Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2018 Dec:63:93-101.
doi: 10.1016/j.seizure.2018.11.004. Epub 2018 Nov 13.

High prevalence of onchocerciasis-associated epilepsy in villages in Maridi County, Republic of South Sudan: A community-based survey

Robert Colebunders  1 , Jane Y Carter  2 , Peter Claver Olore  3 , Kai Puok  4 , Samit Bhattacharyya  5 , Sonia Menon  6 , Gasim Abd-Elfarag  7 , Morrish Ojok  8 , Chellafe Ensoy-Musoro  9 , Richard Lako  10 , Makoy Yibi Logora  11
Affiliations

High prevalence of onchocerciasis-associated epilepsy in villages in Maridi County, Republic of South Sudan: A community-based survey

Robert Colebunders et al. Seizure. 2018 Dec.

Abstract

Purpose: To determine the prevalence and incidence of epilepsy in an onchocerciasis endemic region of South Sudan.

Methods: In May 2018, a door-to-door household survey was conducted in 8 study sites in an onchocerciasis endemic area in Maridi County.

Results: A total of 2511 households agreed to participate in the study, corresponding to 17,652 individuals. An epilepsy screening questionnaire identified 799 persons suspected to have epilepsy (4.5%); in 736 of the 766 persons (96.1%) seen by a clinical officer the diagnosis of epilepsy was confirmed. Adding 38 persons who were not seen but with a positive answer to a combination of screening questions, 774 persons (4.4%) had epilepsy. Epilepsy prevalence was highest in the 11-20 age group (10.5%); 66 persons with epilepsy (PWE) developed their first seizures in the year preceding the survey (annual incidence = 373.9/100.000). Neurocysticercosis cannot explain the high epilepsy prevalence since no pigs are kept in the area. Independent risk factors for epilepsy included male gender, belonging to a "permanent household" and a farming family, and living in a village bordering the Maridi River. Only 7209 (40.8%) of the population took ivermectin in 2017.

Conclusion: A very high prevalence and incidence of epilepsy was observed in several villages in Maridi County located close to the Maridi River and the Maridi dam. Urgent action is needed to prevent children in Maridi County from developing OAE by strengthening the onchocerciasis elimination program.

Keywords: Community directed treatment; Epilepsy; Incidence; Ivermectin; Maridi; Nodding syndrome; Onchocerciasis; Prevalence; South Sudan.

PubMed Disclaimer

Figures

Fig. 1
Fig. 1
South Sudan CDTi areas and distribution of onchocerciasis [2].
Fig. 2
Fig. 2
Map with the localisation of the selected study sites in the Maridi area.
Fig. 3
Fig. 3
Picture of the Maridi dam.
Fig. 4
Fig. 4
Geographic location of persons with a history of nodding seizures (in blue), persons with other forms of epilepsy (in yellow) and persons not confirmed to have epilepsy (in red) (For interpretation of the references to colour in this figure legend, the reader is referred to the web version of this article).
Fig. 5
Fig. 5
Age-specific epilepsy prevalence in each study sites.
Fig. 6
Fig. 6
Prevalence of epilepsy and distance of villages to the Maridi River.
Fig. 7
Fig. 7
Epilepsy prevalence in immigrant households according to their duration of stay in onchocerciasis endemic villages.
Fig. 8
Fig. 8
Number of persons with epilepsy reported to have died per year.
See this image and copyright information in PMC

References

    1. Noma M., Zouré H.G., Tekle A.H., Enyong P.A., Nwoke B.E., Remme a J.H. The geographic distribution of onchocerciasis in the 20 participating countries of the African Programme for Onchocerciasis Control: (1) priority areas for ivermectin treatment. Parasit Vectors. 2014;7(325):1–15. - PMC - PubMed
    1. Ministry of Health Republic of South Sudan . 2008. Neglected tropical diseases and their control in Southern Sudan. Situation analysis, intervention options, appraisal and gap analysis.https://www.malariaconsortium.org/userfiles/file/NTD%20Resources/ntds_so... 2018 pAJ. (Accessed 3 November 2018)
    1. Colebunders R., Nelson Siewe F.J., Hotterbeekx A. Onchocerciasis-associated epilepsy, an additional reason for strengthening onchocerciasis elimination programs. Trends Parasitol. 2017 - PubMed
    1. Pion S.D., Kaiser C., Boutros-Toni F., Cournil A., Taylor M.M., Meredith S.E. Epilepsy in onchocerciasis endemic areas: systematic review and meta-analysis of population-based surveys. PLoS Negl Trop Dis. 2009;3(6):e461. - PMC - PubMed
    1. Prischich F., De Rinaldis M., Bruno F., Egeo G., Santori C., Zappaterreno A. High prevalence of epilepsy in a village in the Littoral Province of Cameroon. Epilepsy Res. 2008;82(2-3):200–210. - PubMed

MeSH terms