Community knowledge, attitudes, and practices regarding epilepsy in Mahenge, Tanzania: A socio-anthropological study in an onchocerciasis-endemic area with a high prevalence of epilepsy

Mmbando, Bruno P.; Bhwana, Dan; Massawe, Isolide S.; Magili, Pendo; Mahone, Sloan; Makunde, Williams H.; Mushi, Adiel K; Colebunders, Robert

doi:10.1016/j.yebeh.2022.108568

Cited by 6 publications

(4 citation statements)

References 36 publications

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“…Moreover, the high biannual coverage in 2021 was sustained in each of the two CDTi rounds (81.5% and 76.8%), with nearly all persons eligible for CDTi taking ivermectin (>90%), especially children and teenagers (93%). The latter may result from an OAE awareness campaign explaining that onchocerciasis might induce OAE and that this form of epilepsy can be prevented by taking ivermectin [ 29 ]. Still, none of the six new onsets of OAE cases took ivermectin in the year they developed their first seizures.…”

Section: Discussionmentioning

confidence: 99%

Impact of a bi-annual community-directed treatment with ivermectin programme on the incidence of epilepsy in an onchocerciasis-endemic area of Mahenge, Tanzania: A population-based prospective study

Bhwana,

Amaral,

Mhina

et al. 2023

PLoS Negl Trop Dis

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Background Community-directed treatment with ivermectin (CDTi) is used to eliminate onchocerciasis. However, despite 25 years of annual CDTi in Mahenge, Tanzania, the prevalence of onchocerciasis and onchocerciasis-associated epilepsy remained high in certain rural villages. Therefore, in 2019, bi-annual CDTi was introduced in the area. This study assessed the impact of the programme on the incidence of epilepsy in four villages. Methodology Door-to-door epilepsy surveys were conducted prior to (2017/18) and after (2021) implementing a bi-annual CDTi program. All household members were screened for epilepsy symptoms using a validated questionnaire, and suspected cases were examined by a medical doctor to confirm/reject the diagnosis of epilepsy. The prevalence and annual incidence of epilepsy, including nodding syndrome, were calculated with 95% Wilson confidence intervals with continuity correction. The latter was also done for CDTi coverage in 2016 and 2021. Results Precisely 5,444 and 6,598 persons were screened for epilepsy before and after implementing the intervention. The CDTi coverage of the overall population was 82.3% (95%CI: 81.3–83.2%) in 2021 and sustained in both distribution rounds (81.5% and 76.8%). The coverage was particularly high in children and teenagers aged 6 to 18 years (93.2%, 95%CI: 92.1–94.2%). The epilepsy prevalence remained similar: 3.3% (95%CI: 2.9–3.9%) in 2017/18 versus 3.1% (95%CI: 2.7–3.5%) in 2021. However, the incidence of epilepsy declined from 177.6 (95%CI: 121.2–258.5) in 2015–2017 and 2016–2018 to 45.5 (95%CI: 22.2–89.7) in 2019–2021 per 100,000 persons-years. The incidence of probable nodding syndrome varied from 18.4 (95%CI: 4.7–58.5) to 5.1 (95%CI: 0.3–32.8). None of the nine incidence cases of epilepsy for which information on ivermectin intake was available took ivermectin in the year they developed their first seizures. Conclusion A bi-annual CDTi programme should be implemented in areas with high prevalence of onchocerciasis and epilepsy. High CDTi coverage among children is particularly important to prevent onchocerciasis-associated epilepsy.

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Section: Discussionmentioning

confidence: 99%

Impact of a bi-annual community-directed treatment with ivermectin programme on the incidence of epilepsy in an onchocerciasis-endemic area of Mahenge, Tanzania: A population-based prospective study

Bhwana,

Amaral,

Mhina

et al. 2023

PLoS Negl Trop Dis

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“…The challenge of treatment attainment poses a significant obstacle for individuals seeking effective care. [18][19][20] The study participants reported difficulties accessing medication and sometimes experienced its ineffectiveness. Despite these challenges, a majority of participants expressed a preference for Western treatment options over faith-based treatments.…”

Section: Discussionmentioning

confidence: 99%

It Goes Beyond Anxiety: Experiences of Family Members and Caregivers of Epilepsy Care and Support

Musekwa,

Makhado

2023

NDT

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Purpose To investigate the knowledge of epilepsy care and the support given by professionals to assist family members and caregivers in providing good care to People Living with Epilepsy (PLWE). Patients and Methods In this case study, fifteen participants participated. Of these, eleven were parents, and four were siblings. Twelve of the participants were primary caregivers, and three were secondary caregivers. Data were collected via in-person semi-structured interviews and analysed via thematic analysis. Results From the study, two themes emerged: Participant experiences regarding epilepsy practices and knowledge regarding epilepsy. From these two themes, four subthemes emerged: Epileptic seizure practice and treatment, as well as epilepsy knowledge and counselling and support. Conclusion This study revealed that although family members and caregivers are essential in patient care, they need more support and care from health providers. The much-needed care and support would assist in alleviating some pressures on epilepsy patient care and increase care standards and quality of life for families and PLWE.

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“…The knowledge about the association between onchocerciasis and epilepsy was recently acquired as a consequence of the ongoing research project in the area [9][10][11][12]24]. The fact that onchocerciasis is associated with epilepsy has shown to increase the adherence to CDTI and coverage in areas with high epilepsy and onchocerciasis prevalence [18].…”

Section: Discussionmentioning

confidence: 99%

“…This qualitative study was conducted between July and August 2019 in four villages (Mdindo, Msogezi, Mzelezi and Sali) in Mahenge (Figure 1). Details of the study have been explained elsewhere [18] and included 11 focus group discussions (FGDs) and two in-depth interviews (IDIs). Purposeful sampling design was used to select persons with epilepsy (PWE) aged >18 years capable of giving informed consent, the parents/caretakers of PWE, community resource persons (CORPs) and community drug distributors (CDDs) to participate in FGDs.…”

Section: Study Design and Participantsmentioning

confidence: 99%

Community Knowledge, Attitudes and Practices Regarding Onchocerciasis in Rural Villages With a High Epilepsy Prevalence in Mahenge, Tanzania: A Qualitative Study

Bhwana¹,

Massawe²,

Mushi³

et al. 2022

Preprint

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Despite of over 20 years of community directed treatment with ivermectin (CDTI), a high prevalence of onchocerciasis and onchocerciasis-associated epilepsy were observed in rural villages in Mahenge, Tanzania. Therefore, we assessed the knowledge, attitude and practice about onchocerciasis in four rural villages in the Mahenge area. This was a qualitative study conducted between June and July 2019. Eleven focus group discussions were organized with persons with epilepsy and their caretakers, community resource persons, and community drug distributors (CDDs), and two in-depth interviews with district programme coordinators of neglected tropical diseases (NTD). Most participants were aware about symptoms of onchocerciasis using local terminologies such as “ukurutu/rough dry skin” and “kuwashwa/itching”. A small proportion of people did not take ivermectin during CDTI for fear of adverse reactions such as itching and swelling. Some men believed that ivermectin may decrease libido. Challenges for high CDTI coverage included, long walking distance by CDDs to deliver drugs to households, persons being away for farming, low awareness of the disease and limited supervision by the NTD coordinators. In conclusion, ivermectin uptake in Mahenge should be optimised by continuous advocacy about the importance of taking ivermectin to prevent onchocerciasis-associated morbidity and by improving supervision during CDTI.

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Community knowledge, attitudes, and practices regarding epilepsy in Mahenge, Tanzania: A socio-anthropological study in an onchocerciasis-endemic area with a high prevalence of epilepsy

Cited by 6 publications

References 36 publications

Impact of a bi-annual community-directed treatment with ivermectin programme on the incidence of epilepsy in an onchocerciasis-endemic area of Mahenge, Tanzania: A population-based prospective study

Impact of a bi-annual community-directed treatment with ivermectin programme on the incidence of epilepsy in an onchocerciasis-endemic area of Mahenge, Tanzania: A population-based prospective study

It Goes Beyond Anxiety: Experiences of Family Members and Caregivers of Epilepsy Care and Support

Community Knowledge, Attitudes and Practices Regarding Onchocerciasis in Rural Villages With a High Epilepsy Prevalence in Mahenge, Tanzania: A Qualitative Study

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