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. 2019 Feb:79:187-194.
doi: 10.1016/j.ijid.2018.10.021.

High prevalence of epilepsy in an onchocerciasis endemic health zone in the Democratic Republic of the Congo, despite 14 years of community-directed treatment with ivermectin: A mixed-method assessment

Deby Mukendi  1 , Floribert Tepage  2 , Innocent Akonda  3 , Joseph Nelson Fodjo Siewe  4 , Anke Rotsaert  5 , Carl Nwana Ndibmun  6 , Anne Laudisoit  7 , Simon Couvreur  8 , Blandine Kabutako  9 , Sonia Menon  10 , An Hotterbeekx  11 , Robert Colebunders  12
Affiliations

High prevalence of epilepsy in an onchocerciasis endemic health zone in the Democratic Republic of the Congo, despite 14 years of community-directed treatment with ivermectin: A mixed-method assessment

Deby Mukendi et al. Int J Infect Dis. 2019 Feb.

Abstract

Objectives: To investigate the reasons for the high prevalence of epilepsy (>6%) discovered in 2015 in the Aketi health zone in the north of the Democratic Republic of the Congo.

Methods: Persons with epilepsy (PWE) diagnosed in a door-to-door survey in 2015 were traced and re-examined in 2017 by a neurologist. Confirmed PWE were paired with matched controls. For onchocerciasis assessment, children 7-10 years old were tested for IgG4 Onchocerca volvulus (OV16) antibodies, a rapid epidemiological mapping of onchocerciasis (REMO) study was performed, and ivermectin coverage was investigated.

Results: Forty-three (61.4%) previously diagnosed PWE were traced; the neurologist confirmed the epilepsy diagnosis in all of them. The overall OV16 positivity rate was 64.5%. Poor ivermectin coverage (55.9%) and a high prevalence of onchocercal nodules (>70%) were observed. The prevalence of epilepsy was 5.7% in Aketi rural town, with nine PWE (13.8%) experiencing head nodding seizures. A case-control study showed that PWE had lower body weight and higher ivermectin coverage in 2017 than healthy controls.

Conclusions: The high prevalence of epilepsy in the Aketi health zone, despite 14 years of community-directed treatment with ivermectin (CDTI), was found to be associated with high onchocerciasis transmission and low ivermectin use. An awareness programme to increase ivermectin coverage and the introduction of a bi-annual CDTI programme should be considered.

Keywords: Case–control; Epilepsy; Focus group discussion; Incidence; Ivermectin; Onchocerciasis; Prevalence; Stigma.

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Figures

Figure 1
Figure 1
The Aketi health zone (in red) located in the province of Bas-Uélé (in yellow) in the Democratic Republic of the Congo.
Figure 2
Figure 2
The villages of Aketi, Makoko, and Wela, and the Itimbiri and Rubi rivers located in the Aketi health zone.
Figure 3
Figure 3
Numbers of persons with epilepsy with onset per age group.
See this image and copyright information in PMC

Comment in

References

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