The functional status of people with epilepsy in rural sub-Saharan Africa

Abstract

Purpose: Little data is available regarding the impact of epilepsy on the functional status of people with epilepsy (PWE) in developing countries. In sub-Saharan Africa, limited medical services and social stigmatization subject PWE to substantial physical, psychological and social deprivation. To better delineate the overall burden and distribution of epilepsy-associated disability in sub-Saharan Africa, we assessed the functional status of PWE in a rural, population-based sample and made comparisons to published reports from urban Zimbabwe.

Methods: A population-based survey of PWE with epilepsy in rural Zambia utilizing WHO questionnaires.

Results: Among 86 PWE in 3 rural Zambian communities, 67% participated in the interviews. Only 62% of PWE were receiving treatment. Five to seven percent of rural PWE reported problems with basic hygiene and 9-14% were unable to fulfill work demands, attend social events or enjoy leisure activities. In contrast, 95% of urban PWE denied any problems with social functioning, work performance or relationships. Compared to the urban population, rural PWE had a greater seizure burden (2.3/month vs. 1/month, p=0.007) and reported more difficulties with activities of daily living, including problem solving (70% vs. 54%, p=0.02), speed of thinking (70% vs. 59%, p=0.02) and relationships with co-workers (68% vs. 26%, p< or =0.005).

Conclusions: A significant proportion of PWE in rural sub-Saharan Africa report problems fulfilling both social and professional functions. These results also suggest that rural PWE may have poorer functional status than their urban counterparts.