Epidemiology of active epilepsy in a suburban community in Southeast Nigeria: A door-to-door survey.

CONTEXT: Epilepsy is one of the most common neurologic conditions afflicting an estimated 65 million people the world over. Current community-based data on the prevalence of active epilepsy in Africa are sparse. AIMS: This study was aimed at determining the prevalence and profile of active epilepsy in a suburban community in Southeast Nigeria. METHODS: It was a two phase cross-sectional descriptive study. In the first phase, those with possible active epilepsy were identified in a door-to-door survey using a modification of the World Health Organization Neuroscience research protocol. In the second phase, cases of active epilepsy were identified and the clinical forms of epilepsy diagnosed based on the International League against Epilepsy guidelines 1993. RESULTS: A total of 6,800 persons was screened in the first phase of the study. There were 29 cases (16 males and 13 females) of active epilepsy. The point prevalence of active epilepsy was 4.3/1,000 (95% confidence interval (95% CI): 2.7-5.9) for the total population, 4.9/1,000 (95% CI: 2.5-7.3) for males and 3.7/1,000 (95% CI: 1.7-5.7) for females. The age-adjusted prevalence for the total population was 4.1/1,000 (US Population 2000). Classified using clinical criteria only, generalized seizures occurred in 62.1% (n=18) while partial seizures occurred in 37.9% (n=11) of cases. CONCLUSIONS: The prevalence of active epilepsy in Southeast Nigeria is comparable to that found in developed and some developing countries but less than that reported in suburban Southwest Nigeria about three decades ago.

Illness concept among people with epilepsy and their caregivers and preferred treatment methods in a suburban community in Southeast Nigeria.

BACKGROUND: Epilepsy, one of the world's most prevalent chronic diseases is still regarded as a supernatural disease in many parts of the world. These superstitious and cultural beliefs tend to influence treatment seeking behavior of people living with epilepsy (PWE) and their caregivers. STUDY DESIGN: People living with epilepsy in a semi-urban community in Southeast Nigeria were identified in a two phase door-to-door cross-sectional descriptive study. Those identified and their caregivers were further interviewed to determine their concepts of the disease, their treatment (actual and preferred) and what informed treatment. RESULTS: We found 29 cases of active epilepsy, 16 (55.2%) males and 13 (44.8%) females. Witchcraft was held as a major cause of epilepsy in the community accounting for 36.2% (n=17) of the responses. The three major treatment modalities used were spiritual (healing churches), traditional (herbal medicines) and orthodox treatment with antiepileptic drugs. Spiritual treatment was the preferred treatment modality, though most (89.7%) have used traditional (herbal medicine) treatment at one point in the course of the disease. Beliefs on epilepsy and information on the disease obtained mostly from non-medical sources informed treatment. CONCLUSION: The epileptic population studied preferred spiritual treatment though use of traditional treatment was also common. Treatment seeking behavior was greatly influenced by their beliefs and information on the disease obtained mainly from non-medical sources.

Epilepsy treatment gap: prevalence and associated factors in Southeast Nigeria.

OBJECTIVES: The treatment gap of epilepsy in developing countries is high, and data on the magnitude and causes of epilepsy treatment gap in Africa are sparse. We aimed to determine the prevalence and causes of epilepsy treatment gap among people with epilepsy in a Suburban community in Southeast Nigeria. MATERIALS AND METHODS: The direct method was used to determine epilepsy treatment gap in a two-phase cross-sectional study. Those with probable epilepsy were identified in a door-to-door survey using a modification of World Health Organization (WHO) protocol in the first phase. In the second phase, an epilepsy-specific questionnaire that was further designed to determine the magnitude and causes of epilepsy treatment gap was used. RESULTS: The overall treatment gap of epilepsy was 76% (n = 22/29). The major contributors to the overall treatment gap were people who were never diagnosed accounting for a diagnostic gap of 38% (n = 11/29) and those who were diagnosed but discontinued antiepileptic drug (AED) treatment of their own volition accounting for a therapeutic gap of 38% (n = 11/29). CONCLUSIONS: Epilepsy treatment gap in Southeast Nigeria is comparable to that in many developing countries. Fifty percent of the overall treatment gap was caused by patients discontinuing AED treatment of their own volition despite continuing fits. This result may indicate that perhaps with appropriate education on the need to adhere to therapy, the treatment gap in the community may be narrowed.

Availability of childhood social services in leprosy settlements in southern Nigeria.

BACKGROUND: Children of leprosy patients deserve social services such as free education, health care services including HIV/AIDS prevention like others. The extent to which these children benefit from such services is not clear. One expects that since they are exposed to health hazards in settlements that they would benefit immensely from preventive health care and other services. Study investigates the extent to which such services are available to them. METHODS: Study was carried out in 3 purposively selected leprosy settlements, Uzuakoli in Abia State, Ohaozara in Ebonyi State and Ogbomoso in Oyo State using 86 children from 10 years and above who are available during study. Structured questionnaire and interview schedule were instruments used. Data were analyzed with Stat Pac Gold package. RESULTS: Provision of social services to children of leprosy patients studied is limited. Only 13 (16.5%) of the children said their parents did not pay school fees. The rest paid. However, despite payment of fees, higher proportion of children in Abia State 43 (95.6%) more than in Oyo State 36 (87.9%) went to school P = .03. About 42 (97.7%) of children in Abia State and 30 (83.3%) in Oyo State lack knowledge of HIV prevention. Neither reproductive health services including HIV/AIDS prevention nor prophylactic treatments are available to them. CONCLUSION: In view of above results, increased social services including HIV/AIDS prevention, prophylactic treatments and health promotions are recommended.

Disabled Persons and HIV/ AIDS Prevention: a Case Study of Deaf and Leprosy Persons in Nigeria

Objective (s): (i) To investigate factors and conditions that influence HIV/AIDS prevention among leprosy and deaf persons in leprosy settlements in Nigerian; (ii) to examine the extent to which the Government includes leprosy and deaf persons in HIV prevention programmes; (iii) To identify immediate needs of leprosy and deaf patients in settlements (iv) to determine possible areas for improving services so as to explore potential solutions Methods: Total sample of 227 inmates and 34 Health Care Workers were studied in three purposively selected settlements. Two intervention concepts; participatory reservation approach (PRA) and planned action (PLA) were utilized in the study. The concepts enabled researchers to examine factors that influenced provision of HIV/AIDS prevention programmes to inmates in settlements. Data collection instruments were questionnaire and focus group discussions for inmates and interview guides for Health Workers. Data were analysed qualitatively and quantitatively with the help of Stat Pac Gold package. Results: Findings showed that there were no reproductive health and and HIV prevention programmes in the settlements. There was lack of Governments' commitment to fund health programmes and to train Health Workers; as well as rejection; isolation; discrimination and discouragement of HIV/AIDS prevention programmes in settlements. There was poor knowledge of mode of transmission of HIV/AIDS among inmates. About 59 (53.6) of inmates in Abia; and 60 (51.3) in Oyo were not interested in voluntary counselling and sex education. Findings showed that inmates in the leprosy settlements were at risk of unprotected sex. About 99 (43.6) in Oyo and 88 (38.8) in Abia State; especially those who were single cohabited with opposite sexes to have babies in settlements (p = 003). Conclusion: Number of inmates that had babies in settlements justifies providing sex education; reproductive health and HIV/AIDS prevention programmes. This will assist in reducing HIV/AIDS prevalence among disabled persons in Nige