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Epilepsy in rural South African children--prevalence, associated disability and management
A L Christianson1, M E Zwane, P Manga
1Department of Human Genetics and Developmental Biology, University of Pretoria.
Insights
Epilepsy prevalence in rural South African children is high, with significant associated disabilities. Many children with epilepsy do not receive necessary anticonvulsant treatment, indicating a need for improved healthcare services.
Area of Science:
- Pediatrics
- Neurology
- Public Health
Background:
- Epilepsy is a common neurological disorder with a significant impact on child development.
- Data on childhood epilepsy prevalence and management in rural sub-Saharan Africa, particularly South Africa, is limited.
- Understanding the epidemiology of epilepsy is crucial for effective public health interventions.
Purpose of the Study:
- To determine the prevalence of epilepsy in children aged 2-9 years in rural South Africa.
- To identify associated disabilities in children diagnosed with epilepsy.
- To assess the utilization of anticonvulsant medication among affected children.
Main Methods:
- A two-phase study was conducted in eight villages in Bushbuckridge, South Africa.
- Phase 1 involved house-to-house screening of 6,692 children using a validated questionnaire.
- Phase 2 included paediatric/neurodevelopmental assessments for children screening positive for disability.
Main Results:
- Epilepsy was diagnosed in 49 children, with active prevalence of 6.7/1,000.
- Associated developmental disabilities were present in 71.4% of children with epilepsy.
- Over half (57.1%) of children with epilepsy were not receiving anticonvulsant medication.
Conclusions:
- The prevalence of childhood epilepsy in this rural South African population is higher than previously reported in similar regions.
- Underutilization of anticonvulsant treatment is a significant concern, highlighting deficiencies in healthcare delivery.
- Further research is essential to improve the diagnosis and management of childhood epilepsy in primary healthcare settings.
Objective:
To determine the prevalence of epilepsy and its associated disabilities in rural South African children aged 2-9 years.
Setting:
Eight villages in the district of Bushbuckridge, Northern Province, South Africa.
Design:
A two-phase design was used. The first phase involved screening children on a house-to-house basis by interviewing mothers or caregivers using an internationally validated questionnaire for detecting childhood disability in developing countries. The second phase consisted of a paediatric/neurodevelopmental assessment of the children who screened positive.
Results:
A total of 6,692 children were screened; 722 (10.8%) had a paediatric evaluation and 49 (0.73%) had epilepsy. The lifetime and active prevalences of epilepsy in these children were 7.3/1,000 and 6.7/1,000 respectively. Associated developmental disability was recorded in 35 affected children (71.4%), including 8 (16.3%) in whom this was moderate to severe. More than a half of the children with epilepsy (57.1%) did not receive anticonvulsant medication.
Conclusion:
The prevalence of epilepsy in the rural childhood population investigated is higher than that recorded in most similar studies from sub-Saharan Africa, and the poor utilisation of appropriate anticonvulsant treatment is cause for concern. This study highlights the paucity of relevant information on the epidemiology of epilepsy in South Africa and that the system available for its management, especially in rural areas, appears to have functional deficiencies. Appropriate research is needed to identify the problems in service delivery and to enable the planning and implementation of an appropriate primary health care-based system for the diagnosis and management of epilepsy in children.