Translation, adaptation and validation of an epilepsy screening instrument in two Ghanaian languages

The prevalence of epilepsy in sub-Saharan Africa varies considerably, and the exact estimate for Ghana remains unclear, particularly in peri-urban areas where data are scarce. More community-based studies are required to understand better the actual burden of epilepsy in these areas and the difficulties in accessing healthcare.

To adapt and validate a household survey epilepsy-screening instrument in Shai-Osudoku and Ningo-Prampram District of Greater Accra Region, Ghana.

We developed a 17-item epilepsy screening instrument by modifying previously validated English language questionnaires. We included questions that could identify convulsive and non-convulsive seizures. Language experts forward- and back-translated the questionnaires into the two languages: Asante Twi and Dangme. Cases were people with confirmed epilepsy attending healthcare facilities where these languages are used. Controls were unaffected relatives of cases or people attending the same healthcare facilities for other medical conditions. We matched cases and controls for geographical location and ethnicity. An affirmative response to one of the seventeen questions by a participant was deemed a positive screen. The questionnaires were divided into two stages. The first stage consisted of broader, more general questions aimed at identifying potential cases of epilepsy. The second stage involved a more detailed and focused set of questions administered to those who screened positive in the first stage.

One hundred and forty Dangme speakers (70 cases and 70 controls) and 100 Asante Twi speakers (50 cases and 50 controls) were recruited. The sensitivity and specificity for Dangme were: Stage 1, 100% and 80%, and Stage 2, 98.6% and 85.7%. The Dangme version reliably identified epilepsy with positive predictive values of 83.3% and 87.3% at stages 1 and 2. The questionnaire excluded epilepsy with 100% and 98.4% negative predictive values. For the Asante Twi version, the sensitivity and specificity were 98% and 92% (95% at Stage 1, and for Stage 2, 96% and 94%. The Asante Twi questionnaire reliably specified epilepsy with positive predictive values of 92.5% and 94.1% at stages 1 and 2. It excluded epilepsy with negative predictive values of 97.9% and 95.9% for the two stages.

Our questionnaire is valid for the two languages and usable for community-based epilepsy surveys in Ghana. It can also be adapted for other resource-poor settings, although translation and iterative in-country testing will be needed to ensure its validity.