Excess Mortality in Active Convulsive Epilepsy and Associated Risk Factors in Sub-Saharan Africa

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Background: In sub-Saharan Africa, there is a paucity of evidence on the magnitude of excess mortality in epilepsy relative to the general population and risk factors associated to this excess. This study estimated excess mortality in people with active convulsive epilepsy (ACE) using data from the Studies of Epidemiology of Epilepsy in Demographic Surveillance Sites in three sub-Saharan African (SSA) countries. Methods: We followed those with and without epilepsy and documented deaths in Agincourt (South Africa), Ifakara (Tanzania) and Kilifi (Kenya) for duration of seven, six and eight years, respectively. Findings: A total of 199 deaths in ACE and 16,801 in general population were observed from the time of diagnosis to the most recent household survey. Mortality rates in ACE were estimated at 31.5 deaths per 1,000 person-years (95%CI: 19.4-43.6) in Agincourt, 23.9 (95%CI: 11.7-36.1) in Ifakara and 24.6 (95%CI: 19.5-29.6) in Kilifi. Pooled estimates of excess mortality (Standardized mortality ratio (SMR)), was 4.8 (95% CI: 4.2-5.6) times higher in PWE than those without epilepsy. Adjusting for age, SMRs were 3.20 (95%CI: 2.41-4.27) in Agincourt, 4.66 (95%CI: 3.46-6.29) in Ifakara and 6.22 (95%CI: 5.15-7.50) in Kilifi. Interpretation: This study demonstrates evidence of excess mortality in PWE in SSA countries. Mortality burden may be reduced by managing seizures with improved access to antiepileptic drugs, preventive measures against accidents, reducing perinatal adverse events at birth, preventing parasite infections with proper management of domesticated animals and hygiene, empowering PWE with education and decent low-risk jobs and managing co-morbidities. Funding Statement: This work was supported by grants from The Wellcome Trust [Grant No. 083744] to C.R.N.; Ifakara Health Institute under Training Unit and Basel Canton. The Agincourt HDSS is funded by the Wellcome Trust, UK (grants 058893/Z/99/A; 069683/Z/02/Z; 085477/Z/08/Z), with important contributions from the University of the Witwatersrand, the South African Medical Research Council, and the William and Flora Hewlett Foundation, National Institute on Aging (NIA) of the NIH, and Andrew W Mellon Foundation, USA. Declaration of Interests: Authors declare no conflict of Interest. Ethics Approval Statement: The study protocol was approved by Ifakara Health Institution Internal Review Board (IHI/IRB/No. A 70-2009) and National Institute of Health Research and Commission of Science and Technology with reference NIMR/HQ/R.8a/Vol. IX/1256. All participants were enrolled through verbal consent.