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Biset G, Abebaw N, Gebeyehu NA, Estifanos N, Birrie E, Tegegne KD. Prevalence, incidence, and trends of epilepsy among children and adolescents in Africa: a systematic review and meta-analysis. BMC Public Health 2024; 24:771. [PMID: 38475724 PMCID: PMC10935902 DOI: 10.1186/s12889-024-18236-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 02/29/2024] [Indexed: 03/14/2024] Open
Abstract
BACKGROUND Epilepsy contributes to a significant disease burden in children and adolescents worldwide. The incidence of childhood epilepsy is threefold higher in low and middle income countries compared in high-income countries. Epilepsy is a serious neurological condition associated with stigma and discrimination, an impaired quality of life, and other mental health related problems. OBJECTIVE This study is aimed to synthesize existing evidence and estimate the pooled prevalence and incidence of epilepsy in children and adolescents in Africa. METHODS A comprehensive and systematic search of relevant databases was conducted. The quality of each study was assessed using the Newcastle-Ottawa Quality Assessment Scale adapted for meta-analysis. Two reviewers screened retrieved articles, conducted critical appraisals, and extracted the data. Heterogeneity between studies was assessed by visual inspection of forest plots and statistically using Cochran's Q statistics and the I2 test. Publication bias was checked by visual inspection of funnel plots as well as statistically using Egger's correlation and Begg's regression tests. Finally, the pooled prevalence and incidence of childhood epilepsy were computed with 95% confidence intervals. RESULT In this review and meta-analysis 42 studies with 56 findings were included to compute the pooled prevalence of childhood epilepsy. On the other hand, 6 studies were included to estimate the combined incidence. The pooled prevalence of cumulative epilepsy was 17.3 per 1000 children. Whereas the pooled prevalence of active and lifetime epilepsy was 6.8 and 18.6 per 1000 children respectively. The pooled incidence of childhood epilepsy was 2.5 per 1000 children. CONCLUSION Nearly 1 in 50 children are suffering from epilepsy in Africa. However, little attention has been paid to the prevention and treatment of childhood epilepsy. Mass epilepsy screening, scaling up treatment coverage, and designing strict treatment follow up and monitoring mechanisms are recommended.
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Affiliation(s)
- Gebeyaw Biset
- Department of Pediatrics and Child Health Nursing, School of Nursing and Midwifery, College of Medicine and Health Sciences, Wollo University, Dessie, P.O.BOX: 1145, Ethiopia.
| | - Nigusie Abebaw
- Department of Midwifery, School of Nursing and Midwifery, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Natnael Atnafu Gebeyehu
- School of Midwifery, College of Health Sciences and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| | - Natan Estifanos
- Department of Nursing, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Endalk Birrie
- Department of Pediatrics and Child Health Nursing, School of Nursing and Midwifery, College of Medicine and Health Sciences, Wollo University, Dessie, P.O.BOX: 1145, Ethiopia
| | - Kirubel Dagnaw Tegegne
- Department of Nursing, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
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Odhiambo M, Kariuki SM, Newton CR. Therapeutic monitoring of anti-seizure medications in low- and middle-income countries: a systematic review. Wellcome Open Res 2024; 6:92. [PMID: 37457427 PMCID: PMC10349269 DOI: 10.12688/wellcomeopenres.16749.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/19/2024] [Indexed: 07/18/2023] Open
Abstract
Background The treatment gap for epilepsy is large in low- and middle-income countries (LMICs) and the effectiveness and safety of the available anti-seizure medication (ASMs) is not fully understood. We systematically reviewed available evidence on therapeutic drug monitoring (TDM) of ASM in LMIC. Methods We searched four main databases (PubMed, Psych-Info, CINAHL and Embase) up to 31 st December 2020, with eligible articles screened using a PRISMA checklist and a set of exclusion and inclusion criteria. Full texts were examined to evaluate the extent and practice of TDM in LMICs. Analyses were performed using Stata 13 and descriptive statistics were used to pool median distribution of TDM across studies. Results Of the 6,309 articles identified in the initial search, 65 (1.0%) met the eligibility criteria. TDM of ASMs was mostly done to assess toxicity (42.8%), but rarely to monitor adherence (9.0%). TDM differed by economic status and infrastructural status with majority of the studies coming from Europe (53.8%) and upper-middle-income countries (87.6%). First generation ASMs (82.3%) were more likely to be monitored than second generation ASMs (17.6%) and carbamazepine was the most frequently monitored drug. Fluorescence Polarization Immunoassay (FPIA) was the most common technique used for TDM (41.5%) followed by High-Performance Liquid Chromatography (HPLC) (16.9%). In addition, FPIA was the cheapest method of TDM based on approximated costs ($1000, TDx system). Assay validation and quality control were reported variably, and reference ranges used during TDM of ASMs were relatively uniform. Conclusions TDM is mostly done to evaluate ASM toxicity, but rarely for other reasons such as evaluating adherence or assessing clinical efficacy. There is a need for more investment in comprehensive and targeted TDM in LMICs when initiating treatment, switching therapies, adding or removing ASM and evaluating treatment response and safety of both first generation and second generation ASMs.
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Affiliation(s)
- Mercy Odhiambo
- Neurosciences Unit, KEMRI Wellcome Trust Research Programme, KILIFI, 80108, Kenya
- Department of Public Health, School of Human and Health Sciences, Pwani University, Kilifi, 80108, Kenya
| | - Symon M. Kariuki
- Neurosciences Unit, KEMRI Wellcome Trust Research Programme, KILIFI, 80108, Kenya
- Department of Public Health, School of Human and Health Sciences, Pwani University, Kilifi, 80108, Kenya
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Charles R. Newton
- Neurosciences Unit, KEMRI Wellcome Trust Research Programme, KILIFI, 80108, Kenya
- Department of Public Health, School of Human and Health Sciences, Pwani University, Kilifi, 80108, Kenya
- Department of Psychiatry, University of Oxford, Oxford, UK
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Kariuki SM, Wagner RG, Gunny R, D'Arco F, Kombe M, Ngugi AK, White S, Odhiambo R, Cross JH, Sander JW, Newton CRJC. Magnetic resonance imaging findings in Kenyans and South Africans with active convulsive epilepsy: An observational study. Epilepsia 2024; 65:165-176. [PMID: 37964464 DOI: 10.1111/epi.17829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Revised: 11/10/2023] [Accepted: 11/10/2023] [Indexed: 11/16/2023]
Abstract
OBJECTIVE Focal epilepsy is common in low- and middle-income countries. The frequency and nature of possible underlying structural brain abnormalities have, however, not been fully assessed. METHODS We evaluated the possible structural causes of epilepsy in 331 people with epilepsy (240 from Kenya and 91 from South Africa) identified from community surveys of active convulsive epilepsy. Magnetic resonance imaging (MRI) scans were acquired on 1.5-Tesla scanners to determine the frequency and nature of any underlying lesions. We estimated the prevalence of these abnormalities using Bayesian priors (from an earlier pilot study) and observed data (from this study). We used a mixed-effect modified Poisson regression approach with the site as a random effect to determine the clinical features associated with neuropathology. RESULTS MRI abnormalities were found in 140 of 240 (modeled prevalence = 59%, 95% confidence interval [CI]: 53%-64%) of people with epilepsy in Kenya, and in 62 of 91 (modeled prevalence = 65%, 95% CI: 57%-73%) in South Africa, with a pooled modeled prevalence of 61% (95% CI: 56%-66%). Abnormalities were common in those with a history of adverse perinatal events (15/23 [65%, 95% CI: 43%-84%]), exposure to parasitic infections (83/120 [69%, 95% CI: 60%-77%]) and focal electroencephalographic features (97/142 [68%, 95% CI: 60%-76%]), but less frequent in individuals with generalized electroencephalographic features (44/99 [44%, 95% CI: 34%-55%]). Most abnormalities were potentially epileptogenic (167/202, 82%), of which mesial temporal sclerosis (43%) and gliosis (34%) were the most frequent. Abnormalities were associated with co-occurrence of generalized non-convulsive seizures (relative risk [RR] = 1.12, 95% CI: 1.04-1.25), lack of family history of seizures (RR = 0.91, 0.86-0.96), convulsive status epilepticus (RR = 1.14, 1.08-1.21), frequent seizures (RR = 1.12, 1.04-1.20), and reported use of anti-seizure medication (RR = 1.22, 1.18-1.26). SIGNIFICANCE MRI identified pathologies are common in people with epilepsy in Kenya and South Africa. Mesial temporal sclerosis, the most common abnormality, may be amenable to surgical correction. MRI may have a diagnostic value in rural Africa, but future longitudinal studies should examine the prognostic role.
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Affiliation(s)
- Symon M Kariuki
- Neurosciences Unit, KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Ryan G Wagner
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Roxana Gunny
- Department of Neuroradiology, Great Ormond Street Hospital, London, UK
| | - Felice D'Arco
- Department of Neuroradiology, Great Ormond Street Hospital, London, UK
| | - Martha Kombe
- Neurosciences Unit, KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Anthony K Ngugi
- Department of Population Health, Medical College, Aga Khan University of East Africa, Nairobi, Kenya
| | | | - Rachael Odhiambo
- Department of Population Health, Medical College, Aga Khan University of East Africa, Nairobi, Kenya
| | - J Helen Cross
- Developmental Neurosciences, UCL, NIHR BRC Great Ormond Street Institute of Child Health, London, UK
| | - Josemir W Sander
- Department of Clinical & Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, UK
- Chalfont Centre for Epilepsy, Chalfont St Peter, UK
- Stichting Epilepsie Instellingen Nederland (SEIN), Heemstede, The Netherlands
- Department of Neurology, West China Hospital, Chengdu, China
- Institute of Brain Science & Brain-Inspired Technology, Sichuan University, Chengdu, China
| | - Charles R J C Newton
- Neurosciences Unit, KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
- Department of Psychiatry, University of Oxford, Oxford, UK
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Siewe Fodjo JN, Van Cutsem G, Amaral LJ, Colebunders R. Mortality among persons with epilepsy in onchocerciasis-endemic and non-endemic areas of sub-Saharan Africa: A systematic review and meta-analysis. Seizure 2023; 110:253-261. [PMID: 37451075 DOI: 10.1016/j.seizure.2023.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Revised: 07/03/2023] [Accepted: 07/10/2023] [Indexed: 07/18/2023] Open
Abstract
PURPOSE To document epilepsy-related mortality in sub-Saharan Africa (SSA) and investigate possible associations with onchocerciasis endemicity. METHODS Systematic review with meta-analysis. Searches were performed in PubMed and Google Scholar (search terms: 'epilepsy'; 'mortality/death'; 'sub-Saharan Africa'). Included studies were classified as high-risk or low-risk for onchocerciasis based on documented endemicity data. Pooled mortality rates and annual case fatality rates (CFR) were calculated, and risk factors for mortality among persons with epilepsy (PWE) were investigated using meta-regression analysis. RESULTS The 28 eligible studies reported 30 epilepsy surveys, of which 9 (30.0%) were conducted in onchocerciasis high-risk sites. The pooled epilepsy mortality rate was 20.9 (95% CI: 5.9-74.4) per 100,000 person-years, and the pooled CFR was 36.2 (95% CI: 23.9-54.4) per 1,000 PWE per year, albeit with substantial between-study heterogeneity. Compared to onchocerciasis low-risk sites, high-risk sites had higher pooled mortality (342.9 versus 10.0 per 100,000 PY; p<0.001) and CFR (57.0 versus 26.6 per 1,000 PWE per year; p = 0.001). Mortality of PWE was almost five-fold that of people without epilepsy (mortality risk ratio: 4.9; 95% CI: 3.5-6.8). Studies in onchocerciasis high-risk sites and the study which recruited only PWE with nodding syndrome were associated with higher CFR (p = 0.044 and p = 0.002, respectively). The leading causes of epilepsy-related death were status epilepticus (58.5%), drowning (15.7%), and sudden unexpected death in epilepsy (10.1%). CONCLUSION Epilepsy mortality remains high in SSA. Most reported causes of death among PWE might be averted by improving seizure control. Better epilepsy prevention and care are urgently needed, particularly in onchocerciasis-endemic settings.
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Affiliation(s)
| | - Gilles Van Cutsem
- Global Health Institute, University of Antwerp, Belgium; Translational Neurosciences, University of Luxembourg, Luxembourg; Centre for Infectious Disease Epidemiology and Research, University of Cape Town, South Africa
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Liu J, Zhang P, Zou Q, Liang J, Chen Y, Cai Y, Li S, Li J, Su J, Li Q. Status of epilepsy in the tropics: An overlooked perspective. Epilepsia Open 2023; 8:32-45. [PMID: 36588194 PMCID: PMC9977758 DOI: 10.1002/epi4.12686] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 12/13/2022] [Indexed: 01/03/2023] Open
Abstract
Epilepsy is one of the most common serious chronic neurological diseases affecting people of all ages globally. It is characterized by recurrent seizures. About 50 million people worldwide have epilepsy. Indubitably, people with epilepsy (PWE) may be without access to appropriate treatment. Many studies have examined the molecular mechanisms and clinical aspects of epilepsy; nonetheless, the treatment gap exists in some special areas. In the tropics, the specific geographical and ecological conditions and a lack of medical resources result in neglect or delay of diagnosis for PWE. Herein, we summarized the epidemiology of epilepsy in the tropics and discussed the disease burden and existing problems, aiming to offer a medical environment for patients in need and highlight the importance of reducing the epileptic disease burden in tropical countries.
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Affiliation(s)
- Jiaqi Liu
- Department of Neurology, the First Affiliated Hospital, International School of Public Health and One Health, Hainan Medical University, Haikou, China.,Hainan Provincial Key Laboratory of Tropical Brain Research and Transformation, Hainan Medical University, Haikou, China
| | - Peng Zhang
- Department of Neurology, the First Affiliated Hospital, International School of Public Health and One Health, Hainan Medical University, Haikou, China.,Hainan Provincial Key Laboratory of Tropical Brain Research and Transformation, Hainan Medical University, Haikou, China.,Department of Forensic Medicine, Hainan Medical University, Haikou, China
| | - Qin Zou
- Department of Medical Psychology, The First Affiliated Hospital of Hainan Medical University, Haikou, China
| | - Jiantang Liang
- Department of Neurology, the First Affiliated Hospital, International School of Public Health and One Health, Hainan Medical University, Haikou, China.,Hainan Provincial Key Laboratory of Tropical Brain Research and Transformation, Hainan Medical University, Haikou, China
| | - Yongmin Chen
- Department of Functional Diagnosis, The Second Affiliated Hospital of Hainan Medical University, Haikou, China
| | - Yi Cai
- Department of Neurology, the First Affiliated Hospital, International School of Public Health and One Health, Hainan Medical University, Haikou, China
| | - Shichuo Li
- China Association Against Epilepsy, Beijing, China
| | - Jinmei Li
- Department of Neurology, West China Hospital of Sichuan University, Chengdu, China
| | - Jing Su
- Department of Neurology, the First Affiliated Hospital, International School of Public Health and One Health, Hainan Medical University, Haikou, China
| | - Qifu Li
- Department of Neurology, the First Affiliated Hospital, International School of Public Health and One Health, Hainan Medical University, Haikou, China.,Hainan Provincial Key Laboratory of Tropical Brain Research and Transformation, Hainan Medical University, Haikou, China
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Abuga J, Mwangi L, Ndolo J, Kariuki S, Newton C. Healthcare utilization by children with neurological impairments and disabilities in rural Kenya: a retrospective cohort study combined with secondary analysis of audit data. Wellcome Open Res 2022. [DOI: 10.12688/wellcomeopenres.18405.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Background: There is a paucity of data on healthcare utilization by children with neurological impairments (NI) in sub-Saharan Africa. We determined the rate, risk factors, causes, and outcomes of hospital admission and utilization patterns for rehabilitative care among children with NI in a defined rural area in Kenya. Methods: We designed two sub-studies to address the primary objectives. Firstly, we retrospectively observed 251 children aged 6–9 years with NI and 2162 age-matched controls to determine the rate, causes and outcomes of hospitalization in a local referral hospital. The two cohorts were identified from an epidemiological survey conducted in 2015 in a defined geographical area. Secondly, we reviewed hospital records to characterize utilization patterns for rehabilitative care. Results: Thirty-four in-patient admissions occurred in 8503 person-years of observation (PYO), yielding a crude rate of 400 admissions per 100 000 PYO (95% confidence interval (Cl): 286–560). The risk of admission was similar between cases and controls (rate ratio=0.70, 95%CI: 0.10–2.30, p = 0.31). The presence of electricity in the household was associated with reduced odds of admission (odds ratio=0.32, 95% Cl: 0.10–0.90, p < 0.01). Seizures and malaria were the main causes of admission. We confirmed six (0.3%) deaths during the follow-up period. Over 93% of outpatient paediatric visits for rehabilitative care were related to cerebral palsy and intellectual developmental delay. Health education (87%), rehabilitative exercises (79%) and assistive technology (64%) were the most common interventions. Conclusions: Surprisingly, the risk of hospitalization was not different between children with NI and those without, possibly because those with severe NI who died before this follow-up were under seclusion and restraint in the community. Evidence-based and tailored rehabilitative interventions are urgently required based on the existing secondary data.
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Shamsalinia A, Ghadimi R, Ebrahimi Rad R, Jahangasht Ghoozlu K, Mahmoudian A, Moradi M, Masoudi R, Ghaffari F. Psychometric Properties of the Persian Version of Adult Eating Behavior Questionnaire in Patients with Epilepsy. IRANIAN JOURNAL OF MEDICAL SCIENCES 2022; 47:236-247. [PMID: 35634526 PMCID: PMC9126902 DOI: 10.30476/ijms.2021.89396.2011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Revised: 03/21/2021] [Accepted: 04/28/2021] [Indexed: 11/04/2022]
Abstract
Background Adult eating behavior questionnaire (AEBQ) is an age upward extension tool that measures appetite traits in individuals. This instrument was developed by Hunot in 2016. The present study aimed to determine the psychometric properties of the Persian version of AEBQ in adults with epilepsy. Methods The current research is a cross-sectional study conducted in 2019 in Iran. 700 adults with epilepsy completed the 35-item AEBQ. Qualitative face validity, qualitative content and structure validity (exploratory factor analysis [EFA], N=400, and confirmatory factor analysis [CFA], N=300) appetitive traits were evaluated. Reliability was also measured using Cronbach's alpha, Construct reliability (CR), and Intra-Class Correlation (ICC). The SPSS 26-AMOS24 software was employed to analyze the data with a significance level of 0.05. Results The EFA and CFA results comprised eight factors, namely enjoyment of food, emotional over-eating, food responsiveness, hunger, satiety responsiveness, emotional under-eating, food fussiness, and eating slowly. Indices of root mean square error of approximation=0.068, parsimonious normed fit index=0.644, parsimonious comparative fit index=0.671, adjusted goodness of fit index=0.618, goodness of fit index=0.911, and Chi square degree-of-freedom ratio (normalized Chi square CMIN/DF=2.842) confirmed the fitness of the final model. Convergent and divergent validity was acceptable for all the factors. The results revealed that the internal stability>0.8 and CR>0.7 of the eight extracted AEBQ structures are confirmed. The ICC was 0.899 (95% CI: 0.878-0.917; P<0.001). The results also showed that AEBQ has acceptable convergent and divergent validity. Conclusion The eight-factor structure of AEBQ can measure eating behavior traits and is of good validity and reliability for assessing the eating behavior of Iranian adults with epilepsy.
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Affiliation(s)
- Abbas Shamsalinia
- Nursing Care Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - Reza Ghadimi
- Social Determinants of Health Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - Reza Ebrahimi Rad
- Department of Medicine, Islamic Azad University, Tonekabon Branch, Tonekabon, Mazandaran, Iran
| | | | - Amaneh Mahmoudian
- Nursing Care Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - Mozhgan Moradi
- Department of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
| | - Reza Masoudi
- Department of Nursing, School of Nursing and Midwifery, Shahr-e-Kord University of Medical Sciences Shahr-e-kord, Iran
| | - Fatemeh Ghaffari
- Nursing Care Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
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Odhiambo M, Kariuki SM, Newton CR. Therapeutic monitoring of anti-seizure medications in low- and middle-income countries: a systematic review. Wellcome Open Res 2021. [DOI: 10.12688/wellcomeopenres.16749.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: The treatment gap for epilepsy is large in low- and middle-income countries (LMICs) and the effectiveness and safety of the available anti-seizure medication (ASMs) is not fully understood. We conducted a systematic review to evaluate the extent of therapeutic drug monitoring (TDM) of ASM in LMIC, including purposes and methods used during monitoring. Methods: A search was conducted on four main databases (PubMed, Psych-Info, CINAHL and Embase), with eligible articles screened using a PRISMA checklist and a set of exclusion and inclusion criteria. Full texts were examined to evaluate the extent and practice of TDM in LMICs. Descriptive statistics were used to pool median distribution of TDM across studies. Results: Of the 6,309 articles identified in the initial search, 65 (1.0%) met the eligibility criteria. TDM of ASMs was mostly done to assess toxicity (42.8%), but rarely to monitor adherence (9.0%). TDM differed by economic status and infrastructural status with majority of the studies coming from Europe (53.8%) and upper-middle-income countries (87.6%). First generation ASMs (82.3%) were more likely to be monitored than second generation ASMs (17.6%) and carbamazepine was the most frequently monitored drug. Fluorescence Polarization Immunoassay (FPIA) was the most common technique used for TDM (41.5%) followed by High-Performance Liquid Chromatography (HPLC) (16.9%). In addition, FPIA was the cheapest method of TDM based on approximated costs ($1000, TDx system). Assay validation and quality control were reported variably, and reference ranges used during TDM of ASMs were relatively uniform. Conclusions: TDM is mostly done to evaluate ASM toxicity, but rarely for other reasons such as evaluating adherence or assessing clinical efficacy. There is a need for more investment in comprehensive TDM in LMICs that incorporates dose titration of ASM using pharmacokinetics and pharmacodynamics modelling, for both first generation and second generation ASMs.
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Wagner RG, Kabudula CW, Forsgren L, Ibinda F, Lindholm L, Kahn K, Tollman S, Newton CR. Epilepsy care cascade, treatment gap and its determinants in rural South Africa. Seizure 2020; 80:175-180. [PMID: 32593141 PMCID: PMC7443697 DOI: 10.1016/j.seizure.2020.06.013] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 05/14/2020] [Accepted: 06/06/2020] [Indexed: 12/20/2022] Open
Abstract
Most people with active convulsive epilepsy in rural South Africa are diagnosed. Most individuals diagnosed have some blood level of anti-seizure medication. Most individuals do not have optimal levels of medication. The epilepsy treatment gap is high in rural South Africa, especially in children. Identifying the epilepsy care cascade may better allow for targeting of interventions.
Purpose The percentage of people who are diagnosed with epilepsy (diagnostic gap), access, receive and adhere (treatment gap) to anti-seizure medication (ASM) in low- and middle- income countries remains low. We explored the epilepsy care cascade, measured the diagnostic and treatment gaps, and examined socio-demographic factors associated with adherence to ASMs in rural South Africa. Methods Utilizing a population-based cohort of 311 people with active convulsive epilepsy (ACE) residing in rural northeastern South Africa, a questionnaire was administered to examine associations between demographic and socioeconomic factors and the epilepsy treatment gap. Blood was taken to measure levels of ASMs. Results Of the 311 individuals diagnosed, 93 % of individuals reported being previously told they had epilepsy and 94 % reported previously attending a health facility for their epilepsy. ASMs were detected in 138 individuals (76 %) and optimal levels were detected in 67 individuals, resulting in a treatment gap of 63 % (95 % confidence interval [95 %CI]: 56 %–70 %). Self-reported specificity of ASM use was 23 % (95 %CI: 12–39 %) and individuals ≥18 years were significantly more likely to report taking ASM than children and were significantly (p = 0.011) more likely to be adherent. Conclusion Most people with epilepsy in rural South Africa had been previously diagnosed with epilepsy and had accessed care for epilepsy, yet the level of ASM adherence remained low, significantly lower amongst children. Understanding ways of improving knowledge of and adherence to ASM in rural South Africa is necessary, especially amongst children. The epilepsy care cascade can be useful in identifying gaps in care and targeting interventions to reduce these gaps.
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Affiliation(s)
- Ryan G Wagner
- Studies of Epidemiology of Epilepsy in Demographic Surveillance Systems (SEEDS) - INDEPTH Network, Accra, Ghana; MRC/Wits Rural Public Health & Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden; Department of Clinical Science, Neurosciences, Umeå University, Umeå, Sweden.
| | - Chodziwadziwa W Kabudula
- MRC/Wits Rural Public Health & Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Lars Forsgren
- Department of Clinical Science, Neurosciences, Umeå University, Umeå, Sweden
| | - Fredrick Ibinda
- KEMRI/Wellcome Trust Research Programme, Centre for Geographic Medicine Research - Coast, Kilifi, Kenya
| | - Lars Lindholm
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | - Kathleen Kahn
- MRC/Wits Rural Public Health & Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden; INDEPTH Network, Accra, Ghana
| | - Stephen Tollman
- MRC/Wits Rural Public Health & Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden; INDEPTH Network, Accra, Ghana
| | - Charles R Newton
- Studies of Epidemiology of Epilepsy in Demographic Surveillance Systems (SEEDS) - INDEPTH Network, Accra, Ghana; MRC/Wits Rural Public Health & Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; KEMRI/Wellcome Trust Research Programme, Centre for Geographic Medicine Research - Coast, Kilifi, Kenya; Neurosciences Unit, UCL Institute of Child Health, London, United Kingdom; Department of Psychiatry, University of Oxford, Oxford, United Kingdom
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Contextualizing and pilot testing the Mental Health Gap Action Programme Intervention Guide (mhGAP-IG) to primary healthcare workers in Kilifi, Kenya. Glob Ment Health (Camb) 2020; 7:e11. [PMID: 32742669 PMCID: PMC7379318 DOI: 10.1017/gmh.2020.6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Revised: 03/01/2020] [Accepted: 03/29/2020] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Little data exists about the methodology of contextualizing version two of the Mental Health Gap Action Programme Intervention Guide (mhGAP-IG) in resource-poor settings. This paper describes the contextualisation and pilot testing of the guide in Kilifi, Kenya. METHODS Contextualisation was conducted as a collaboration between the KEMRI-Wellcome Trust Research Programme (KWTRP) and Kilifi County Government's Department of Health (KCGH) between 2016 and 2018. It adapted a mixed-method design and involved a situational analysis, stakeholder engagement, local adaptation and pilot testing of the adapted guide. Qualitative data were analysed using content analysis to identify key facilitators and barriers to the implementation process. Pre- and post-training scores of the adapted guide were compared using the Wilcoxon signed-rank test. RESULTS Human resource for mental health in Kilifi is strained with limited infrastructure and outdated legislation. Barriers to implementation included few specialists for referral, unreliable drug supply, difficulty in translating the guide to Kiswahili language, lack of clarity of the roles of KWTRP and KCGH in the implementation process and the unwillingness of the biomedical practitioners to collaborate with traditional health practitioners to enhance referrals to hospital. In the adaptation process, stakeholders recommended the exclusion of child and adolescent mental and behavioural problems, as well as dementia modules from the final version of the guide. Pilot testing of the adapted guide showed a significant improvement in the post-training scores: 66.3% (95% CI 62.4-70.8) v. 76.6% (95% CI 71.6-79.2) (p < 0.001). CONCLUSION The adapted mhGAP-IG version two can be used across coastal Kenya to train primary healthcare providers. However, successful implementation in Kilifi will require a review of new evidence on the burden of disease, improvements in the mental health system and sustained dialogue among stakeholders.
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Bitta MA, Kariuki SM, Gona J, Abubakar A, Newton CRJC. Priority mental, neurological and substance use disorders in rural Kenya: Traditional health practitioners' and primary health care workers' perspectives. PLoS One 2019; 14:e0220034. [PMID: 31335915 PMCID: PMC6650073 DOI: 10.1371/journal.pone.0220034] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Accepted: 07/07/2019] [Indexed: 11/21/2022] Open
Abstract
Background Over 75% of people with mental neurological and substance use disorders (MNSD) live in low and middle-income countries with limited access to specialized care. The World Health Organization’s Mental Health Gap Action Program (mhGAP) aims to address the human resource gap but it requires contextualization. Aims We conducted a qualitative study in rural coastal Kenya to explore the local terms, perceived causes and management modalities of priority MNSD listed in the mhGAP, to inform implementation in this setting. Methods We conducted 8 focus group discussions with primary health care providers and traditional health practitioners and used the framework method to conduct thematic analysis. We identified local terms, perceived causes and treatment options for MNSD. We also explored possibilities for collaboration between the traditional health practitioners and primary health care providers. Results We found local terms for depression, psychoses, epilepsy, disorders due to substance use and self-harm/ suicide but none for dementia. Child and adolescent mental and behavioral problems were not regarded as MNSD but consequences of poor parenting. Self-harm/suicide was recognized in the context of other MNSD. Causes of MNSD were broadly either biological or supernatural. Treatment options were dependent on perceived cause of illness. Most traditional health practitioners were willing to collaborate with primary health care providers mainly through referring cases. Primary health care providers were unwilling to collaborate with traditional health practitioners because they perceived them to contribute to worsening of patients’ prognoses. Conclusions Local terms and management modalities are available for some priority MNSD in this setting. Community level case detection and referral may be hindered by lack of collaboration between traditional health practitioners and primary health care providers. There is need for training on the recognition and management of all priority MNSD.
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Affiliation(s)
- Mary A. Bitta
- Tropical Neurosciences, KEMRI/Wellcome Trust Research Programme, Centre for Geographic Medicine Research (Coast), Kilifi, Kenya
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
- * E-mail:
| | - Symon M. Kariuki
- Tropical Neurosciences, KEMRI/Wellcome Trust Research Programme, Centre for Geographic Medicine Research (Coast), Kilifi, Kenya
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | - Joseph Gona
- Tropical Neurosciences, KEMRI/Wellcome Trust Research Programme, Centre for Geographic Medicine Research (Coast), Kilifi, Kenya
| | - Amina Abubakar
- Tropical Neurosciences, KEMRI/Wellcome Trust Research Programme, Centre for Geographic Medicine Research (Coast), Kilifi, Kenya
- Aga Khan University, Nairobi, Kenya
| | - Charles R. J. C. Newton
- Tropical Neurosciences, KEMRI/Wellcome Trust Research Programme, Centre for Geographic Medicine Research (Coast), Kilifi, Kenya
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
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Samia P, Hassell J, Hudson JA, Murithi MK, Kariuki SM, Newton CR, Wilmshurst JM. Epilepsy diagnosis and management of children in Kenya: review of current literature. Res Rep Trop Med 2019; 10:91-102. [PMID: 31388319 PMCID: PMC6607977 DOI: 10.2147/rrtm.s201159] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Accepted: 04/12/2019] [Indexed: 01/04/2023] Open
Abstract
Introduction: The growing impact of non-communicable diseases in low- to middle-income countries makes epilepsy a key research priority. We evaluated peer-reviewed published literature on childhood epilepsy specific to Kenya to identify knowledge gaps and inform future priorities. Methodology: A literature search utilizing the terms "epilepsy" OR "seizure" as exploded subject headings AND "Kenya" was conducted. Relevant databases were searched, generating 908 articles. After initial screening to remove duplications, irrelevant articles, and publications older than 15 years, 154 papers remained for full-article review, which identified 35 publications containing relevant information. Data were extracted from these reports on epidemiology, etiology, clinical features, management, and outcomes. Results: The estimated prevalence of lifetime epilepsy in children was 21-41 per 1,000, while the incidence of active convulsive epilepsy was 39-187 cases per 100,000 children per year. The incidence of acute seizures was 312-879 per 100,000 children per year and neonatal seizures 3,950 per 100,000 live births per year. Common risk factors for both epilepsy and acute seizures included adverse perinatal events, meningitis, malaria, febrile seizures, and family history of epilepsy. Electroencephalography abnormalities were documented in 20%-41% and neurocognitive comorbidities in more than half. Mortality in children admitted with acute seizures was 3%-6%, and neurological sequelae were identified in 31% following convulsive status epilepticus. Only 7%-29% children with epilepsy were on antiseizure medication. Conclusion: Active convulsive epilepsy is a common condition among Kenyan children, remains largely untreated, and leads to extremely poor outcomes. The high proportion of epilepsy attributable to preventable causes, in particular neonatal morbidity, contributes significantly to the lifetime burden of the condition. This review reaffirms the ongoing need for better public awareness of epilepsy as a treatable disease and for national-level action that targets both prevention and management.
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Affiliation(s)
- Pauline Samia
- Department of Paediatrics and Child Health, Aga Khan University, Nairobi, Kenya
| | - Jane Hassell
- Gertrude’s Children’s Hospital, Child development Centre, Nairobi, Kenya
| | | | | | - Symon M Kariuki
- Kemri–Wellcome Trust Collaborative Programme, Centre for Geographic Medicine Research Programme, Kilifi, Kenya
| | - Charles R Newton
- Kemri–Wellcome Trust Collaborative Programme, Centre for Geographic Medicine Research Programme, Kilifi, Kenya
| | - Jo M Wilmshurst
- Division of Paediatric Neurology, Department of Paediatrics and Child Health, Red Cross War Memorial Children’s Hospital, Neuroscience Institute, University of Cape Town, Rondebosch, South Africa
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Vaughan KA, Lopez Ramos C, Buch VP, Mekary RA, Amundson JR, Shah M, Rattani A, Dewan MC, Park KB. An estimation of global volume of surgically treatable epilepsy based on a systematic review and meta-analysis of epilepsy. J Neurosurg 2019; 130:1127-1141. [PMID: 30215556 DOI: 10.3171/2018.3.jns171722] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2017] [Accepted: 03/12/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Epilepsy is one of the most common neurological disorders, yet its global surgical burden has yet to be characterized. The authors sought to compile the most current epidemiological data to quantify global prevalence and incidence, and estimate global surgically treatable epilepsy. Understanding regional and global epilepsy trends and potential surgical volume is crucial for future policy efforts and resource allocation. METHODS The authors performed a systematic literature review and meta-analysis to determine the global incidence, lifetime prevalence, and active prevalence of epilepsy; to estimate surgically treatable epilepsy volume; and to evaluate regional trends by WHO regions and World Bank income levels. Data were extracted from all population-based studies with prespecified methodological quality across all countries and demographics, performed between 1990 and 2016 and indexed on PubMed, EMBASE, and Cochrane. The current and annual new case volumes for surgically treatable epilepsy were derived from global epilepsy prevalence and incidence. RESULTS This systematic review yielded 167 articles, across all WHO regions and income levels. Meta-analysis showed a raw global prevalence of lifetime epilepsy of 1099 per 100,000 people, whereas active epilepsy prevalence is slightly lower at 690 per 100,000 people. Global incidence was found to be 62 cases per 100,000 person-years. The meta-analysis predicted 4.6 million new cases of epilepsy annually worldwide, a prevalence of 51.7 million active epilepsy cases, and 82.3 million people with any lifetime epilepsy diagnosis. Differences across WHO regions and country incomes were significant. The authors estimate that currently 10.1 million patients with epilepsy may be surgical treatment candidates, and 1.4 million new surgically treatable epilepsy cases arise annually. The highest prevalences are found in Africa and Latin America, although the highest incidences are reported in the Middle East and Latin America. These regions are primarily low- and middle-income countries; as expected, the highest disease burden falls disproportionately on regions with the fewest healthcare resources. CONCLUSIONS Understanding of the global epilepsy burden has evolved as more regions have been studied. This up-to-date worldwide analysis provides the first estimate of surgical epilepsy volume and an updated comprehensive overview of current epidemiological trends. The disproportionate burden of epilepsy on low- and middle-income countries will require targeted diagnostic and treatment efforts to reduce the global disparities in care and cost. Quantifying global epilepsy provides the first step toward restructuring the allocation of healthcare resources as part of global healthcare system strengthening.
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Affiliation(s)
- Kerry A Vaughan
- 1Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
- 5Global Neurosurgery Initiative/Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts
| | - Christian Lopez Ramos
- 2University of California San Diego School of Medicine, La Jolla, California
- 5Global Neurosurgery Initiative/Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts
| | - Vivek P Buch
- 1Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Rania A Mekary
- 3Department of Pharmaceutical Business and Administrative Sciences, School of Pharmacy, MCPHS University, Boston
- 4Cushing Neurosurgical Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School
| | - Julia R Amundson
- 5Global Neurosurgery Initiative/Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts
- 6Miller School of Medicine, University of Miami, Florida
| | - Meghal Shah
- 5Global Neurosurgery Initiative/Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts
- 7Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | - Abbas Rattani
- 5Global Neurosurgery Initiative/Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts
- 8Meharry Medical College, School of Medicine, Nashville; and
| | - Michael C Dewan
- 5Global Neurosurgery Initiative/Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts
- 9Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Kee B Park
- 5Global Neurosurgery Initiative/Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts
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Mwangala PN, Kariuki SM, Nyongesa MK, Mwangi P, Chongwo E, Newton CR, Abubakar A. Cognition, mood and quality-of-life outcomes among low literacy adults living with epilepsy in rural Kenya: A preliminary study. Epilepsy Behav 2018; 85:45-51. [PMID: 29908383 PMCID: PMC6086937 DOI: 10.1016/j.yebeh.2018.05.032] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 05/18/2018] [Accepted: 05/19/2018] [Indexed: 12/25/2022]
Abstract
Epilepsy is frequently associated with neurocognitive impairments, mental health, and psychosocial problems but these are rarely documented in low- and middle-income countries. The aim of this study was to examine the neurocognitive outcomes, depressive symptoms, and psychosocial adjustments of people with epilepsy (PWE) in Kilifi, Kenya. We evaluated the impact of these outcomes on health-related quality of life. Self-report, interviewer-administered measures of depression (Major Depression Inventory) and quality of life (RAND SF-36) were administered to 63 PWE and 83 community controls. Neurocognitive functioning was assessed using Raven's Standard Progressive Matrices, Digit Span, and Contingency Naming Test. The results show that PWE have poorer scores for executive function, working memory, intelligence quotient (IQ), depression, and quality of life than controls. Twenty-seven (27%) of PWE had depressive symptoms, which was significantly greater than in controls (6%); P < 0.001. Quality-of-life scores were significantly lower in PWE with depressive symptoms than in those without depressive symptoms (Mean QoL scores (standard deviation (SD)): 46.43 (13.27) versus 64.18 (17.69); P = 0.01. On adjusted linear regression models, depression affected total quality-of-life scores (P = 0.07) as well as individual health indicator domains touching on pain (P = 0.04), lethargy/fatigue (P = 0.01), and emotional well-being (P = 0.02). Our results show that epilepsy is associated with a significant burden of mental health and neurocognitive impairments in the community; however, community-based studies are needed to provide precise estimates of these disorders.
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Affiliation(s)
- Patrick N. Mwangala
- Neuroassessment Group, KEMRI-Wellcome Trust Research Programme, Center for Geographic Medicine Research (Coast), Kilifi, Kenya,Corresponding author at: Center for Geographic Medicine Research (Coast), Kenya Medical Research Institute, PO Box 230, 80108 Kilifi, Kenya.
| | - Symon M. Kariuki
- Neuroassessment Group, KEMRI-Wellcome Trust Research Programme, Center for Geographic Medicine Research (Coast), Kilifi, Kenya
| | - Moses K. Nyongesa
- Neuroassessment Group, KEMRI-Wellcome Trust Research Programme, Center for Geographic Medicine Research (Coast), Kilifi, Kenya
| | - Paul Mwangi
- Neuroassessment Group, KEMRI-Wellcome Trust Research Programme, Center for Geographic Medicine Research (Coast), Kilifi, Kenya
| | - Esther Chongwo
- Neuroassessment Group, KEMRI-Wellcome Trust Research Programme, Center for Geographic Medicine Research (Coast), Kilifi, Kenya,Department of Public Health, Pwani University, Kilifi, Kenya
| | - Charles R. Newton
- Neuroassessment Group, KEMRI-Wellcome Trust Research Programme, Center for Geographic Medicine Research (Coast), Kilifi, Kenya,Department of Public Health, Pwani University, Kilifi, Kenya,Department of Psychiatry, University of Oxford, Oxford, UK
| | - Amina Abubakar
- Neuroassessment Group, KEMRI-Wellcome Trust Research Programme, Center for Geographic Medicine Research (Coast), Kilifi, Kenya,Department of Public Health, Pwani University, Kilifi, Kenya,Department of Psychiatry, University of Oxford, Oxford, UK
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Kariuki SM, Abubakar A, Kombe M, Kazungu M, Odhiambo R, Stein A, Newton CRJC. Prevalence, risk factors and behavioural and emotional comorbidity of acute seizures in young Kenyan children: a population-based study. BMC Med 2018; 16:35. [PMID: 29510713 PMCID: PMC5840716 DOI: 10.1186/s12916-018-1021-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Accepted: 02/09/2018] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Acute symptomatic seizures and febrile seizures are common in children admitted to hospitals in Africa and may be markers of brain dysfunction. They may be associated with behavioural and emotional problems, but there are no published community-based studies in Africa. METHODS We screened 7047 children aged 1-6 years (randomly sampled from 50,000 in the community) for seizures (using seven questions) and invited those who screened positive and a proportion of negatives for a clinical assessment. Risk factors were identified using a parental questionnaire. Behavioural and emotional problems were examined using the Child Behaviour Checklist (CBCL) in 3273 children randomly selected from 7047. Generalised linear models with appropriate link functions were used to determine risk factors and associations between behavioural or emotional problems and acute seizures. Sobel-Goodman mediation tests were used to investigate if the association between acute seizures and CBCL scores was mediated by co-diagnosis of epilepsy. RESULTS Acute seizures were identified in 429 (6.1%) preschool children: 3.2% (95% confidence interval CI: 2.9-3.5%) for symptomatic seizures, and 2.9% (95% CI: 2.6-3.3%) for febrile seizures. Risk factors for acute seizures included family history of febrile seizures (odds ratio OR = 3.19; 95% CI: 2.03-5.01) and previous hospitalisation (OR = 6.65; 95% CI: 4.60-9.63). Total CBCL problems occurred more frequently in children with acute seizures (27%; 95% CI: 21-34%) than for those without seizures (11%; 95% CI: 11-12%; chi-squared p ≤ 0.001). Acute seizures were associated with total CBCL problems (adjusted risk ratio (aRR) = 1.92; 95% CI: 1.34-2.77), externalising problems (aRR = 1.82; 95% CI: 1.21-2.75) and internalising problems (aRR = 1.57; 95% CI: 1.22-2.02), with the proportion of the comorbidity mediated by a co-diagnosis of epilepsy being small (15.3%; 95% CI: 4.5-34.9%). Risk factors for this comorbidity included family history of febrile seizures (risk ratio (RR) = 3.36; 95% CI: 1.34-8.41), repetitive acute seizures (β = 0.36; 95% CI: 0.15-0.57) and focal acute seizures (RR = 1.80; 95% CI: 1.05-3.08). CONCLUSIONS Acute seizures are common in preschool children in this area and are associated with behavioural and emotional problems. Both conditions should be assessed and addressed in children.
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Affiliation(s)
- Symon M. Kariuki
- KEMRI-Wellcome Trust Research Programme, PO Box 230, Kilifi, Kenya
| | - Amina Abubakar
- KEMRI-Wellcome Trust Research Programme, PO Box 230, Kilifi, Kenya
- Department of Public Health, Pwani University, PO Box 195, Kilifi, Kenya
- Department of Psychiatry, University of Oxford, Oxford, OX3 7JX UK
| | - Martha Kombe
- KEMRI-Wellcome Trust Research Programme, PO Box 230, Kilifi, Kenya
| | - Michael Kazungu
- KEMRI-Wellcome Trust Research Programme, PO Box 230, Kilifi, Kenya
| | - Rachael Odhiambo
- KEMRI-Wellcome Trust Research Programme, PO Box 230, Kilifi, Kenya
| | - Alan Stein
- Department of Psychiatry, University of Oxford, Oxford, OX3 7JX UK
| | - Charles R. J. C. Newton
- KEMRI-Wellcome Trust Research Programme, PO Box 230, Kilifi, Kenya
- Department of Public Health, Pwani University, PO Box 195, Kilifi, Kenya
- Department of Psychiatry, University of Oxford, Oxford, OX3 7JX UK
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Kind CJ, Newton CRJC, Kariuki SM. Prevalence, risk factors, and neurobehavioral comorbidities of epilepsy in Kenyan children. Epilepsia Open 2017; 2:388-399. [PMID: 29588970 PMCID: PMC5862110 DOI: 10.1002/epi4.12069] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/06/2017] [Indexed: 12/25/2022] Open
Abstract
Objective To investigate the prevalence, risk factors, clinical features, and neurobehavioral comorbidities of epilepsy and acute symptomatic seizures in school‐aged children in Kilifi, Kenya. Methods Randomly selected children (N = 11,223) were screened for epilepsy and other neurodevelopmental disorders. Those who screened positive were invited for further clinical, electroencephalographic (EEG), and neuropsychological evaluations. Prevalence was measured by dividing cases by screened population, providing Agresti–Coull confidence intervals (CIs). Prevalence ratios were computed using log binomial regression, and odds ratios (ORs) were computed using logistic regression; both were implemented with generalized linear models. Attention‐deficit hyperactivity disorder (ADHD), autism spectrum disorder (ASD), and other neurodevelopmental impairments were assessed in cases and controls. Results Prevalence of lifetime epilepsy was 20.9 per 1,000 (95% CI = 18.4–23.7), and that of active epilepsy was 11.5 per 1,000 (95% CI = 9.7–13.6). Prevalence of acute symptomatic seizures was 68.8 per 1,000 (95% CI = 64.2–73.6). Acute symptomatic seizures preceded a diagnosis of epilepsy in 8% of children. Of 98 children diagnosed with epilepsy, focal seizures were seen in 79%, abnormal EEG was seen in 39%, and 83% were not receiving antiepileptic drugs. Childhood absence epilepsy and Lennox–Gastaut epilepsy were the most easily identifiable epilepsy syndromes. Perinatal complications, previous hospitalization, geophagia, and snoring were risk factors for epilepsy. Family history of seizures, abnormal pregnancy, previous hospitalization, and snoring were risk factors for acute symptomatic seizures. Neurobehavioral comorbidities were present in 54% of subjects with lifetime epilepsy and in 3% of controls, with associations for individual comorbidities being statistically significant: ADHD (OR = 14.55, 95% CI = 7.54–28.06), ASD (OR = 36.83, 95% CI = 7.97–170.14), and cognitive impairments (OR = 14.55, 95% CI = 3.52–60.14). Significance The burden of seizure disorders in this area is higher than in locations in high‐income countries, and can be reduced by preventing risk factors. A comprehensive management plan for neurobehavioral comorbidities of epilepsy should be incorporated into standard epilepsy care.
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Affiliation(s)
- Charles J Kind
- St. Johns College University of Oxford Oxford United Kingdom
| | - Charles R J C Newton
- St. Johns College University of Oxford Oxford United Kingdom.,KEMRI-Wellcome Trust Research Programme Kilifi Kenya.,Department of Psychiatry University of Oxford Oxford United Kingdom
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Bitta MA, Kariuki SM, Chengo E, Newton CRJC. An overview of mental health care system in Kilifi, Kenya: results from an initial assessment using the World Health Organization's Assessment Instrument for Mental Health Systems. Int J Ment Health Syst 2017; 11:28. [PMID: 28416966 PMCID: PMC5392905 DOI: 10.1186/s13033-017-0135-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Accepted: 04/06/2017] [Indexed: 11/10/2022] Open
Abstract
Background Little is known about the state of mental health systems in Kenya. In 2010, Kenya promulgated a new constitution, which devolved national government and the national health system to 47 counties including Kilifi County. There is need to provide evidence from mental health systems research to identify priority areas in Kilifi’s mental health system for informing county health sector decision making. We conducted an initial assessment of state of mental health systems in Kilifi County and documented resources, policy and legislation and spectrum of mental, neurological and substance use disorders. Methods This was a pilot study that used the brief version of the World Health Organization’s Assessment Instrument for Mental Health Systems Version 2.2 to collect data. Data collection was based on the year 2014. Results Kilifi county has two public psychiatric outpatient units that are part of general hospitals. There is no standalone mental hospital in Kilifi. There are no inpatients or community based facilities for people with mental health problems. Although the psychiatric facilities in Kilifi have an essential drugs list, supply of drugs is erratic with frequent shortages. There is no psychiatrist or psychologist in Kilifi with only two psychiatric nurses for a population of approximately 1.2 million people. Schizophrenia was the commonest reason for visiting outpatient facilities (47.1%) while suicidal ideation was the least common (0.4%). Kenya’s mental health policy, which is being used by Kilifi County, is outdated and does not cater for the current mental health needs of Kilifi. There is no specific legislation to protect the rights of people with mental health problems. No budget exists specifically for mental health care. There have been no efforts to integrate mental health care into primary care in Kilifi, and there is no empirical research work to evaluate its feasibility. Conclusion There is an urgent need to increase resources allocated for mental health in particular infrastructure and human resource. Policy and legislations need to be established to protect the rights of people with mental illnesses, and mental health should be integrated with primary care to increase access to services.
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Affiliation(s)
- Mary A Bitta
- KEMRI-Wellcome Trust Research Programme, Centre for Geographic Medicine Research (Coast), P O Box 230, Kilifi, 80108 Kenya
| | - Symon M Kariuki
- KEMRI-Wellcome Trust Research Programme, Centre for Geographic Medicine Research (Coast), P O Box 230, Kilifi, 80108 Kenya
| | - Eddie Chengo
- Ubuntu Afya Clinic for People with Epilepsy, Malindi, Kenya
| | - Charles R J C Newton
- KEMRI-Wellcome Trust Research Programme, Centre for Geographic Medicine Research (Coast), P O Box 230, Kilifi, 80108 Kenya.,Department of Psychiatry, University of Oxford, Oxford, UK
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18
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Ibinda F, Odermatt P, Kariuki SM, Kakooza-Mwesige A, Wagner RG, Owusu-Agyei S, Masanja H, Ngugi AK, Mbuba CK, Doku VCK, Neville BG, Sander JW, Newton CRJC. Magnitude and factors associated with nonadherence to antiepileptic drug treatment in Africa: A cross-sectional multisite study. Epilepsia Open 2017; 2:226-235. [PMID: 29588951 PMCID: PMC5719857 DOI: 10.1002/epi4.12052] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/27/2017] [Indexed: 12/30/2022] Open
Abstract
Objectives The epilepsy treatment gap is large in low‐ and middle‐income countries, but the reasons behind nonadherence to treatment with antiepileptic drugs (AEDs) across African countries remain unclear. We investigated the extent to which AEDs are not taken and associated factors in people with active convulsive epilepsy (ACE) identified in cross‐sectional studies conducted in five African countries. Methods We approached 2,192 people with a confirmed diagnosis of ACE for consent to give blood voluntarily. Participants were asked if they were taking AEDs, and plasma drug concentrations were measured using a fluorescence polarization immunoassay analyzer. Information about possible risk factors was collected using questionnaire‐based clinical interviews. We determined factors associated with nonadherence to AED treatment in children and adults, as measured by detectable and optimal levels, using multilevel logistic regression. Results In 1,303 samples assayed (43.7% were children), AEDs were detected in 482, but only 287 had optimal levels. Of the 1,303 samples, 532 (40.8%) were from people who had reported they were on AEDs. The overall prevalence of nonadherence to treatment was 63.1% (95% confidence interval [CI] 60.5–65.6%) as measured by detectable AED levels and 79.1% (95% CI 73.3–84.3%) as measured by optimal AED levels; self‐reported nonadherence was 65.1% (95% CI 45.0–79.5%). Nonadherence was significantly (p < 0.001) more common among the children than among adults for optimal and detectable levels of AEDs, as was the self‐reported nonadherence. In children, lack of previous hospitalization and learning difficulties were independently associated with nonadherence to treatment. In adults, history of delivery at home, absence of burn marks, and not seeking traditional medicine were independently associated with the nonadherence to AED treatment. Significance Only about 20% of people with epilepsy benefit fully from antiepileptic drugs in sub‐Saharan Africa, according to optimum AEDs levels. Children taking AEDs should be supervised to promote compliance.
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Affiliation(s)
- Fredrick Ibinda
- Centre for Geographic Medicine Research (Coast) Kenya Medical Research Institute Kilifi Kenya.,Studies of Epidemiology of Epilepsy in Demographic Surveillance Systems (SEEDS)-INDEPTH Network Accra Ghana
| | - Peter Odermatt
- Studies of Epidemiology of Epilepsy in Demographic Surveillance Systems (SEEDS)-INDEPTH Network Accra Ghana.,Department of Public Health and Epidemiology Swiss Tropical and Public Health Institute Basel Switzerland.,University of Basel Basel Switzerland
| | - Symon M Kariuki
- Centre for Geographic Medicine Research (Coast) Kenya Medical Research Institute Kilifi Kenya.,Studies of Epidemiology of Epilepsy in Demographic Surveillance Systems (SEEDS)-INDEPTH Network Accra Ghana
| | - Angelina Kakooza-Mwesige
- Studies of Epidemiology of Epilepsy in Demographic Surveillance Systems (SEEDS)-INDEPTH Network Accra Ghana.,Iganga-Mayuge Health and Demographic Surveillance System Kampala Uganda.,Department of Paediatrics and Child Health Makerere University College of Health Sciences Kampala Uganda
| | - Ryan G Wagner
- Studies of Epidemiology of Epilepsy in Demographic Surveillance Systems (SEEDS)-INDEPTH Network Accra Ghana.,MRC/Wits Rural Public Health & Health Transitions Research Unit (Agincourt) School of Public Health Faculty of Health Sciences University of the Witwatersrand Johannesburg South Africa.,Department of Public Health and Clinical Medicine Epidemiology and Public Health Sciences Umeå University Umeå Sweden
| | - Seth Owusu-Agyei
- Studies of Epidemiology of Epilepsy in Demographic Surveillance Systems (SEEDS)-INDEPTH Network Accra Ghana.,Kintampo Health Research Centre Kintampo Ghana
| | - Honorati Masanja
- Studies of Epidemiology of Epilepsy in Demographic Surveillance Systems (SEEDS)-INDEPTH Network Accra Ghana.,Ifakara Health InstituteI fakara Tanzania
| | - Anthony K Ngugi
- Studies of Epidemiology of Epilepsy in Demographic Surveillance Systems (SEEDS)-INDEPTH Network Accra Ghana.,Research Support Unit Faculty of Health Sciences Aga Khan University-East Africa Nairobi Kenya
| | - Caroline K Mbuba
- Department of Public Health School of Medicine and Health Sciences Kenya Methodist University Meru Kenya
| | - Victor C K Doku
- Studies of Epidemiology of Epilepsy in Demographic Surveillance Systems (SEEDS)-INDEPTH Network Accra Ghana.,Institute of Psychiatry Kings College London London United Kingdom
| | - Brian G Neville
- Studies of Epidemiology of Epilepsy in Demographic Surveillance Systems (SEEDS)-INDEPTH Network Accra Ghana.,Neurosciences Unit Institute of Child Health University College London London United Kingdom
| | - Josemir W Sander
- Studies of Epidemiology of Epilepsy in Demographic Surveillance Systems (SEEDS)-INDEPTH Network Accra Ghana.,NIHR University College London Hospitals Biomedical Research Centre UCL Institute of Neurology Queen Square United Kingdom.,Epilepsy Society Chalfont St. Peter United Kingdom.,Stichting Epilepsie Instellingen Nederland (SEIN) SW Heemstede the Netherlands
| | - Charles R J C Newton
- Centre for Geographic Medicine Research (Coast) Kenya Medical Research Institute Kilifi Kenya.,Studies of Epidemiology of Epilepsy in Demographic Surveillance Systems (SEEDS)-INDEPTH Network Accra Ghana.,Neurosciences Unit Institute of Child Health University College London London United Kingdom.,Department of Psychiatry University of Oxford Oxford United Kingdom
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Anticonvulsant activity of the antidepressant drug, tianeptine, against pentylenetetrazole-induced seizures mitigates cognitive impairment in rats. Behav Pharmacol 2016; 27:623-32. [DOI: 10.1097/fbp.0000000000000257] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Bistervels IM, Kariuki SM, Newton CRJC. Risk of convulsive epilepsy following acute seizures in Kenyan children. Epilepsia Open 2016; 1:112-120. [PMID: 29588934 PMCID: PMC5719838 DOI: 10.1002/epi4.12013] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/29/2016] [Indexed: 12/27/2022] Open
Abstract
Objective The prevalence of epilepsy is high in Africa, and people with epilepsy often have a history of acute seizures. We determined whether acute seizures are associated with risk for epilepsy in rural Africa, where both conditions are common and may have shared risk factors. Methods A total of 16,438 children (2,991 with acute seizures and 13,447 without seizures) admitted to Kilifi County Hospital from 2002 to 2008 were followed up with epidemiological surveys conducted in 2003 and 2008 to assess the prevalence of epilepsy and the associated risk factors. Cox proportional hazards regression models were used to identify the risk factors. Prevalence ratios were computed using log binomial regression models. Results The prevalence of epilepsy was higher in admissions with acute seizures (5.0% [95% confidence interval (CI), 4.3–5.9%]) than in those without seizures (0.7% [95% CI, 0.5–0.8%]), p < 0.0001). Acute seizures were associated with epilepsy after accounting for potential confounders in a Cox regression model (hazard ratio [HR] = 1.53 [95% CI, 1.10–2.14]). Prevalence was greater in complex acute seizures (5.9%; prevalence ratio [PR] = 1.58 [95% CI, 1.13–2.20]) or status epilepticus (7.5%; PR = 1.96 [95% CI, 1.32–2.91]) than in simple acute seizures (3.7%). Factors independently associated with epilepsy following acute seizures in Cox regression models were perinatal complications (HR = 3.60 [95% CI, 1.89–6.87]), cerebral palsy (HR = 1491.51 [95% CI, 144.30–15,416.21]), duration of follow‐up (HR = 1.21 [95% CI, 1.09–1.35]), and malnutrition (relative risk [RR] = 0.24 [95% CI, 0.08–0.69]). Significance Acute seizures in children are associated with subsequent risk for epilepsy that is greater than in the general population. The burden of epilepsy may be reduced by control of causes of acute seizures.
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Affiliation(s)
- Ingrid M Bistervels
- Global Child Health Group EKZ/AMC University of Amsterdam Amsterdam the Netherlands
| | | | - Charles R J C Newton
- KEMRI-Wellcome Trust Research Programme Kilifi Kenya.,Department of Psychiatry University of Oxford Oxford United Kingdom
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Kariuki SM, White S, Chengo E, Wagner RG, Ae-Ngibise KA, Kakooza-Mwesige A, Masanja H, Ngugi AK, Sander JW, Neville BG, Newton CR. Electroencephalographic features of convulsive epilepsy in Africa: A multicentre study of prevalence, pattern and associated factors. Clin Neurophysiol 2015; 127:1099-1107. [PMID: 26337840 PMCID: PMC4725253 DOI: 10.1016/j.clinph.2015.07.033] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2015] [Revised: 07/22/2015] [Accepted: 07/28/2015] [Indexed: 12/27/2022]
Abstract
Electroencephalographic abnormalities are common in Africans with epilepsy, with an adjusted prevalence of 2.7 (95% confidence interval, 2.5–2.9) per 1000 population. Electroencephalographic abnormalities are associated with preventable factors such as adverse perinatal events and frequent seizures. Electroencephalography is helpful in identifying focal epilepsy in Africa, where timing of focal aetiologies is problematic and there is a lack of neuroimaging services.
Objective We investigated the prevalence and pattern of electroencephalographic (EEG) features of epilepsy and the associated factors in Africans with active convulsive epilepsy (ACE). Methods We characterized electroencephalographic features and determined associated factors in a sample of people with ACE in five African sites. Mixed-effects modified Poisson regression model was used to determine factors associated with abnormal EEGs. Results Recordings were performed on 1426 people of whom 751 (53%) had abnormal EEGs, being an adjusted prevalence of 2.7 (95% confidence interval (95% CI), 2.5–2.9) per 1000. 52% of the abnormal EEG had focal features (75% with temporal lobe involvement). The frequency and pattern of changes differed with site. Abnormal EEGs were associated with adverse perinatal events (risk ratio (RR) = 1.19 (95% CI, 1.07–1.33)), cognitive impairments (RR = 1.50 (95% CI, 1.30–1.73)), use of anti-epileptic drugs (RR = 1.25 (95% CI, 1.05–1.49)), focal seizures (RR = 1.09 (95% CI, 1.00–1.19)) and seizure frequency (RR = 1.18 (95% CI, 1.10–1.26) for daily seizures; RR = 1.22 (95% CI, 1.10–1.35) for weekly seizures and RR = 1.15 (95% CI, 1.03–1.28) for monthly seizures)). Conclusions EEG abnormalities are common in Africans with epilepsy and are associated with preventable risk factors. Significance EEG is helpful in identifying focal epilepsy in Africa, where timing of focal aetiologies is problematic and there is a lack of neuroimaging services.
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Affiliation(s)
- Symon M Kariuki
- KEMRI-Wellcome Trust Research Programme, P.O. Box 230, Kilifi, Kenya; Nuffield Department of Medicine, University of Oxford, OX3 7BN Oxford, UK.
| | - Steven White
- Department of Clinical Neurophysiology, Great Ormond Street Hospital for Children, WC1N 3JH London, UK
| | - Eddie Chengo
- KEMRI-Wellcome Trust Research Programme, P.O. Box 230, Kilifi, Kenya; Foundation for People with Epilepsy, 80200 Malindi, Kenya
| | - Ryan G Wagner
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, P.O. Box 2 Cornhoek 1360, Johannesburg, South Africa; Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, 901 85 Umeå, Sweden
| | - Kenneth A Ae-Ngibise
- Kintampo Health and Demographic Surveillance System, P.O. Box 200, Kintampo, Ghana
| | - Angelina Kakooza-Mwesige
- Iganga-Mayuge Health and Demographic Surveillance System, P.O. Box 111, Iganga, Uganda; Department of Paediatrics and Child Health, Makerere University College of Health Sciences, P.O. Box 7072, Kampala, Uganda
| | - Honorati Masanja
- Ifakara Health and Demographic Surveillance System, P.O. Box 78373, Ifakara, Tanzania
| | - Anthony K Ngugi
- Population Health Sciences/Research Support Unit, Faculty of Health Sciences, Aga Khan University (East Africa), Aga Khan Hospital Building, Third Parklands Ave., P.O. Box 30270, Nairobi, Kenya
| | - Josemir W Sander
- NIHR University College London Hospitals Biomedical Research Centre, UCL Institute of Neurology, Queen Square, London WC1N 3BG and Epilepsy Society, Chalfont St. Peter SL9 8ES, Bucks, UK; Stichting Epilepsie Instellingen Nederland-SEIN, 2103SW Heemstede, Netherlands
| | - Brian G Neville
- Neurosciences Unit, UCL Institute of Child Health, WC1E 6BT London, UK
| | - Charles R Newton
- KEMRI-Wellcome Trust Research Programme, P.O. Box 230, Kilifi, Kenya; Department of Psychiatry, University of Oxford, OX3 7JX Oxford, UK
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