindered formal healthcare access. Clinical follow-up indicated that 85.1% of patients achieved complete seizure freedom under conventional anti-seizure medications. Conclusion Traditional medicine remains a powerful primary resort following an inaugural seizure in Mali, driven by geographic barriers and socioeconomic determinants. Bridging the epilepsy treatment gap requires scaling universal health insurance, decentralizing care through community health workers, and formalizing collaborative triage networks with trained traditional healers.