By Joyce Nyakato
Parasites and poor antenatal care are the main causes of epilepsy in sub-Saharan Africa. The findings of a study titled, Prevalence of active convulsive epilepsy in sub-Saharan Africa and associated risk factors: cross-sectional and case-control studies, were published on Friday in the Lancet Neurology Journal, reveals.
The study was conducted by the International Network for the Demographic Evaluation of Populations and Their Health in Uganda, Kenya, South Africa, Tanzania and Ghana.
It targeted 1,711 people that had already been diagnosed as having active convulsive epilepsy. These, along with 2,033, who did not have epilepsy, were given a questionnaire to complete about their lifestyle habits. They also had their blood samples taken to test for exposure to malaria, HIV and other parasitic diseases that are common in the developing world.
Epilepsy is one of the most common neurological conditions worldwide and is more common in poor countries. This study in sub-Saharan Africa has been the first to reveal the true extent of the neurological problem and the associated risk factors.
The study chose to focus on people with convulsive epilepsies as they are the most reliably detected and reported and there remains a substantial stigma attached to patients with the disease. It was found that those who had been exposed to parasitic diseases were more likely to have epilepsy than those who had not.
“Epilepsy had previously been linked with various parasite infections, but this is the first study to reveal the extent of the problem,” says Dr. Anthony Ngugi, one of the leading researchers. He says several studies had been done before, but did not exactly tell if the risk factors were the same throughout Africa.
The most common parasitic infection identified as a risk factor was onchocerciasis (Infestation with slender threadlike roundworms deposited under the skin by the bite of black fleas), which is most common in parts of western Uganda and northern Tanzania.
Among children, the greatest risk factors for developing epilepsy were complications associated with delivery and head injury. Ngugi explains that the researchers gave questionnaires to parents or guardians of children who had convulsive epilepsy, to find out the circumstances surrounding their birth.
Prof. Charles Newton from the Wellcome Trust Programme at the Kenyan Medical Research Institute and the Department of Psychiatry at Oxford University, who led the study, also noted that the study demonstrates that many cases of epilepsy could be entirely preventable with elimination of parasites in Africa.
Some of these have been controlled in some areas. The incidence of epilepsy could be reduced by 30%-60% with appropriate control measures. The study recommends that programmes to control parasitic diseases and access to better antenatal care could substantially reduce the prevalence of the disease in this region.
Facilities for diagnosis, treatment and on-going management of epilepsy are virtually non-existent in many of the world’s poorest regions. That is why it is important that the health systems improve care of pregnant mothers so they can have safe deliveries.