Abstract
A high prevalence of epilepsy has been observed in several onchocerciasis-endemic villages in the Sanaga River basin, Cameroon. Recent studies suggest that ivermectin, a drug that is distributed annually with the aim of eliminating onchocerciasis, may have a protective effect against acquiring onchocerciasis-associated epilepsy (OAE). This study, therefore, provides an in-depth understanding of both the complex therapeutic landscape for epilepsy as well as the experiences related to the 'community-directed treatment with ivermectin' (CDTI) campaign in order to identify a more trenchant path forward in the fight against epilepsy. Based on a mixed methods study combining a qualitative strand with a quantitative survey, we found that epilepsy was perceived to have had an epidemic emergence in the past and was still considered an important health issue in the study area. Socio-economic status, availability and accessibility of drugs and practitioners, as well as perceived aetiology shaped therapeutic itineraries for epilepsy, which included frequenting (in)formal biomedical health care providers, indigenous and/or faith healing practitioners. Ivermectin uptake for onchocerciasis was generally well known and well regarded. The CDTI faced structural and logistical bottlenecks undermining equal access and optimal adherence to the drug. Locally accessible, uninterrupted, sustainable and comprehensive health-service delivery is essential to help alleviate the epilepsy burden on afflicted households. Addressing structural challenges of CDTI and communicating the potential link with epilepsy to local populations at risk could optimize the uptake of this potentially significant tool in OAE prevention.
Highlights
In Cameroon, a high prevalence of epilepsy has been reported in several onchocerciasisendemic villages in the Sanaga River basin (Centre and Littoral Region) [1,2,3,4]
Based on a mixed methods study combining a qualitative strand with a quantitative survey, we found that epilepsy was perceived to have had an epidemic emergence in the past and was still considered an important health issue in the study area
We describe our findings on the knowledge, experiences and perceptions of onchocerciasis and community-directed treatment with ivermectin’ (CDTI)
Summary
In Cameroon, a high prevalence of epilepsy has been reported in several onchocerciasisendemic villages in the Sanaga River basin (Centre and Littoral Region) [1,2,3,4]. Epilepsy is “a brain disease characterized by abnormal brain activity causing seizures or unusual behaviour, sensations and sometimes loss of awareness” ([5] p.xiii). Epilepsy is characterized by the neurobiological, cognitive and psychological consequences of this condition. The condition results in considerable psychological, social and economic ramifications for people living with epilepsy and their relatives [5,6,7,8]. Research has repeatedly shown that people with epilepsy can be confronted with stigmatisation and discrimination. They are more likely to abandon school at an early age and have reduced prospects of employment and marriage.
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