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Published on: December 18, 2016
Epidemiology of Epilepsy in Nigeria: A Community-Based Study From 3 Sites
Musa M Watila1, Salisu A Balarabe1, Morenikeji A Komolafe1
1From the NIHR University College London Hospitals Biomedical Research Centre (M.M.W., J.W.S.), UCL Queen Square Institute of Neurology; Chalfont Centre for Epilepsy (M.M.W., J.W.S.), Chalfont St. Peter, UK; Neurology Unit (M.M.W., J.M., Y.W.N.), Department of Medicine, University of Maiduguri Teaching Hospital. PMB 1414, Borno State; Neurology Unit (S.A.B.), Department of Medicine, Usman Danfodiyo University Teaching Hospital, Sokoto, Sokoto State; Department of Medicine (M.A.K., M.B.F.), Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Osun State; Department of Psychiatry (S.C.I.), Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Ebonyi State, Nigeria; Biomedical MR Imaging and Spectroscopy Group (W.M.O.), Center for Image Sciences, University Medical Center Utrecht and Utrecht University; Department of Pediatric Neurology (W.M.O., E.v.D.), UMC Utrecht Brain Center, University Medical Center Utrecht, the Netherlands; Department of Clinical and Movement Neurosciences (O.O.), UCL Queen Square Institute of Neurology, London, UK; Department of Mental Health (A.A.M.), Federal Neuropsychiatric Hospital Maiduguri, Borno State; Federal Medical Center (I.A.) Azare, Bauchi State; Department of Clinical Pharmacy and Pharmacy Practice (E.W.H.), Faculty of Pharmaceutical Sciences, Gombe State University; Department of Neurology (G.S.) and Research and Development Unit (G.S.), Dayanand Medical College, Ludhiana, India; Centre for Global Health (A.W.S.), Institute of Health and Society, University of Oslo, Norway; Center for Global Health (A.W.S.), Department of Neurology, Technical University Munich, Germany; and Stichting Epilepsie Instellingen Nederland (J.W.S.), Achterweg 5, SW Heemstede, the Netherlands.
Background:
We determined the prevalence, incidence, and risk factors for epilepsy in Nigeria.
Methods:
We conducted a door-to-door survey to identify cases of epilepsy in 3 regions. We estimated age-standardized prevalence adjusted for nonresponse and sensitivity and the 1-year retrospective incidence for active epilepsy. To assess potential risk factors, we conducted a case-control study by collecting sociodemographic and risk factor data. We estimated odds ratios using logistic regression analysis and corresponding population attributable fractions (PAFs).
Results:
We screened 42,427 persons (age ≥6 years), of whom 254 had confirmed active epilepsy. The pooled prevalence of active epilepsy per 1,000 was 9.8 (95% confidence interval [CI] 8.6-11.1), 17.7 (14.2-20.6) in Gwandu, 4.8 (3.4-6.6) in Afikpo, and 3.3 (2.0-5.1) in Ijebu-Jesa. The pooled incidence per 100,000 was 101.3 (95% CI 57.9-167.6), 201.2 (105.0-358.9) in Gwandu, 27.6 (3.3-128.0) in Afikpo, and 23.9 (3.2-157.0) in Ijebu-Jesa. Children's significant risk factors included febrile seizures, meningitis, poor perinatal care, open defecation, measles, and family history in first-degree relatives. In adults, head injury, poor perinatal care, febrile seizures, family history in second-degree relatives, and consanguinity were significant. Gwandu had more significant risk factors. The PAF for the important factors in children was 74.0% (71.0%-76.0%) and in adults was 79.0% (75.0%-81.0%).
Conclusion:
This work suggests varied epidemiologic numbers, which may be explained by differences in risk factors and population structure in the different regions. These variations should differentially determine and drive prevention and health care responses.
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