Adverse perinatal events, treatment gap, and positive family history linked to the high burden of active convulsive epilepsy in Uganda: A population‐based study. Issue 2 (13th March 2017)

• Record Type: Journal Article
• Authors: Kakooza‐Mwesige, Angelina; Ndyomugyenyi, Donald; Pariyo, George; Peterson, Stefan Swartling; Waiswa, Paul Michael; Galiwango, Edward; Chengo, Eddie; Odhiambo, Rachael; Ssewanyana, Derrick; Bottomley, Christian; Ngugi, Anthony K.; Newton, Charles R. J. C.
• Other Names: Wagner Ryan investigator.; Twine Rhian investigator.; Connor Myles investigator.; Gómez‐Olivé F Xavier investigator.; Collinson Mark investigator.; Kahn Kathleen investigator.; Tollman Stephen investigator.; Masanja Honorati investigator.; Mathew Alexander investigator.; Chabi Martin investigator.; Bauni Evasius investigator.; Kamuyu Gathoni investigator.; Odera Victor Mung'ala investigator.; Mageto James O investigator.; Ae‐Ngibise Ken investigator.; Akpalu Bright investigator.; Akpalu Albert investigator.; Agbokey Francis investigator.; Adjei Patrick investigator.; Owusu‐Agyei Seth investigator.; Kleinschmidt Immo investigator.; Doku Victor C K investigator.; Odermatt ePeter investigator.; Neville Brian investigator.; Sander Josemir W investigator.; White Stev investigator.; Nutman Thomas investigator.; Wilkins Patricia investigator.; Noh John investigator.
• Is Part Of: Epilepsia open. Volume 2:Issue 2(2017)
• Page Start: 188
• Page End: 198
• Publication Date: 2017-03-13
• Subjects: Adverse perinatal events -- Population study of epilepsy -- Risk factors -- Treatment gap -- Uganda; Epilepsy -- Periodicals; Epilepsy -- Research -- Periodicals; Epilepsy; Periodicals; Fulltext; Internet Resources; Periodicals; 616.853005
• DOI: 10.1002/epi4.12048
• Languages: English
• ISSNs: 2470-9239

Abstract

Summary: Objective: To determine the prevalence of active convulsive epilepsy (ACE) and describe the clinical characteristics and associated factors among a rural Ugandan population. Methods: The entire population in Iganga/Mayuge Health Demographic Surveillance Site (IM‐HDSS) was screened using two questions about seizures during a door‐to‐door census exercise. Those who screened positive were assessed by a clinician to confirm diagnosis of epilepsy. A case control study with the patients diagnosed with ACE as the cases and age/sex‐matched controls in a ratio of 1:1 was conducted. Results: A total of 64, 172 (92.8%) IM‐HDSS residents, with a median age of 15.0 years (interquartile range [IQR]: 8.0–29.0), were screened for epilepsy. There were 152 confirmed ACE cases, with a prevalence of 10.3/1, 000 (95% confidence interval [CI]: 9.5–11.1) adjusted for nonresponse and screening sensitivity. Prevalence declined with age, with the highest prevalence in the 0–5 years age group. In an analysis of n = 241 that included cases not identified in the survey, nearly 70% were unaware of their diagnosis. Seizures were mostly of focal onset in 193 (80%), with poor electroencephalogram (EEG) agreement with seizure semiology. Antiepileptic drug use was rare, noted in 21.2% (95% CI: 16.5–25.8), and 119 (49.3%) reported using traditional medicines. History of an abnormal antenatal period (adjusted odds ratio [aOR] 10.28; 95%CI 1.26–83.45; p = 0.029) and difficulties in feeding, crying, breathing in the perinatal period (aOR 10.07; 95%CI 1.24–81.97; p = 0.031) were associated with ACE in children. In adults a family history of epilepsy (aOR 4.38 95%CI 1.77–10.81; p = 0.001) was the only factor associated with ACE. Significance: There is a considerable burden of epilepsy, low awareness, and a large treatment gap in this population of rural sub‐Saharan Africa. The identification of adverse perinatal events as a risk factor for developing epilepsy in children suggests that epilepsy burden may be decreased by improving obstetric and postnatal care.