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Siewe Fodjo JN, Jada SR, Rovarini J, Bol YY, Carter JY, Hadermann A, Lakwo T, Colebunders R. Accelerating onchocerciasis elimination in humanitarian settings: lessons from South Sudan. Int Health 2024:ihae051. [PMID: 39077839 DOI: 10.1093/inthealth/ihae051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Revised: 04/30/2024] [Accepted: 07/12/2024] [Indexed: 07/31/2024] Open
Abstract
There is persistent meso- and hyperendemicity of onchocerciasis (river blindness) in South Sudan, a country that has endured armed conflict for many years. In 2018, Amref Health Africa, in collaboration with local communities, the South Sudan Ministry of Health and other stakeholders, initiated some interventions, among which was Innovative Approaches to Reduce the Burden of Disease Caused by Onchocerciasis (IARDO) project. This project implemented several strategies, including identifying areas where onchocerciasis elimination programs need strengthening, switching from annual to biannual community-directed treatment with ivermectin (CDTI), additional ivermectin administration to postpartum women and school children and a community-based 'slash and clear' vector control strategy. These measures resulted in increased CDTI coverage, fewer bites from blackfly vectors and decreased onchocerciasis-related morbidity. The feasibility of these interventions, low cost, national government support and community ownership suggest their long-term sustainability.
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Affiliation(s)
- J N Siewe Fodjo
- Global Health Institute, University of Antwerp, Gouverneur Kinsbergen Center, Doornstraat 331, 2610 Wilrijk, Belgium
| | - S R Jada
- Amref Health Africa, UN-OCHA Road, Juba, Republic of South Sudan
| | - J Rovarini
- Amref Health Africa, UN-OCHA Road, Juba, Republic of South Sudan
| | - Y Y Bol
- Neglected Tropical Diseases Unit, Ministry of Health, Ministries Road Juba, Republic of South Sudan
| | - J Y Carter
- Amref Health Africa Headquarters, P.O. Box 30125 Nairobi, Kenya
| | - A Hadermann
- Global Health Institute, University of Antwerp, Gouverneur Kinsbergen Center, Doornstraat 331, 2610 Wilrijk, Belgium
| | - T Lakwo
- Vector Control Division, Ministry of Health, P.O. Box 7272 Kampala, Uganda
| | - R Colebunders
- Global Health Institute, University of Antwerp, Gouverneur Kinsbergen Center, Doornstraat 331, 2610 Wilrijk, Belgium
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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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Efon-Ekangouo A, Nana-Djeunga HC, Nwane P, Lisongue-Tonga E, Domche A, Sumo L, Osei-Atweneboana MY, Geiger A, Kamgno J. Prevalence of epilepsy in Ndom Health District (Littoral Region, Cameroon) after long-term ivermectin-based preventive chemotherapy for the control of onchocerciasis. Epilepsy Behav 2022; 136:108939. [PMID: 36252289 DOI: 10.1016/j.yebeh.2022.108939] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Revised: 09/27/2022] [Accepted: 09/27/2022] [Indexed: 12/14/2022]
Abstract
Assuming the causality relationship between Onchocerca volvulus infection and epilepsy onset, preventive chemotherapy for the control onchocerciasis can result to a significant impact on epilepsy burden. This study aimed at assessing the prevalence of epilepsy in an onchocerciasis endemic area under annual CDTI for 16 years. A cross-sectional survey was conducted in two communities (Kelleng and Nkonkwalla) located in the Ndom Health District (Littoral Region, Cameroon) to assess the prevalence of epilepsy using a standardized questionnaire for non-specialists in tropical areas. Data on the nuisance of onchocerciasis vector and distance of surveyed households to the river were also collected. Epilepsy status was collected from 367 participants (sex ratio (M/F): 1.13). The crude prevalence of epilepsy was estimated at 8.4 % (95 % CI: 5.8-11.8); the highest prevalence was found in females (13.8 %; 95 % CI: 8.8-20.3) compared to males (5.0 %; 95 % CI: 2.4-9.04)) (p-value = 0.02) and in Nkonkwalla (9.0 %; 95 % CI: 5.5-13.6) (p-value = 0.82) compared to Kelleng (7.7 %; 95 % CI: 4.06-13.13). After 16 years of CDTI in Kelleng, crude prevalence of epilepsy decreased from 10.2 % to 7.2 % (p-value = 0.19), whereas the age sex-standardized prevalence dropped from 13.5 % to 7.7 % between 2004 and 2020 (p-value = 0.05). The median age of epilepsy cases shifted from 24 (IQR: 20-30) in 2004 to 28 years (IQR: 23-34) in 2020. The shift in age-specific prevalence over the years suggests a decreasing incidence of epilepsy in areas under long-term CDTI and a significant impact of onchocerciasis control on the prevalence of epilepsy.
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Affiliation(s)
- Arnauld Efon-Ekangouo
- Centre for Research on Filariasis and Other Tropical Diseases (CRFilMT), PO Box 5797, Yaoundé, Cameroon; INTERTRYP, Institut de Recherche pour le Développement (IRD), University of Montpellier, TA A-17/G Campus International de Baillarguet, 34398 Montpellier cedex 5, France
| | - Hugues C Nana-Djeunga
- Centre for Research on Filariasis and Other Tropical Diseases (CRFilMT), PO Box 5797, Yaoundé, Cameroon.
| | - Philippe Nwane
- Centre for Research on Filariasis and Other Tropical Diseases (CRFilMT), PO Box 5797, Yaoundé, Cameroon; Department of Animal Biology and Physiology, Faculty of Sciences, University of Yaoundé I, PO Box 812, Yaoundé, Cameroon
| | - Elvis Lisongue-Tonga
- Centre for Research on Filariasis and Other Tropical Diseases (CRFilMT), PO Box 5797, Yaoundé, Cameroon
| | - André Domche
- Centre for Research on Filariasis and Other Tropical Diseases (CRFilMT), PO Box 5797, Yaoundé, Cameroon; Department of Animal Biology and Physiology, Faculty of Sciences, University of Yaoundé I, PO Box 812, Yaoundé, Cameroon
| | - Laurentine Sumo
- Department of Biological Sciences, Faculty of Science, University of Bamenda, PO Box 39, Bambili, Cameroon
| | - Mike Yaw Osei-Atweneboana
- Biomedical and Public Health Research Unit, CSIR-Water Research Institute, Council for Scientific and Industrial Research (CSIR), Ghana; CSIR-College of Science and Technology, Accra, Ghana
| | - Anne Geiger
- INTERTRYP, Institut de Recherche pour le Développement (IRD), University of Montpellier, TA A-17/G Campus International de Baillarguet, 34398 Montpellier cedex 5, France
| | - Joseph Kamgno
- Centre for Research on Filariasis and Other Tropical Diseases (CRFilMT), PO Box 5797, Yaoundé, Cameroon; Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, PO Box 1364, Yaoundé, Cameroon
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Dilliott D, Addiss D, Thickstun C, Djima AM, Comoe E, Thompson L, Neema S, Amuyunzu-Nyamongo M, Wung-Buh A, McFarland D, Gyapong M, Krentel A. A mixed-methods exploration into the resilience of community drug distributors conducting mass drug administration for preventive chemotherapy of lymphatic filariasis and onchocerciasis in Côte d'Ivoire and Uganda. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000700. [PMID: 36962463 PMCID: PMC10022276 DOI: 10.1371/journal.pgph.0000700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 06/06/2022] [Indexed: 11/18/2022]
Abstract
Volunteer community drug distributors (CDDs) have been vital to progress made in the elimination of onchocerciasis and lymphatic filariasis; two neglected tropical diseases amenable to preventive chemotherapy (PC-NTDs). However, formative work in Côte d'Ivoire and Uganda revealed that CDDs can encounter considerable challenges during mass drug administration (MDA). CDDs must be resilient to overcome these challenges, yet little is known about their resilience. This mixed-methods study explored the resilience of CDDs in Côte d'Ivoire and Uganda. The characteristics and experiences of 248 CDDs involved in the 2018 MDAs in Côte d'Ivoire (N = 132) and Uganda (N = 116) were assessed using a micronarrative survey. Thematic analysis of CDDs' micronarratives was used to identify challenges they encountered during MDA. Resilience was assessed using the Connor-Davidson Resilience Scale 25 (CD-RISC-25). Variables from the micronarrative survey found to be individually associated with mean CD-RISC-25 score (P<0.05) through bivariate analyses were included in a multiple linear regression model. Post-hoc, country-specific analyses were then conducted. Thematic analysis showed that CDDs encountered a wide range of challenges during MDA. The aggregate model revealed that CDDs who had positive relationships or received support from their communities scored higher on the CD-RISC-25 on average (P<0.001 for both), indicating higher resilience. These trends were also observed in the country-specific analyses. Mean CD-RISC-25 scores were unaffected by variations in district, age, gender, and length of involvement with the NTD program. Community support during MDA and positive community-CDD relationships appear to be associated with CDDs' personal capacity to overcome adversity. Involving communities and community leadership in the selection and support of CDDs has the potential to benefit their well-being. This study establishes the CD-RISC-25 as a useful tool for assessing the resilience of CDDs. Further research is needed to understand, promote, and support the resilience of this valuable health workforce, upon which NTD programs depend.
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Affiliation(s)
| | - David Addiss
- NTD Support Center, Task Force for Global Health, Decatur, Georgia, United States of America
| | - Charles Thickstun
- Bruyère Research Institute, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Adam Mama Djima
- Programme National de Lutte contre la Schistosomie, les Géo-Helminthiases et la Filariose Lymphatique, Ministère de la Santé et de l'Hygiène Publique, Abidjan, Côte d'Ivoire
| | - Esther Comoe
- Programme National de Lutte contre la Schistosomie, les Géo-Helminthiases et la Filariose Lymphatique, Ministère de la Santé et de l'Hygiène Publique, Abidjan, Côte d'Ivoire
| | - Lakwo Thompson
- Onchocerciasis Control Programme, Ministry of Health, Kampala, Uganda
| | | | | | | | - Deborah McFarland
- Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
| | - Margaret Gyapong
- Center for Health Policy and Implementation Research, Institute for Health Research, University for Health and Allied Sciences, Ho, Volta Region, Ghana
| | - Alison Krentel
- Bruyère Research Institute, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
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Angwafor SA, Bell GS, Ngarka L, Otte W, Tabah EN, Nfor LN, Njamnshi TN, Njamnshi AK, Sander JW. Incidence and prevalence of epilepsy and associated factors in a health district in North-West Cameroon: A population survey. Epilepsy Behav 2021; 121:108048. [PMID: 34083120 DOI: 10.1016/j.yebeh.2021.108048] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 04/28/2021] [Accepted: 04/28/2021] [Indexed: 11/25/2022]
Abstract
This population-based cross-sectional survey with a follow-up case-control study assessed the prevalence, incidence, and risk factors for epilepsy in a rural health district in the North-West Region of Cameroon. Community-based epilepsy screening targeted all inhabitants, six years and older, in all 16 health areas in the Batibo Health District. During door-to-door visits, trained fieldworkers used a validated questionnaire to interview consenting household heads to screen for epilepsy in eligible residents. Trained physicians subsequently assessed people with suspected seizures. After clinical assessment, they confirmed or refuted the diagnosis and estimated the date of epilepsy onset. A trained nurse interviewed people with epilepsy and randomly selected healthy individuals, obtaining relevant demographic details and information on exposure to risk factors for epilepsy. Out of 36,282 residents screened, 524 had active epilepsy. The age-standardized prevalence of active epilepsy was 33.9/1,000 (95% CI: 31.0-37.1/1,000). We estimated the one-year age-standardized epilepsy incidence at 171/100,000 (95%CI: 114.0-254.6). Active epilepsy prevalence varied widely between health areas, ranging between 12 and 75 per 1,000. The peak age-specific prevalence was in the 25-34 age group. In adults, multivariate analysis showed that having a relative with epilepsy was positively associated with epilepsy. Epilepsy characteristics in this population, geographical heterogeneity, and the age-specific prevalence pattern suggest that endemic neurocysticercosis and onchocerciasis may be implicated. Further investigations are warranted to establish the full range of risk factors for epilepsy in this population.
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Affiliation(s)
- Samuel A Angwafor
- NIHR University College London Hospitals Biomedical Research Centre, UCL Queen Square Institute of Neurology, London WC1N 3BG and Chalfont Centre for Epilepsy, Chalfont St Peter, Bucks SL9 0RJ, United Kingdom; Faculty of Health Sciences, University of Bamenda, Cameroon
| | - Gail S Bell
- NIHR University College London Hospitals Biomedical Research Centre, UCL Queen Square Institute of Neurology, London WC1N 3BG and Chalfont Centre for Epilepsy, Chalfont St Peter, Bucks SL9 0RJ, United Kingdom
| | - Leonard Ngarka
- Neurology Department, Central Hospital Yaoundé/Faculty of Medicine and Biomedical Sciences (FMBS), The University of Yaoundé I, Yaoundé, Cameroon; Brain Research Africa Initiative (BRAIN), Yaoundé, Cameroon/Geneva, Switzerland
| | - Willem Otte
- Department of Pediatric Neurology, UMC Utrecht Brain Center, University Medical Center Utrecht and Utrecht University, Utrecht, Netherlands
| | - Earnest N Tabah
- Department of Public Health, Faculty of Medicine and Biomedical Sciences, University Of Dschang, Cameroon & Department of Disease Control, Ministry of Public Health, Yaounde, Cameroon
| | - Leonard N Nfor
- Neurology Department, Central Hospital Yaoundé/Faculty of Medicine and Biomedical Sciences (FMBS), The University of Yaoundé I, Yaoundé, Cameroon; Brain Research Africa Initiative (BRAIN), Yaoundé, Cameroon/Geneva, Switzerland
| | - Theophilus N Njamnshi
- Department of Medical Laboratory Science, School of Health and Medical Science, Kumbo, Catholic University of Cameroon, Bamenda, Cameroon
| | - Alfred K Njamnshi
- Neurology Department, Central Hospital Yaoundé/Faculty of Medicine and Biomedical Sciences (FMBS), The University of Yaoundé I, Yaoundé, Cameroon; Brain Research Africa Initiative (BRAIN), Yaoundé, Cameroon/Geneva, Switzerland.
| | - Josemir W Sander
- NIHR University College London Hospitals Biomedical Research Centre, UCL Queen Square Institute of Neurology, London WC1N 3BG and Chalfont Centre for Epilepsy, Chalfont St Peter, Bucks SL9 0RJ, United Kingdom; Stichting Epilepsie Instelligen Nederland (SEIN), Heemstede, Netherlands
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Konipo FDN, Dolo H, Daou M, Coulibaly YI, Diallo H, Sangare M, Coulibaly SY, Sangare M, Doumbia S, Maiga YM. Using community health workers as an alternative approach for epidemiological research on epilepsy in six health districts in Mali. Epilepsy Behav 2021; 117:107842. [PMID: 33631436 DOI: 10.1016/j.yebeh.2021.107842] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 12/25/2020] [Accepted: 02/01/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND In Mali, the burden of epilepsy is underestimated due to socio-cultural barriers that keep most people with epilepsy out of the local health facilities. The objective of this study was to evaluate the performance of trained community health workers (CHWs) in identifying epilepsy cases (active case detection) as compared to the passive cases detection (PCD) during outpatient visits at the community health centers in the health districts (HDs) of Kolokani, Kayes, Kéniéba, Sikasso, Kadiolo, and Tominian. METHODS A two-phase cross-sectional study was conducted from February to December 2019. In phase 1, trained CHWs conducted a census in 1017 villages organized into 174 community health centers which are part of the six study HDs to identify suspected epilepsy cases (SEC). Investigators used a modified epilepsy screening questionnaire from a validated standard questionnaire with the following three (3) questions: (i) Does or did the subject have a loss of consciousness and/or a loss of urine and/or drooling? (ii) Does or did the subject have an uncontrollable shake or abnormal movements of limb(s) (convulsions), with sudden onset and duration of a few minutes? (iii) Has or had the subject ever been told that he or she has epilepsy? During phase 2, neurologists confirmed the supposedly SEC (censed by the CHWs) in the first 30 villages with the highest number of SEC in each HD that were reported during phase 1. RESULTS Of a total of 4830 SEC, 422 (10%) were identified by PCD during routine outpatient visits and 4408 (90%) through the active case detection (ACD) using the trained CHWs. The majority of SEC reported by the CHWs (PCD) were confirmed by neurologists, i.e. 82.9% (1645/1985). Phenobarbital was available in only 26 (14.9%) of the 174 surveyed health centers. Confirmed cases of epilepsy were reported in all the 174 health centers with prevalence varying from 91/100,00 to 285/100,000. CONCLUSION Active case detection of epilepsy using trained CHWs is an effective approach for epidemiological studies of epilepsy in the community settings as compared to the passive approach.
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Affiliation(s)
- Fatoumata Dite Nènè Konipo
- International Center of Excellence in Research (ICER), Faculty of Medicine and Odontostomatology, Point G, Bamako, Mali; Unité de Recherche et de Formation sur les Filarioses (Research and Training Unit on Filarioses), Mali.
| | - Housseini Dolo
- International Center of Excellence in Research (ICER), Faculty of Medicine and Odontostomatology, Point G, Bamako, Mali; Unité de Recherche et de Formation sur les Filarioses (Research and Training Unit on Filarioses), Mali; Faculty of Medicine and Odontostomatology, Point G, Bamako, Mali
| | - Mariam Daou
- Neurology Department of the Gabriel Touré Teaching Hospital, Mali
| | - Yaya Ibrahim Coulibaly
- International Center of Excellence in Research (ICER), Faculty of Medicine and Odontostomatology, Point G, Bamako, Mali; Unité de Recherche et de Formation sur les Filarioses (Research and Training Unit on Filarioses), Mali; Faculty of Medicine and Odontostomatology, Point G, Bamako, Mali
| | - Hassane Diallo
- Neurology Department of the Gabriel Touré Teaching Hospital, Mali
| | - Moussa Sangare
- International Center of Excellence in Research (ICER), Faculty of Medicine and Odontostomatology, Point G, Bamako, Mali; Unité de Recherche et de Formation sur les Filarioses (Research and Training Unit on Filarioses), Mali; Faculty of Medicine and Odontostomatology, Point G, Bamako, Mali
| | - Siaka Yamoussa Coulibaly
- International Center of Excellence in Research (ICER), Faculty of Medicine and Odontostomatology, Point G, Bamako, Mali; Unité de Recherche et de Formation sur les Filarioses (Research and Training Unit on Filarioses), Mali
| | - Modibo Sangare
- Faculty of Medicine and Odontostomatology, Point G, Bamako, Mali
| | - Seydou Doumbia
- International Center of Excellence in Research (ICER), Faculty of Medicine and Odontostomatology, Point G, Bamako, Mali; Faculty of Medicine and Odontostomatology, Point G, Bamako, Mali
| | - Youssoufa M Maiga
- Faculty of Medicine and Odontostomatology, Point G, Bamako, Mali; Neurology Department of the Gabriel Touré Teaching Hospital, Mali
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