Abstract
In June 2020, a door-to-door household survey was conducted in Mvolo County, an onchocerciasis-endemic area in South Sudan. A total of 2357 households containing 15,699 individuals agreed to participate in the study. Of these, 5046 (32.1%, 95% CI: 31.4–32.9%) had skin itching and 445 (2.8%, 95% CI: 2.6–3.1%) were blind. An epilepsy screening questionnaire identified 813 (5.1%) persons suspected of having epilepsy. Of them, 804 (98.9%) were seen by a medical doctor, and in 798 (98.1%) the diagnosis of epilepsy was confirmed. The overall epilepsy prevalence was 50.8/1000 (95% CI: 47.6–54.4/1000), while the prevalence of nodding syndrome was 22.4/1000 (95% CI: 20.1–24.9/1000). Younger age, being male, skin itching, blindness, and living in a neighbourhood or village close to the Naam River were risk factors for epilepsy. The annual incidence of epilepsy was 82.8/100,000 (95% CI: 44.1–141.6/100,000). Among children 7–9 years old without epilepsy, 34% were Ov16 seropositive, suggesting high ongoing Onchocerca volvulus transmission, but only 41.9% of them took ivermectin during the last mass distribution. In conclusion, a high prevalence and incidence of epilepsy was observed in Mvolo, South Sudan. Strengthening of the onchocerciasis elimination programme is urgently needed in order to prevent epilepsy in this region.
Highlights
A high prevalence of epilepsy, including nodding syndrome (NS), has been observed in onchocerciasis-endemic areas in South Sudan [1,2,3,4]
In 2013, the epilepsy prevalence in Mvolo County in Western Equatoria was estimated by the South Sudan Relief and Rehabilitation Commission to be 8.4% (4025/48,100) (Anthony Amba, personal communication)
This high prevalence was confirmed during a rapid assessment of the epilepsy prevalence in Mvolo in Western Equatoria
Summary
A high prevalence of epilepsy, including nodding syndrome (NS), has been observed in onchocerciasis-endemic areas in South Sudan [1,2,3,4]. In 2013, the epilepsy prevalence in Mvolo County in Western Equatoria was estimated by the South Sudan Relief and Rehabilitation Commission to be 8.4% (4025/48,100) (Anthony Amba, personal communication). This high prevalence was confirmed during a rapid assessment of the epilepsy prevalence in Mvolo in Western Equatoria. In 1948, DJ Lewis, a medical entomologist, described Mvolo as a place with extremely intense Simulium spp. biting and high Onchocerca volvulus infection prevalence in the flies (in up to 10% of flies L3 larvae were identified in the heads) [5] He described Mvolo as having only a police post with very few people residing in the area.
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