Background-There are few large-scale studies of epilepsy in sub-Saharan Africa. We estimate the prevalence, treatment gap and risk factors for active convulsive epilepsy (ACE) in Kenyans aged ≥6 years in a rural area.

SUMMARYPurpose: Epilepsy is common in sub-Saharan Africa but is poorly characterized. Most studies are hospital-based, and may not reflect the situation in rural areas with limited access to medical care. We examined people with active convulsive epilepsy (ACE), to determine if the clinical features could help elucidate the causes. Methods: We conducted a detailed descriptive analysis of 445 people with ACE identified through a communitybased survey of 151,408 people in rural Kenya, including the examination of electroencephalograms.Results: Approximately half of the 445 people with ACE were children aged 6 to 18 years. Seizures began in childhood in 78% of those diagnosed. An episode of status epilepticus was recalled by 36% cases, with an episode of status epilepticus precipitated by fever in 26%. Overall 169 had an abnormal electroencephalogram, 29% had focal features, and 34% had epileptiform activity. In the 146 individuals who reported generalized tonic-clonic seizures only, 22% had focal features on their electroencephalogram. Overall 71% of patients with ACE had evidence of focal abnormality, documented by partial onset seizures, focal neurologic deficits, or focal abnormalities on the electroencephalogram. Increased seizure frequency was strongly associated with age and cognitive impairment in all ages and nonattendance at school in children (p < 0.01). Discussion: Children and adolescents bear the brunt of epilepsy in a rural population in Africa. The predominance of focal features and the high proportion of patients with status epilepticus, suggests that much of the epilepsy in this region has identifiable causes, many of which could be prevented.

BackgroundMetabolic syndrome refers to a cluster of interrelated disorders which occur together causing an increase in the risk of developing cardiovascular disease and diabetes. The university population is an understudied group despite the increase in the frequency of related disorders and metabolic risk factors e.g. obesity and diabetes, majorly due to the assumption that they are in their most active phase of life therefore healthy. This study looked at metabolic syndrome, the sedentary lifestyles and dietary habits present among university students attending Mount Kenya University, main campus.MethodsStratified sampling was used to select participants. Self-administered questionnaires were issued to participants after a signed consent had been obtained following which clinical assessments and biochemical measures were performed. They included blood pressure, fasting blood glucose, triglycerides, high density lipoprotein-cholesterol, anthropometric measurements; height, weight, BMI and waist circumference. Pearson’s chi-square tests and non-parametric independent t-test were used to analyze the prevalence of metabolic syndrome criteria per gender, the number of metabolic syndrome criteria per BMI and prevalence of metabolic syndrome criteria per BMI category.ResultsThe study established that 1.9% of the participants met the criteria for diagnosis of metabolic syndrome according to HJSS criteria. Among the elements, there was statistical difference in gender BMI and waist circumference. 11.8% of subjects had two metabolic syndrome components while 3.1% had three components while none of the subjects had all six components. Elevated triglycerides was the most prevalent defining component for metabolic syndrome. There is a statistically significant relationship between sedentary lifestyle and dietary habits as risk factors to metabolic syndrome.ConclusionYoung adults in university have begun developing metabolic syndrome and the risk of developing the syndrome continues to increase with the components being reported in early age. Educational initiatives to encourage healthy eating should be conducted within school premises in order to reinforce the message on healthy diets and physical exercise. Pre-admission screening to identify at risk students should be conducted. Targeted interventions development through a mandatory extra co-curricular program should be enforced to positively engage those at risk.

The occurrence of these lifestyle related practices and dietary habits at early age has been shown to increase the predisposition towards metabolic syndrome. Metabolic syndrome refers to disorders occurring together resulting in an increase in the risk of diabetes and cardiovascular diseases. Prevalence rate was established at 1.9% indicative of occurrence of predisposing risks of metabolic syndrome in university students. A cross-sectional, quantitative research design was used. 323 participants were sampled from a population of 40,000 students with stratification according to the various school sizes. A self-administered questionnaire was used to collect data. 61.3% of the respondents did not exercise regularly, 72.3% snacked frequently, 60.6% of the subjects that were not diagnosed with metabolic syndrome were fit, 37.2% needed to work on their fitness while only 2.2% were out of shape. The relationship between sedentary lifestyle as a risk factor and metabolic syndrome was statistically significant, as was the relationship between dietary habits and metabolic syndrome. The study established that 85.4% of the subjects were not sure of the amount of calories they consumed in a day and 13.9% of the subjects reported they had weight issues that affected their academics. Modifications in lifestyle habits, physical activity and dietary composition can result in a positive impact on metabolic syndrome and its progression. A mandatory extra co-curricular program requiring students to participate in exercise and sports activities should be enforced to positively engage university students. Vulnerable groups such as the prehypertensive and obese should also be closely monitored.