A house-to-house, cross-sectional, population study of epilepsy on 24,130 individuals of all ages from southern Pakistan indicates an age-specific prevalence rate of 9.99 in 1,000 (14.8 in 1,000 in rural and 7.4 in 1,000 in urban areas) for recurrent, nonfebrile "active" epilepsy in Pakistan. Mean onset of epilepsy was 13.3 years, and 74.3% epileptic persons were aged < 19 years at onset of the disorder. The most common seizure type was tonicclonic in 77% [primary generalized tonic-clonic (GTC) in 59% and secondarily generalized in 18%], simple partial (SPS) in 5%, complex partial (CPS) in 6%, generalized absence in 1%, tonic in 3%, and myoclonic in 3% cases. Multiple seizures types in the same person were evident in 9.6% of only the generalized group. A putative cause could be suggested in 38.4% of cases: 32% had a positive family history of epilepsy, most common among siblings. Common perceived precipitants included fever in 29.2% and emotional disturbances in 16.6%. Only 3% of epileptic persons believed that their illness was due to super-natural causes. Treatment status was very poor, with only 2% rural and 27% urban epileptic persons receiving antiepileptic drugs (AEDs) at the time of the survey. We discuss the logistic and management problems of population-based epidemiologic studies in developing countries.

This paper reports estimates of the prevalence of mental retardation and associated factors based on a population survey of 2- to 9-year-old children in Greater Karachi, Pakistan. A two-phase survey was implemented during the years 1988-1989. In the first phase, a cluster sample of 6,365 children (5,748 from urban areas and 617 from rural areas) was screened for disabilities using a parental report known as the Ten Questions instrument. In the second phase, all children with positive screening results and a 10% sample of those with negative results were referred for structured medical and psychological assessments. Estimates of the prevalence of mental retardation were 19.0/1,000 children (95% confidence interval (CI) 13.5-24.4) for serious retardation and 65.3/1,000 children (95% CI 48.9-81.8) for mild retardation. Both estimates were considerably higher than respective prevalence estimates obtained in industrialized countries and in selected less developed countries. In this population, lack of maternal education was strongly associated with the prevalence of both serious (odds ratio = 3.26, 95% CI 1.26-8.43) and mild (odds ratio = 3.08, 95% CI 1.85-5.14) retardation. Other factors that were independently associated with mental retardation in Karachi included histories of perinatal difficulties, neonatal infections, postnatal brain infections, and traumatic brain injury, as well as current malnourishment. Further research is needed to assess the contribution of consanguineous marriage, improvements in child survival, and other factors to the unusually high prevalence of mental retardation in this population.

Summary: Purpose: To determine comparative prevalence rates, demographics, phenomenology, seizure classification, presumptive etiology, treatment status, and selected socioanthropological aspects of epilepsy in Pakistan and Turkey.

Summary: Purpose: To assess the stigmatization and psychosocial problems of persons with epilepsy in Pakistan.Methods: A population-based, cross-sectional epidemiologic study of 241 persons with epilepsy identified from an at-risk population of 24,130 individuals (64.7% from urban and 35.3% from rural areas). Of these patients, 77% suffered from recurrent non-febrile generalized convulsions. We evaluated degree of stigmatizations (i.e., avoidance by friends, neighbors, and others), and the effect of epilepsy on other psychosocial aspects (e.g., marriage), and also the relationships between gender and level of education of the patients, and stigmatization.Results: Patients with epilepsy in Pakistan do not appear to be highly stigmatized, but their education and grades are affected by the disorder. They have difficulty performing activities of daily living and find it hard to make decisions about whether to marry or to have children. Women believed that they were more dangerous to others, received less help from their families, and, more frequently than men, encouraged others to avoid them. Women were also more likely than men to express the belief that people with epilepsy should not marry, but in fact, women more frequently married as compared men-a fact influenced by social and cultural pressures, including pressure from family, because it is nearly always the responsibility of the parents to arrange the marriage of a daughter. Influence of education indicates that people with epilepsy who have higher education, as compared with those with less education, had fewer children, were less often avoided by their classmates and neighbors, had fewer problems with plans for education, less frequently encouraged others to avoid them, were more frequently married, and believed that they were more dangerous to others. Most people believed that their conditions had a physical basis; only 3.1% attributed their epilepsy to supernatural causes. Conclusions: Stigmatization regarding epilepsy has not been proven to be an important feature in the culture of Pakistan because none of the observations are statistically significant as per P-value.

Objective -To assess the accuracy of the ten questions screen as a measure ofchildhood disability for epidemiologic studies in populations lacking resources for professional assessment of children's development and functioning. Design -Household survey and screening of children in phase one followed by clinical assessments in phase two. Setting -Karachi, Pakistan. Participants -A cluster sample of 6365 children, aged 2 to 9 years, screened using the ten questions and a subsample referred for clinical assessments. Main results -Although the sensitivity of the ten questions as a global screen for serious cognitive, motor, and seizure disabilities is high (84-100%), its sensitivity for identifying and distinguishing specific types ofdisability and for detecting vision, hearing, and mild disabilities, overall, is limited (generally <80% and as low as 4% for mild vision disability). The predictive value of a positive screening result is also limited -using the ten questions in surveys without clinical confirmation results in overestimation ofthe prevalence ofserious disability by more than 300%. Conclusions -The ten questions screen is not an assessment tool. Its utility lies in its ability to screen or select a fraction of the population at high risk for serious disability. As a screening tool, it allows scarce diagnostic and other professional resources to be efficiently directed toward those at high risk. A study in Dhaka, Bangladesh found that the ten questions screen had excellent sensitivity and high specificity for detecting serious disabilities in 2-9 year old children. It also showed that the validity was comparable for boys and girls, and for older and younger children within the 2-9 year age range.'7 Investigators using the ten questions in Jamaica found that it had excellent sensitivity for serious motor, seizure, speech, vision, and hearing disabilities.'8 Recent comparative analyses of the ten questions screen in three countries (Bangladesh, Jamaica, and Pakistan) found that it had good reliability (alpha and kappa coefficients greater than 0.60) in all three countries as well as acceptable to excellent sensitivity (>80%) for detecting serious cognitive, motor, and seizure disabilities. It was found, however, to have relatively poor sensitivity for serious vision and hearing disorders that had not been identified previously, and it was concluded that the ten questions screen must be supplemented with actual tests of vision and hearing in order to detect these disabilities.'920 The studies in all three countries (Bangladesh, Jamaica, and Pakistan) have also shown that the screen has limited positive predictive value for serious disability (<25%), meaning that most (>75%) children who screen positive do not have a serious disability.1619All previous analyses of the ten questions screen have used a broad orglobal interpretation which considers a screening result to be positive for any disability if at least one question is positive; no correspondence is required between specific questions on the s...