Abstract
BackgroundEpilepsy is a severe neurological disorder with huge psychological, social, and economic consequences, including premature deaths and loss of productivity. Sub-Saharan Africa carries the highest burden of epilepsy. The management of epilepsy in Cameroon remains unsatisfactory due to poor identification of cases and a limited knowledge of the distribution of the disease. The objective of this study was to determine whether community drug distributors (CDDs) - volunteers selected by their communities to distribute ivermectin against onchocerciasis and who have been proven efficient to deliver other health interventions such as insecticide-treated bed nets to prevent malaria, vitamin A tablets, and albendazole to treat soil transmitted helminthiasis - can be used to reliably identify people living with epilepsy to promote better management of cases.MethodsThis study was carried out in three health Districts in Cameroon. An exhaustive house to house census was carried out by trained CDDs under the supervision of local nurses. In each household, all suspected cases of epilepsy were identified. In each health district, five communities were randomly selected for a second census by trained health personnel (research team). The results of the two censuses were compared for verification purposes.ResultsA total of 53,005 people was registered in the 190 communities surveyed with 794 (1.4%) individuals identified as suspected cases of epilepsy (SCE) by the CDDs. In the 15 communities where the SCE census was verified, the average ratio between the number of suspected cases of epilepsy reported in a community by the research team and that reported by the CDDs was 1.1; this ratio was < 0.8 and > 1.2 in 6 communities.ConclusionsThe results of this study suggest that CDDs, who are present in about 200,000 communities in 31 Sub Saharan African countries where onchocerciasis is endemic, can be successfully used to assess epilepsy prevalence, and therefore map epilepsy in many African countries.
Highlights
Epilepsy is a severe neurological disorder with huge psychological, social, and economic consequences, including premature deaths and loss of productivity
The results of this study suggest that community drug distributors (CDDs), who are present in about 200,000 communities in 31 Sub Saharan African countries where onchocerciasis is endemic, can be successfully used to assess epilepsy prevalence, and map epilepsy in many African countries
These three Health Districts (HDs) are highly endemic for onchocerciasis [45, 46] and community-directed treatment with ivermectin (CDTI) has been in place since 1999
Summary
Epilepsy is a severe neurological disorder with huge psychological, social, and economic consequences, including premature deaths and loss of productivity. Epilepsy is associated with significant psychological, neurobiological, cognitive, social, and economic consequences including increased health care needs, premature deaths and loss of productivity. The number of people suffering from lifetime epilepsy (i.e. with a history of epilepsy, regardless of treatment or recent seizure activity) is estimated to be 6.8 million in high-income countries and 62 million in low- and middle-income countries (45 and 17 million in rural and urban areas, respectively) [2]. The numbers of people with active epilepsy (i.e. those who may benefit from treatment) are estimated at 5.7 and 27 million in high-income and low- and middle-income countries, respectively [2]. The median annual incidence of epilepsy - estimated to be 50.4/100,000 - is significantly higher in low- and middle-income countries (81.7/100,000) than in high-income countries (45.0/100,000) [4]
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