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. 2017 Mar 13;2(2):188-198.
doi: 10.1002/epi4.12048. eCollection 2017 Jun.

Adverse perinatal events, treatment gap, and positive family history linked to the high burden of active convulsive epilepsy in Uganda: A population-based study

Angelina Kakooza-Mwesige  1   2   3 , Donald Ndyomugyenyi  1 , George Pariyo  4 , Stefan Swartling Peterson  5   6   7 , Paul Michael Waiswa  1 , Edward Galiwango  1 , Eddie Chengo  8 , Rachael Odhiambo  8 , Derrick Ssewanyana  8 , Christian Bottomley  9 , Anthony K Ngugi  10 , Charles R J C Newton  8   11   12   13 ; SEEDS Writing Group
Collaborators, Affiliations

Adverse perinatal events, treatment gap, and positive family history linked to the high burden of active convulsive epilepsy in Uganda: A population-based study

Angelina Kakooza-Mwesige et al. Epilepsia Open. .

Abstract

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.

Keywords: Adverse perinatal events; Population study of epilepsy; Risk factors; Treatment gap; Uganda.

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Figures

Figure 1
Figure 1
Flow diagram showing selection of study participants and prevalence of active convulsive epilepsy in Iganga‐Mayuge HDSS. ACE‐ active convulsive epilepsy. #On the basis of estimates adjusted for attrition and sensitivity; p = 0.006.
Figure 2
Figure 2
Age‐specific prevalence of active convulsive epilepsy in Iganga‐Mayuge HDSS.
See this image and copyright information in PMC

References

    1. Ngugi AK, Bottomley C, Kleinschmidt I, et al. Estimation of the burden of active and life‐time epilepsy: a meta‐analytic approach. Epilepsia 2010;51:883–890. - PMC - PubMed
    1. World Health Organization . Neurological Disorders: public health challenges. Geneva: World Health Organization; 2006.
    1. World Health Organization . Epilepsy in the WHO African region: bridging the gap. Geneva: World Health Organization; 2004.
    1. Duggan MB. Epilepsy in rural Ugandan children: seizure pattern, age of onset and associated findings. Afr Health Sci 2010;10:218–225. - PMC - PubMed
    1. Sharper AG, Sharper L. Analysis of medical admissions to Mulago Hospital, 1957. East Afr Med J 1958;35:647. - PubMed