The prevalence of active convulsive epilepsy in children in Kilifi, Kenya

Abstract

Epilepsy is a common neurological disorder affecting 50 million people globally, 80% of them living in resource poor countries. Children below 15 years account for 25% of those affected and 40% of the new epilepsy cases annually. The incidence of epilepsy is 3 times higher in the first year of life compared to mid-adulthood. Median prevalence of epilepsy in Africa is 15/1000, about 2-3 times more than in the Western countries.

In Kenya the prevalence is 4-18.211000 in older children and adults. Active convulsive epilepsy (ACE) is defined as having two unprovoked seizures in a lifetime, with at least one in the last year. It is the criteria for treatment of epilepsy in Kenya, and can be controlled in 75% of cases using monotherapy, but 90% of people with epilepsy are not on treatment. There is no data on epilepsy in young children in Kenya.

Objective: To determine the prevalence of active convulsive epilepsy (ACE) in children in Kilifi and to determine the treatment gap in children with ACE.

Study setting: Kilifi, a rural district in the coastal area of Kenya.

Study subjects: Children aged 4 months to 13 years residing in the study area.

Methods: A cross-sectional survey was conducted in a demarcated area of Kilifi District with a total population of 260,000, using a questionnaire to identify children with history of seizures. A second team of fieldworkers administered a more detailed questionnaire to those selected in Stage one to identify children with epilepsy, and referred them for clinical evaluation at the neurological assessment centre at the Kilifi District hospital. At the unit, the principle investigator obtained a more detailed history of the seizures to make a diagnosis of ACE, and the treatment used if any, while a second clinician blinded to the clinical history, conducted physical examination on the children.

Results: Prevalence of active convulsive epilepsy was found to be 2/1000. The treatment gap among those diagnosed to have ACE was 78.5%.

Conclusion: The prevalence of ACE among children in Kilifi is 211 000. Although there is a significant reduction in seizures among those using the MOR recommended treatment, majority of children with ACE are not on appropriate treatment.