IT happened so fast. In the middle of the end of term examinations, I fell off my desk and hit my head on the floor. I kicked like I was possessed by demons and my eyes turned white. Other students ran out of the examination room. Teachers who were supervising the exams rushed me to the sick bay. La
IT happened so fast. In the middle of the end of term examinations, I fell off my desk and hit my head on the floor. I kicked like I was possessed by demons and my eyes turned white. Other students ran out of the examination room. Teachers who were supervising the exams rushed me to the sick bay. Later, I was referred to Mulago Hospital.â€
This is the story of Moses, who has battled epilepsy for three years.
It is a similar experience for Joseph, who works for a non-governmental organisation in Jinja.
â€œI fell off a boda boda while going for community mobilisation. I sustained several injuries and was admitted for two months. After being discharged, I was told I had epilepsy.â€
Josephâ€™s relatives attribute the problem to witchcraft. They do not believe that Joseph, who has not had the problem since childhood, could get it in adulthood.
It is a common belief in Africa that epileptic people are victims of witchcraft. Justine Engole, the programme officer of the Epilepsy Support Association Uganda, says studies carried out by the association show that 50% of the people affected by the disease believe it is caused by witchcraft and that intensive sensitisation on the likely causes of the illness is still a challenge.
Medical research has proved that epilepsy can be caused by illness, brain damage or abnormal development of the brain. Since epilepsy has so many causes, it is sometimes difficult to determine the cause of a particular case. The disease may be a result of disorders, head and prenatal injuries, environmental and hereditary causes. Recent studies have also linked epilepsy to eating unhygienic pork.
The new studies could force doctors in Africa to go back to the drawing table and re-evaluate the magnitude of the link between eating pork and epilepsy. New findings by neurologists at Texas University in the US have indicated that the main cause of epilepsy in Africa could be related to eating pork.
Neurologists argue that three times more people in Africa than in Europe suffer from epilepsy because of eating pork that is not well cooked. The primary cause of epilepsies in developing countries, they say, is infection by the pork tapeworm known as taenia solium.
Almost one-third of the worldâ€™s epilepsy cases are caused by an avoidable food-borne parasite, according to unpublished research commissioned by the World Health Organisation (WHO).
Neurocysticercosis (NCC), an infection of the brain, has long been known to cause epilepsy and seizures, but the size of the link has surprised experts.
Common in areas with poor sanitation, NCC is the result of infection with the eggs of taenia solium tapeworms. The researchers say eating raw or undercooked meat from pigs infected with taenia solium larvae allows tapeworms to develop in the gut and shed eggs which are passed in human faeces. The eggs are ingested, either by pigs or humans, through contaminated food. They then mature into larvae which travel to the brain and cause cysts, inducing seizures.
This new research is the first to investigate the global burden of epilepsy resulting from NCC infection. The researchers reviewed over 500 articles on NCC published between 1990 and 2008.
â€œThirty percent of all people suffering from epilepsy in countries where tapeworm is frequent â€”developing countries where pork is consumed â€” also suffer from NCC,â€ said epidemiologist Christine Budke, while presenting her preliminary findings to a food safety meeting in Geneva recently.
Arve Lee Willingham, the deputy director of the WHO/Food African Organisation Collaborating Centre for Parasitic Zoonoses, said the 30% figure was â€œfar higher than anyone had ever thought possibleâ€.
Fifty million people worldwide are affected by NCC, resulting in 50,000 deaths in developing countries. Research published in 2004 suggested that two to three million people in Sub-Saharan Africa suffer from NCC-related epilepsy.
Magnitude of the problem in Uganda
Dr. Sheila Ndyanabangi, the principal medical officer in charge of mental health, observes that most people who report mental health problems are diagnosed with epilepsy. â€œIt is a very big issue. About 75% of all cases which register in mental units across the country are epileptic,â€ Ndyanabangi says.
However, she says, epilepsy can be treated. â€œSome people are completely cured and are advised to keep off the medicine,â€ she says.
She adds that generally for all patients, there is great improvement after medication. Ndyanabangi says the cost of epilepsy medicine ranges from sh5,000 to sh100,000 per month, depending on the type of epilepsy and its severity.
According to the Epilepsy Support Association Uganda (ESAU), people become infected with the adult tape worm from the parasite (taeniosis) by eating infested raw or undercooked pork. Large numbers of the eggs of the tapeworm are shed in the infected persons stool and can be ingested by free-roaming pigs if people defecate outdoors. Pigs develop the immature larval form of the parasite (cysticercosis) with hundreds to thousands of small cysts, commonly called pork measles. forming in their muscles, heart and brain, rendering the pork unfit for consumption. Pigs thus affected usually show no signs of disease. People can also become infected with the cystic larval form of the parasite by ingesting it.
In humans, the cysts often develop in the brain, causing a condition called neurocysticercosis, which can cause severe headaches, epileptic seizures and sometimes death.
Neurocysticercosis is considered to be the most common preventable cause of epilepsy in the developing world, rendering people incapacitated and unproductive, and sometimes leading to fatal accidents as a result of seizures. In 2005, veterinary doctors asserted that poorly prepared pork can cause epilepsy.
In May 2008, the Faculty of Veterinary Medicine, Makerere University held a workshop about the same issue and also concurred that poorly prepared pork can cause epilepsy. According to the May 2003 issue of the State Legislatures Magazine, it was confirmed that if pork is poorly stored, prepared and cooked, its chances of causing epilepsy are high.
Doctors advise that prevention strategies should focus on raising standards of hygiene and sanitation. Pigs must be inspected before human consumption. These measures are included in a six-point plan on the control and prevention of NCC in developing countries by WHO.
Medical experts stress that in the short term, epilepsy prevention will need to focus on treatment with anti-tapeworm drugs â€” for both infected people and pigs.
A seven-year $15.5m project in Peru has eradicated NCC from a test site by treating human carriers and checking and treating pigs every two months.
Think twice before you order another stick of pork