Impact of COVID-19 on the well-being of children with epilepsy including nodding syndrome in Uganda: A qualitative study.

OBJECTIVE: To investigate the impact of the COVID-19 pandemic and related restrictions on the access and use of health services by children with epilepsy including nodding syndrome in Uganda. METHODS: Four focus group discussions (FGD) with parents/caregivers of children with epilepsy and five in-depth interviews with key informants were conducted between April and May 2021 at Butabika National Mental Referral Hospital and Kitgum General Hospital. RESULTS: COVID-19-related restrictions, including the halting of non-essential services and activities, and suspension of public transport, created several challenges not only for children with epilepsy and their parents/caregivers but also for their healthcare providers. Study participants described extreme transport restrictions that reduced their access to healthcare care services, increased food insecurity and shortage or inability to afford essential medicines as consequences of COVID-19-related restrictions. However, parents/caregivers and healthcare workers adopted several coping strategies for these challenges. Parents/caregivers mentioned taking on casual work to earn an income to buy food, medicines, and other necessities. Healthcare workers intensified outreach services to affected communities. A positive impact of lockdown measures described by some FGD participants was that most family members stayed at home and were able to care for children with epilepsy in turn. CONCLUSIONS: Our study highlights the significant negative impact of the COVID-19 pandemic and related restrictions on access to health services and the general well-being of children with epilepsy. Decentralized epilepsy treatment services and nutritional support could reduce the suffering of children with epilepsy and their families during the ongoing COVID-19 pandemic and similar future emergencies.

Gardening activity and its relationship to mental health: Understudied and untapped in low-and middle-income countries.

There is increasing awareness among researchers and health practitioners from high income countries about the potential mental health benefits of participating in gardening activities and spending substantial time in green spaces. However, this phenomenon is not well established in low- and middle-income countries. In this commentary, we discuss the evidence base surrounding the potential mental health benefits of participating in gardening activity and spending substantial time in a green space. We hope to stimulate discourse about incorporating these activities into mental health prevention in low- and middle-income countries.

Impact of the COVID-19 pandemic on persons with epilepsy in Uganda: A descriptive cross-sectional study.

OBJECTIVE: To evaluate the impact of the coronavirus disease 2019 (COVID-19) pandemic on the disease course, lives, and psychosocial wellbeing of persons with epilepsy (PWE) in Uganda. METHODS: From April 2021 till May 2021, we carried out a descriptive cross-sectional study at four hospitals located in four regions of Uganda. PWE presenting at the study sites were offered a structured questionnaire in the local language. We used the PHQ-9 questionnaire to screen for depression and the GAD-7 to screen for anxiety. Univariate and multivariable logistic regression was used to investigate factors associated with anxiety and depression. RESULTS: A total of 370 responses were collected. The median age of the respondents was 20.5 years (IQR 15-29), and 51.9% were males. During the lockdown period, the seizure frequency increased in 87 (23.5%) PWE. Various forms of physical and psychological violence were inflicted upon 106 (28.6%) PWE. Fifty-eight (15.7%) screened positive for anxiety and 65 (17.6%) positive for depression. Both increased seizure frequency and experienced violence were associated with experiencing depression and anxiety. CONCLUSION: The COVID-19 pandemic and lockdown impacted seizure frequency and the psychosocial wellbeing of PWE in Uganda. Increased seizure frequency was associated with higher rates of anxiety and depression. This underlines the importance of continued follow-up of PWE and a low threshold to screen for depression, anxiety, and domestic violence.

Psychological distress and associated factors among hospital workers in Uganda during the COVID-19 lockdown - A multicentre study.

OBJECTIVE: To assess the prevalence of psychological distress (PD), and its associated demographic, psychosocial, hospital and health-related factors among hospital workers in Uganda during the COVID-19 related lockdown. METHODS: An online cross-sectional study was conducted among three hundred ninety six participants recruited from eight hospitals and PD was assessed using the Kessler 6 distress scale from May to June 2020. RESULTS: PD was present in 92.7% of the participants with majority (78.3%) having mild to moderate PD whereas 14.4% had severe PD. Severe PD had statistically significant association with having financial liabilities (O.R = 3.69 (1.55-8.77), p = 0.003). However, ability to maintain contact with family members and friends (O.R = 0.43 (0.22-0.84), p value = 0.013), and having enough personal protective equipment and safety tools at work place (O.R = 0.44 (0.23-0.84), p value = 0.012) were protective against severe PD. having excessive worry about getting infected with COVID-19, conflicts within a home, segregation by friends or community, longer working hours or involvement in management of suspected or confirmed case were not associated with severe PD. CONCLUSION: The findings indicate the need to take into consideration the mental wellbeing of health workers during this COVID-19 outbreak. Whereas hospital workers continue to provide their services during the COVID-19 pandemic and related lockdown, it is important that they maintain contact with social support networks and be provided with counselling and mental health and psychosocial services in order to optimise their mental health during this pandemic.

Risk Factors for Nodding Syndrome and Other Forms of Epilepsy in Northern Uganda: A Case-Control Study.

Epidemiological studies suggest a link between onchocerciasis and various forms of epilepsy, including nodding syndrome (NS). The aetiopathology of onchocerciasis associated epilepsy remains unknown. This case-control study investigated potential risk factors that may lead to NS and other forms of non-nodding epilepsy (OFE) in northern Uganda. We consecutively recruited 154 persons with NS (aged between 8 and 20 years), and age-frequency matched them with 154 with OFE and 154 healthy community controls. Participants' socio-demography, medical, family, and migration histories were recorded. We tested participants for O. volvulus serum antibodies. The 154 controls were used for both OFE and NS separately to determine associations. We recruited 462 people with a median age of 15 years (IQR 14, 17); 260 (56.4%) were males. Independent risk factors associated with the development of NS were the presence of O. volvulus antibodies [aOR 8.79, 95% CI (4.15-18.65), p-value < 0.001] and preterm birth [aOR 2.54, 95% CI (1.02-6.33), p-value = 0.046]. Risk factors for developing OFE were the presence of O. volvulus antibodies [aOR 8.83, 95% CI (4.48-17.86), p-value < 0.001] and being born in the period before migration to IDP camps [aOR 4.28, 95% CI (1.20-15.15), p-value = 0.024]. In conclusion, O. volvulus seropositivity was a risk factor to develop NS and OFE; premature birth was a potential co-factor. Living in IDP camps was not a risk factor for developing NS or OFE.

Case Report: Nakalanga Syndrome Revisited: Long-Term Follow-Up of a Patient Living in Western Uganda, 1994-2018.

Nakalanga syndrome is a childhood developmental disorder that has been reported from various parts of sub-Saharan Africa with the major sign of retarded growth, regularly combined with physical deformities, impaired mental and pubertal development, and epilepsy. We present a follow-up over a 24-year period of a patient living in the Itwara onchocerciasis focus of western Uganda. We demonstrate the strong similarity of Nakalanga syndrome to the more recently described Nodding syndrome, and we discuss the possible causation of both disorders by onchocerciasis. We suggest that the growing knowledge about the tight interconnections between Nakalanga and nodding syndrome, other forms of epilepsy, and onchocerciasis should be taken into consideration in a revised classification system.

Mental health problems related to COVID-19: A call for psychosocial interventions in Uganda.

As different countries grapple with COVID-19, stringent measures aimed at controlling its spread have been put in place. However, these preventive measures coupled with the fear of contracting the disease are likely to have negative effects on the mental health of the general population. We describe the containment measures taken by the government of Uganda and highlight how these measures are likely to impact the mental health of different groups of people. We also propose future directions and interventions on mental health problems resulting from COVID-19 pandemic. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Changes in epilepsy burden after onchocerciasis elimination in a hyperendemic focus of western Uganda: a comparison of two population-based, cross-sectional studies.

BACKGROUND: In 1994, prevalence and incidence of epilepsy were high in the Itwara onchocerciasis focus (western Uganda), and cases of nodding and Nakalanga syndrome were documented. Onchocerciasis transmission was interrupted successfully in 2001. 17 years later, we re-investigated the epilepsy burden in this area. METHODS: From Dec 11 to Dec 15, 2018, a door-to-door survey was done in the three villages (Kabende Centre, Masongora South, and Rwesenene) with the highest epilepsy rates in 1994 to identify people with suspected epilepsy. Epilepsy diagnoses were confirmed by an interview and physical examination by a study clinician. The prevalence and incidence of epilepsy were measured using methods consistent with those used in 1994. Results from 2018 were compared with those from 1994. FINDINGS: The overall crude prevalence of epilepsy in the study villages decreased from 3·0% (35 of 1169) in 1994 to 1·2% (27 of 2325) in 2018 (p=0·0002), with a concomitant decrease in the proportion of people with epilepsy with unknown cause (p=0·037). Between 1994 and 2018, the overall incidence of epilepsy decreased from 418 cases per 100 000 person-years (95% CI 265-626) to 73 new cases per 100 000 person-years (32-114; p<0·0001); this reduction was more pronounced for cases having the first seizure between ages 3 years and 18 years (p<0·0001). No new case of nodding or Nakalanga syndromes had occurred since the interruption of onchocerciasis transmission. INTERPRETATION: Our findings support the existence of a negative association between onchocerciasis elimination and epilepsy burden in previously hyperendemic areas. Therefore, onchocerciasis elimination efforts should be intensified in endemic regions with a high prevalence of epilepsy, which might reduce the burden of epilepsy. FUNDING: Flemish University Development Cooperation and the European Research Council.

Prevalence and incidence of nodding syndrome and other forms of epilepsy in onchocerciasis-endemic areas in northern Uganda after the implementation of onchocerciasis control measures.

BACKGROUND: Around 2007, a nodding syndrome (NS) epidemic appeared in onchocerciasis-endemic districts of northern Uganda, where ivermectin mass distribution had never been implemented. This study evaluated the effect of community-directed treatment with ivermectin (CDTI) and ground larviciding of rivers initiated after 2009 and 2012 respectively, on the epidemiology of NS and other forms of epilepsy (OFE) in some districts of northern Uganda. METHODS: In 2012, a population-based community survey of NS/epilepsy was carried out by the Ugandan Ministry of Health in Kitgum and Pader districts. In August 2017, we conducted a new survey in selected villages of these districts and compared our findings with the 2012 data. In addition, two villages in Moyo district (where CDTI was ongoing since 1993) served as comparative onchocerciasis-endemic sites in which larviciding had never been implemented. The comparison between 2012 and 2017 prevalence and cumulative incidence were done using the Fisher's and Pearson's Chi-square tests at 95% level of significance. RESULTS: A total of 2138 individuals in 390 households were interviewed. In the selected villages of Kitgum and Pader, there was no significant decrease in prevalence of NS and OFE between 2012 and 2017. However, the cumulative incidence of all forms of epilepsy decreased from 1165 to 130 per 100 000 persons per year (P = 0.002); that of NS decreased from 490 to 43 per 100 000 persons per year (P = 0.037); and for OFE from 675 to 87 per 100 000 persons per year (P = 0.024). The median age of affected persons (NS and OFE) shifted from 13.5 (IQR: 11.0-15.0) years in 2012 to 18.0 (IQR: 15.0-20.3) years in 2017; P <  0.001. The age-standardized prevalence of OFE in Moyo in 2017 was 4.6%, similar to 4.5% in Kitgum and Pader. CONCLUSIONS: Our findings support the growing evidence of a relationship between infection by Onchocerca volvulus and some types of childhood epilepsy, and suggest that a combination of bi-annual mass distribution of ivermectin and ground larviciding of rivers is an effective strategy to prevent NS and OFE in onchocerciasis-hyperendemic areas.

Onchocerciasis-associated epilepsy: From recent epidemiological and clinical findings to policy implications.

A high prevalence of epilepsy is reported in many onchocerciasis-endemic regions. In this paper we discuss recent epidemiological and clinical aspects as well as public health implications of onchocerciasis-associated epilepsy (OAE) and propose a strategy to reduce the burden of disease. OAE probably presents in a variety of clinical manifestations, including the nodding syndrome and the Nakalanga syndrome. The most common clinical presentation, however, is generalized (primarily tonic-clonic) seizures. A characteristic of OAE is the onset of seizures between the ages of 3 and 18 years and clustering in certain families and villages close to rapid-flowing black-fly-infested rivers. A strategy combining active surveillance for epilepsy with early treatment with antiepileptic drugs and prevention of onchocerciasis by increasing the geographical and therapeutic coverage of community-directed treatment with ivermectin (CDTi) may considerably decrease the burden of disease.