The prevalence of epilepsy in a malaria endemic region of Kenya

Abstract

Epilepsy is the most common chronic neurological disorder and is one of the world's most prevalent non-communicable disorders. Studies examining the epidemiology of epilepsy in the developing world are scarce. In Africa for instance, the World Health Organization (WHO) estimates that there are 10 million people with epilepsy (PWE) but this estimate is based on little data and the actual burden of epilepsy remains unknown. There arc few studies in Kenya. Epilepsy is thought to be more prevalent in Africa, because causes such as birth trauma and infections arc common. Recently an association between severe malaria and the development of epilepsy has been documented. However, there are few reports examining the relationship between malaria and epilepsy in endemic areas

My colleagues and I conducted a cross-sectional survey to detect active convulsive epilepsy in an area, with differing malaria transmission in the Kilifi District on the Coast of Kenya. 1 set out to determine the prevalence and risk factors of active convulsive epilepsy and examine the association between the epilepsy and malaria transmission in this area. Active convulsive epilepsy (ACE) was defined as 2 or more unprovoked convulsions, or which one occurred within the last year, whether or not treatment was being given, since this is the criterion Cor treatment in Kenya.

The prevalence or epilepsy was 3.5 per 1000 inhabitants at risk, 3.8 per 1000 for males 3.3 per 1000 [or females. The highest age-specific prevalence was round 1'01' age's 11-20 years. Generalized tonic -clonic seizures were the predominant seizure type and occurred in 70.4% of subjects. However focal seizures accounted far 75.5% or the seizures when second and third seizures were included. History or head trauma, intrapartum and perinatal complications, family history or febrile seizures, history of a widowed mother and family history of seizures in first-degree relatives and also extended family were associated with a risk or developing epilepsy. Drinking alcohol did not add to the risk of" developing epilepsy. The prevalence of epilepsy in the low malaria transmission zones was generally higher than in the high transmission zones but logistic regression analysis indicates a statistically significant increased risk of Active Convulsive Epilepsy (ACE) in the later.

The study indicates that the prevalence rate of active epilepsy in our study is comparable to that in other well conducted community based studies in Africa and in the western countries. Strongly independent association between five factors and the risk of"epilepsy was noted. Overall the relationship between malaria transmission and epilepsy appears complex and remains unclear.