TY - JOUR
T1 - Adverse perinatal events, treatment gap, and positive family history linked to the high burden of active convulsive epilepsy in Uganda
T2 - A population-based study
AU - the SEEDS Writing Group
AU - Kakooza-Mwesige, Angelina
AU - Ndyomugyenyi, Donald
AU - Pariyo, George
AU - Peterson, Stefan Swartling
AU - Waiswa, Paul Michael
AU - Galiwango, Edward
AU - Chengo, Eddie
AU - Odhiambo, Rachael
AU - Ssewanyana, Derrick
AU - Bottomley, Christian
AU - Ngugi, Anthony K.
AU - Newton, Charles R.J.C.
AU - Wagner, Ryan
AU - Twine, Rhian
AU - Connor, Myles
AU - Gómez-Olivé, F. Xavier
AU - Collinson, Mark
AU - Kahn, Kathleen
AU - Tollman, Stephen
AU - Masanja, Honorati
AU - Mathew, Alexander
AU - Chabi, Martin
AU - Bauni, Evasius
AU - Kamuyu, Gathoni
AU - Odera, Victor Mung ala
AU - Mageto, James O.
AU - Ae-Ngibise, Ken
AU - Akpalu, Bright
AU - Akpalu, Albert
AU - Agbokey, Francis
AU - Adjei, Patrick
AU - Owusu-Agyei, Seth
AU - Kleinschmidt, Immo
AU - Doku, Victor C.K.
AU - Odermatt, e. Peter
AU - Neville, Brian
AU - Sander, Josemir W.
AU - White, Stev
AU - Nutman, Thomas
AU - Wilkins, Patricia
AU - Noh, John
N1 - Funding Information:
This research was funded through a Wellcome Trust Senior Fellowship in Clinical Tropical Medicine (number 083744) to CRJCN. AKM was supported through the DELTAS Africa Initiative grant # DEL-15-011 to THRiVE-2. The DELTAS Africa Initiative is a funding scheme of the Accelerating Excellence in Science in Africa (AESA) with funding from the Wellcome Trust grant # 107742/Z/15/Z and the UK government. The authors wish to thank the study participants, epilepsy fieldworkers involved in the Studies of Epidemiology of Epilepsy in Demographic Surveillance Systems (SEEDS) study, clinical staff of Iganga regional referral hospital, the INDEPTH Network Secretariat for enabling and supporting this work, staff of Iganga/Mayuge Demographic Surveillance Site, the Iganga and Mayuge district administration, Ministry of Health Uganda, and Ms. Rachael Odhiambo for developing and overseeing the study's database.
Funding Information:
This research was funded through a Wellcome Trust Senior Fellowship in Clinical Tropical Medicine (number 083744) to CRJCN. AKM was supported through the DELTAS Africa Initiative grant # DEL‐15‐011 to THRiVE‐2. The DELTAS Africa Initiative is a funding scheme of the Accelerating Excellence in Science in Africa (AESA) with funding from the Wellcome Trust grant # 107742/Z/15/Z and the UK government. The authors wish to thank the study participants, epilepsy fieldworkers involved in the Studies of Epidemiology of Epilepsy in Demographic Surveillance Systems (SEEDS) study, clinical staff of Iganga regional referral hospital, the INDEPTH Network Secretariat for enabling and supporting this work, staff of Iganga/Mayuge Demographic Surveillance Site, the Iganga and Mayuge district administration, Ministry of Health Uganda, and Ms. Rachael Odhiambo for developing and overseeing the study's database.
Publisher Copyright:
© 2017 The Authors. Epilepsia Open published by Wiley Periodicals Inc. on behalf of International League Against Epilepsy.
PY - 2017/6/1
Y1 - 2017/6/1
N2 - Objective: To determine the prevalence of active convulsive epilepsy (ACE) and describe the clinical characteristics and associated factors among a rural Ugandan population. Methods: The entire population in Iganga/Mayuge Health Demographic Surveillance Site (IM-HDSS) was screened using two questions about seizures during a door-to-door census exercise. Those who screened positive were assessed by a clinician to confirm diagnosis of epilepsy. A case control study with the patients diagnosed with ACE as the cases and age/sex-matched controls in a ratio of 1:1 was conducted. Results: A total of 64,172 (92.8%) IM-HDSS residents, with a median age of 15.0 years (interquartile range [IQR]: 8.0–29.0), were screened for epilepsy. There were 152 confirmed ACE cases, with a prevalence of 10.3/1,000 (95% confidence interval [CI]: 9.5–11.1) adjusted for nonresponse and screening sensitivity. Prevalence declined with age, with the highest prevalence in the 0–5 years age group. In an analysis of n = 241 that included cases not identified in the survey, nearly 70% were unaware of their diagnosis. Seizures were mostly of focal onset in 193 (80%), with poor electroencephalogram (EEG) agreement with seizure semiology. Antiepileptic drug use was rare, noted in 21.2% (95% CI: 16.5–25.8), and 119 (49.3%) reported using traditional medicines. History of an abnormal antenatal period (adjusted odds ratio [aOR] 10.28; 95%CI 1.26–83.45; p = 0.029) and difficulties in feeding, crying, breathing in the perinatal period (aOR 10.07; 95%CI 1.24–81.97; p = 0.031) were associated with ACE in children. In adults a family history of epilepsy (aOR 4.38 95%CI 1.77–10.81; p = 0.001) was the only factor associated with ACE. Significance: There is a considerable burden of epilepsy, low awareness, and a large treatment gap in this population of rural sub-Saharan Africa. The identification of adverse perinatal events as a risk factor for developing epilepsy in children suggests that epilepsy burden may be decreased by improving obstetric and postnatal care.
AB - Objective: To determine the prevalence of active convulsive epilepsy (ACE) and describe the clinical characteristics and associated factors among a rural Ugandan population. Methods: The entire population in Iganga/Mayuge Health Demographic Surveillance Site (IM-HDSS) was screened using two questions about seizures during a door-to-door census exercise. Those who screened positive were assessed by a clinician to confirm diagnosis of epilepsy. A case control study with the patients diagnosed with ACE as the cases and age/sex-matched controls in a ratio of 1:1 was conducted. Results: A total of 64,172 (92.8%) IM-HDSS residents, with a median age of 15.0 years (interquartile range [IQR]: 8.0–29.0), were screened for epilepsy. There were 152 confirmed ACE cases, with a prevalence of 10.3/1,000 (95% confidence interval [CI]: 9.5–11.1) adjusted for nonresponse and screening sensitivity. Prevalence declined with age, with the highest prevalence in the 0–5 years age group. In an analysis of n = 241 that included cases not identified in the survey, nearly 70% were unaware of their diagnosis. Seizures were mostly of focal onset in 193 (80%), with poor electroencephalogram (EEG) agreement with seizure semiology. Antiepileptic drug use was rare, noted in 21.2% (95% CI: 16.5–25.8), and 119 (49.3%) reported using traditional medicines. History of an abnormal antenatal period (adjusted odds ratio [aOR] 10.28; 95%CI 1.26–83.45; p = 0.029) and difficulties in feeding, crying, breathing in the perinatal period (aOR 10.07; 95%CI 1.24–81.97; p = 0.031) were associated with ACE in children. In adults a family history of epilepsy (aOR 4.38 95%CI 1.77–10.81; p = 0.001) was the only factor associated with ACE. Significance: There is a considerable burden of epilepsy, low awareness, and a large treatment gap in this population of rural sub-Saharan Africa. The identification of adverse perinatal events as a risk factor for developing epilepsy in children suggests that epilepsy burden may be decreased by improving obstetric and postnatal care.
KW - Adverse perinatal events
KW - Population study of epilepsy
KW - Risk factors
KW - Treatment gap
KW - Uganda
UR - http://www.scopus.com/inward/record.url?scp=85071002900&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85071002900&partnerID=8YFLogxK
U2 - 10.1002/epi4.12048
DO - 10.1002/epi4.12048
M3 - Article
AN - SCOPUS:85071002900
SN - 2470-9239
VL - 2
SP - 188
EP - 198
JO - Epilepsia Open
JF - Epilepsia Open
IS - 2
ER -