High prevalence of epilepsy in onchocerciasis endemic health areas in Democratic Republic of the Congo

Background:A high prevalence of epilepsy has been observed in many onchocerciasis endemic regions.This study is to estimate the prevalence of active epilepsy and exposure to Onchocerca volvulus infection in a rural population in Ituri province,Democratic Republic of Congo.Methods:In August 2016,a community-based cross-sectional study was conducted in an onchocerciasis endemic area in the rural health zone of Logo,Ituri Province.Households within two neighbouring health areas were randomly sampled.To identify persons with epilepsy,a three-stage approach was used.In the first stage,all individuals of the selected households were screened for epilepsy by non-medical field workers using a validated 5-item questionnaire.In the second and third stage,suspected cases of epilepsy were examined by non-specialist medical doctors,and by a neurologist,respectively.A case of epilepsy was defined according to the 2014 International League Against Epilepsy(ILAE)guidelines.Exposure to O.volvulus was assessed by testing for IgG4 antibodies to an O.volvulus antigen(OV16 Rapid Test,)in individuals aged 3 years and older.Results:Out of 1389 participants included in the survey,64 were considered to have active epilepsy(prevalence 4.6%)(95%confidence interval[CI]:3.6-5.8).The highest age-specific epilepsy prevalence estimate was observed in those aged 20 to 29 years(8.2%).Median age of epilepsy onset was 10 years,with a peak incidence of epilepsy in the 10 to 15 year-old age group.OV16 test results were available for 912 participants,of whom 30.5%(95%CI,27.6-33.6)tested positive.The prevalence of OV16 positivity in a village ranged from 8.6 to 68.0%.After adjusting for age,gender and ivermectin use,a significant association between exposure to onchocerciasis and epilepsy was observed(adjusted odds ratio=3.19,95%CI:1.63-5.64)(P<0.001).Conclusions:A high prevalence of epilepsy and a significant association between epilepsy and exposure to O.volvulus were observed in the population in Ituri province,Democratic Republic of Congo.There is an urgent need to implement a CDTI programme and to scale up an epilepsy treatment and care programme.

Community perceptions of epilepsy and its treatment in an onchocerciasis endemic region in Ituri,Democratic Republic of Congo

Background:A recent study in the Logo and Rethy health zones in the Ituri Province in the Democratic Republic of Congo(DRC)reported that the majority of the persons with epilepsy(PWE)had not been treated with anti-epileptic medication(AEM)or had stopped treatment.Prior to the implementation of an epilepsy treatment programme in these health zones,this study investigated the perceptions and experiences regarding epilepsy and its treatment amongst community leaders,PWE and/or their families,traditional healers and health professionals.Methods:A total of 14 focus group discussions(FGD)and 39 semi-structured interviews(SSI)were conducted with PWE and/or their family members,community leaders,traditional healers,and health professionals in the Logo and Rethy health zones during February 2-19,2017.Results:In the two health zones,the clinical signs of convulsive epilepsy were recognized by community members.However,a variety of misconceptions about epilepsy were identified including the beliefs that epilepsy is a family-related condition,a contagious disease,is transmitted by insects,saliva or by touching a person of the same sex during seizures,or is caused by evil spirits and witchcraft.The role of traditional healers in spreading these beliefs was revealed.The study also reported sexual abuse on PWE,stigmatisation of PWE and loss of productivity of PWE and their families.Some PWE had been using AEM and traditional treatment but were not convinced about the efficacy of these treatment options.The lack of training of health providers about epilepsy care,financial barriers in obtaining AEM,and the shortage of AEM at primary health facilities were revealed.As remedies,the community requested access to a decentralized center for epilepsy treatment.They also proposed using churches and community health workers as communication channels for information about epilepsy.Conclusions:Clinical signs of convulsive epilepsy were recognized by the community in the Logo and Rethy health zones but many misconceptions about epilepsy were identified.A comprehensive community-based epilepsy treatment programme with an affordable uninterrupted AEM supply needs to be established.Such a programme should address stigma,misconceptions,sexual abuse and foster the rehabilitation of PWE to alleviate poverty.