Cognition, mood and quality-of-life outcomes among low literacy adults living with epilepsy in rural Kenya: A preliminary study

Patrick N Mwangala,Symon M Kariuki,Moses K Nyongesa,Paul Mwangi,Esther Chongwo,Charles R Newton,Amina Abubakar

doi:10.1016/j.yebeh.2018.05.032

Patrick N Mwangala, Symon M Kariuki + Show 5 more

Open Access

https://doi.org/10.1016/j.yebeh.2018.05.032

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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.

Highlights

Epilepsy, a common neurological disorder, accounts for a significantly high proportion of the global burden of disease [1]
The prevalence of epilepsy is higher in sub-Saharan Africa (SSA) than in other parts of the world its estimates vary across regions [4]
Adults living with epilepsy were significantly younger, presenting with lower educational outcomes, and likely to be unmarried

Summary

Introduction

A common neurological disorder, accounts for a significantly high proportion of the global burden of disease [1]. In Kilifi, the prevalence of active convulsive epilepsy is estimated to be 7.8/1000, but this could double if nonconvulsive epilepsy is taken into account [4]. Over two-thirds of epilepsy cases in Africa present with focal features [5], which are important risk factors for neurological impairments and cognitive and mental health disorders [5,6,7]. Adults living with epilepsy have been observed to present with poor mental health and psychosocial adjustment problems including unemployment, poor marriage prospects, and limited education [10,13,14,15,16]

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