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Title: Standard of care for people with epilepsy in sub-Saharan Africa : the case of Nigeria
Author: Watila, Musa Mamman
ISNI:       0000 0004 8507 7233
Awarding Body: UCL (University College London)
Current Institution: University College London (University of London)
Date of Award: 2019
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Epilepsy in low- and middle-income countries (LMICs) present unique challenges, as the burden is high and the majority of sufferers are not receiving even basic epilepsy care. This work aimed to determine the prevalence, incidence, treatment gap, determinants of access to care and potential risk factors for epilepsy in three Nigerian rural districts of Afikpo, Ijebu-Jesa and Gwandu. A population-based door-to-door screening was undertaken to identify people with epilepsy. This was preceded by a validation study of a screening questionnaire translated into three Nigerian languages. Of the 42,427 persons (six years and above) screened, 254 persons were confirmed to have active epilepsy. The overall age-standardised prevalence was 9.8/1,000 (95% CI: 8.6, 11.1). The prevalence varied between sites; 17.7 (95% CI: 14.2, 20.6) in Gwandu, 4.8 (95% CI: 3.4, 6.6) in Afikpo and 3.3 (95% CI: 2.0, 5.1) in Ijebu Jesa. The overall estimated 1-year age-standardized retrospective incidence was 101.3/100,000 (95% CI: 57.9, 167.6), higher in Gwandu compared to Afikpo and Ijebu-Jesa. The overall peak age-specific prevalence was 10-14 years, while the median age of seizure onset was 6 (IQR: 4-10) years. Epilepsy was of focal onset in 45.2% of the subjects. The treatment gap was 94.4% (95% CI: 90.9, 96.9). Cultural beliefs and stigma are the most important factors associated with the failure to seek medical care. Febrile seizures, poor perinatal care, family history, measles and meningitis are the main contributory factors associated with epilepsy in children and adults, while head injury and consanguinity were peculiar to adults. Physicians interviewed reported significant deficits in manpower, training, available facilities and antiseizure medications. In conclusion, this study hopes to contribute to the understanding and eradication of epilepsy in Nigeria. The varied estimates and potential risk factors observed require larger prospective cohort studies. Strengthening the primary health care and community education would improve the current treatment gap.
Supervisor: Sander, J. ; Singh, G. Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available