Epidemiology of epilepsy in rural Benin: prevalence, incidence, mortality, and follow-up.

PURPOSE: Epilepsy is a major clinical and social issue in Africa. This study was conducted to estimate the prevalence, incidence, mortality, and therapeutic outcome in rural Djidja in Benin. METHODS: This was a two-phase study with a cross-sectional phase and 18 months of follow-up. In the first phase, information was obtained using door-to-door surveys, reports from key informants, and medical sources. People were interviewed using a validated screening questionnaire for epilepsy in tropical regions. The diagnosis of epilepsy was confirmed by a neurologist. We used a capture-recapture method to estimate the number of people with epilepsy (PWE). PWE were followed every month for 18 months after the cross-sectional survey. We asked the health services, the general population, and village leaders in the study area to identify suspected cases of epilepsy occurring during the follow-up. New cases were updated every month after confirmation. Antiepileptic drugs were prescribed to PWE. KEY FINDINGS: We surveyed 11,668 subjects (male-to-female ratio 0.9) and identified 123 PWE, yielding a prevalence of 10.5 per 1,000 (95% confidence interval (CI) 8.8-12.6/1,000). Combining the three sources, we found 148 PWE and a prevalence of 12.7 per 1,000 (95% CI 10.7-14.9/1,000). After application of the capture-recapture method, the prevalence was estimated to be as high as 38.4 per 1,000 (95% CI 34.9-41.9/1,000). The cumulative incidence was 104.2 per 100,000 and the mean annual incidence was 69.4 per 100,000. The mean annual mortality was 20.8 per 1,000. After treatment, 45% of PWE had total seizure remission and 35% had a decrease in the number of seizures. SIGNIFICANCE: This study shows that door-to-door survey findings could be improved by using information from other sources. The follow-up suggests that epilepsy could be controlled. Continuous drug delivery and regular follow-up are key.

Prevalence of epilepsy in the 15 years and older in Benin: a door-to-door nationwide survey.

PURPOSE: Estimate the prevalence of epilepsy in the 15 years and older in Benin. METHODS: We used a random multistage sampling design to select a representative sample of the 15 years and older in Benin. From March to May 2010, people were screened door-to-door in the twelve regions of Benin. Screening and data collection were performed using a validated standardised questionnaire of epilepsy in tropical regions. A neurologist examined all people suspected of epilepsy. RESULTS: We identified 174 suspected epilepsy cases from 13,046 screened people; 105 were confirmed by the neurologist (54 men and 51 women). The mean age of PWE was 28.9±14.3 years. The estimate of crude prevalence of epilepsy in the 15 years and older in Benin was 8.05/1000 (95% CI: 6.52-9.58/1000). The crude prevalence of epilepsy among men was 9.77/1000 (95% CI 7.35-12.73/1000) and 6.79/1000 (95% CI 5.06-8.91/1000) for women. The age-adjusted prevalence of epilepsy on sub-Saharan Africa population was 8.25/1000 and 7.33/1000 on world population. Substantial heterogeneity was noted, with differences from one region to another. The most common seizure types were generalised tonic-clonic (80.0%), partial secondary generalised seizures (14.3%) and partial seizures (5.7%). SIGNIFICANCE: This nationwide study is the first in West Africa. It provides a low prevalence of epilepsy in Benin compared to previous studies performed in this country and in neighbouring countries. Restricted-area studies are often motivated by the presence of specific risk factors and could overestimate the prevalence, while large-scale studies could underestimate other subtle forms of epilepsy.

Understanding the differences in prevalence of epilepsy in tropical regions.

Epilepsy is a frequent chronic neurologic disorder that affects nearly 70 million people worldwide. The majority of people with epilepsy live in developing countries, where epilepsy remains a major public health problem. Wide prevalence differences exist among various populations across sub-Saharan Africa, Latin America, and Asia. In particular, prevalence is lower in Southeast Asia than in sub-Saharan Africa and Latin America. Methodologic problems alone do not seem to explain these differences shown in recent review papers. The distribution of numerous risk or etiologic factors such as infectious diseases with neurologic sequel, head injuries, or genetic factors could explain these differences. Stigmatization of people with epilepsy could lead to underestimating the prevalence of epilepsy, even in well-conducted studies. It is important to standardize the process of epidemiologic monitoring of epilepsy in order to improve the reliability in data comparison. Understanding the reasons for these differences is a crucial issue for eventually raising new hypotheses or prevention strategies.