Using community health workers as an alternative approach for epidemiological research on epilepsy in six health districts in Mali

Konipo, Fatoumata dite Nènè; Dolo, Housseini; Daou, Mariam; Coulibaly, Yaya Ibrahim; Diallo, Hassane; Sangare, Moussa; Coulibaly, Souleymane; Sangaré, Modibo; Doumbia, Seydou; Maiga, Youssoufa

doi:10.1016/j.yebeh.2021.107842

Cited by 2 publications

(4 citation statements)

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“…In Africa, PWE often die prematurely be- cause of accidents, drowning, burns, and inaccessibility to effective epilepsy treatment [32]. In a recent study in Mali, the anti-epileptic drug phenobarbital was only available in 15% of the 174 health centres surveyed [22]. In Mali, there is free malaria treatment for children under 5 and for pregnant women [33,34].…”

Section: Discussionmentioning

confidence: 99%

“…The diagnosis of epilepsy was confirmed by a neurologist after clinical consultation, including neurologic examination using the definition accepted by the International League Against Epilepsy [23]. For all of 30 villages selected in each of the six study HDs, the mean confirmation rate was 82.9% (1,645/1,985) [22]. For each control, at least one control was included for the nested case-control study.…”

Section: Methodsmentioning

confidence: 99%

“…Any person who answered “yes” to any of these three questions was classified as an SEC. Details about the methodology and results of the first phase were previously published by Konipo et al [22] in 2021.…”

Section: Methodsmentioning

confidence: 99%

“…(iii) Has the subject ever been told that he or she has epilepsy? These three questions were reported as specific in capturing convulsive cases of epilepsy [22]. Any person who answered "yes" to any of these three questions was classified as an SEC.…”

Section: Study Design and Populationmentioning

confidence: 99%

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Prevalence and Risk Factors Associated with Epilepsy in Six Health Districts of Mali: A Community-Based Cross-Sectional and Nested Case-Control Study

et al. 2022

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In resource-limited countries, epilepsy prevalence is underestimated and little is known about its risk factors. Objectives: This study aimed to determine the prevalence and risk factors for epilepsy in six health districts (HD) in Mali. Methods A community-based cross-sectional and nested-case–control study was conducted in 180 villages with the highest number of suspicious epilepsy cases (SEC) in the six study HD. The SEC were observed as part of a Phase 1 screening conducted by community health workers (CHWs). For the nested case-control study, one case was matched with at least one control based on residence and age. A case of epilepsy was any person diagnosed with convulsive epilepsy after clinical assessment by a neurologist. A control was a person diagnosed as normal after neurological assessment by a neurologist. Data were collected on sociodemographic characteristics, familial and medical history of epilepsy, consanguinity, place of delivery, pre-term birth, length/type of delivery, and history of meningitis and cerebral malaria. A univariate and multivariate binomial logistic regression model was used to analyse factors associated with epilepsy. Results A total of 1,506 cases of epilepsy and 2,199 controls were enrolled in six HDs. The mean prevalence of epilepsy was 2‰, with the highest in Kenieba (3‰), a previously meso-endemic-onchocerciasis HD, and the lowest in Kadiolo (1.5‰), an hypo-endemic-onchocerciasis HD. Age [aOR=1.02 (95% CI 1.02-1.03)], history of cerebral malaria [aOR=11.41 (95% CI 8.86-14.85)], history of meningitis [aOR=1.95 (95% CI 1.16-3.29)], living in the HD of Tominian [aOR= 1.69 (95% CI 1.29-2.22)], delayed delivery [aOR= 3.21 (95% CI 2.07-5.07)] and dystocia [aOR= 3.37 (95% CI 2.03-5.73)] were all significantly associated with epilepsy. Discussion/Conclusion The prevalence of epilepsy (3‰) in a previously meso-endemic-onchocerciasis HD was much lower than the prevalence (13.35‰) documented in onchocerciasis endemic areas in 2000. This decrease epilepsy prevalence in the previously meso-endemic-region was induced by onchocerciasis and the reduction was due to an effective community direct treatment with ivermectin programme. Cerebral malaria and obstetrical complications were the main risk factors for epilepsy and interventions improving malaria prevention/treatment and optimising prenatal and obstetrical care need to be implemented to reduce incidence.

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