在资源有限的国家,癫痫患病率被低估,对其危险因素知之甚少。
本研究旨在确定马里六个卫生区(HDs)癫痫的患病率和危险因素。
在六个研究HD中,在180个可疑癫痫病例(SECs)最多的村庄进行了一项基于社区的横断面和嵌套病例对照研究。SECs是由社区卫生工作者进行的第一阶段筛查的一部分。对于嵌套的病例对照研究,根据居住地和年龄,1例与至少1例对照相匹配.癫痫病例是经神经科医生临床评估后诊断为惊厥性癫痫的人。对照是在神经科医生进行神经学评估后被诊断为正常的人。收集了有关社会人口统计学特征的数据,癫痫的家族史和病史,血缘,交货地点,早产,交货长度/类型,以及脑膜炎和脑型疟疾的病史。使用单变量和多变量二项逻辑回归模型来分析与癫痫相关的因素。
共纳入6例HDs中的1,506例癫痫患者和2,199例对照。癫痫的平均患病率为2‰,最高的是肯尼巴(3‰),以前的中观地方性盘尾丝虫病HD,卡迪奥洛最低(1.5‰),低地方性盘尾丝虫病HD。年龄(调整后的赔率比[aOR]=1.02[95%置信区间[CI]1.02-1.03]),脑型疟疾病史(aOR=11.41[95%CI8.86-14.85]),脑膜炎病史(aOR=1.95[95%CI1.16-3.29]),生活在托米尼安的HD中(aOR=1.69[95%CI1.29-2.22]),延迟交货(AOR=3.21[95%CI2.07-5.07]),难产(aOR=3.37[95%CI2.03-5.73])均与癫痫显著相关。
以前的中观-盘尾丝虫病HD中癫痫的患病率(3‰)远低于2,000个盘尾丝虫病流行地区的患病率(13.35‰)。在以前的中观流行地区,癫痫患病率的下降是由盘尾丝虫病引起的。减少是由于伊维菌素计划有效的社区直接治疗。脑型疟疾和产科并发症是癫痫的主要危险因素,需要实施改善疟疾预防/治疗和优化产前和产科护理的干预措施,以减少发病率。
In resource-limited countries, epilepsy prevalence is underestimated and little is known about its risk factors.
This study aimed to determine the prevalence and risk factors for epilepsy in six health districts (HDs) in Mali.
A community-based cross-sectional and nested
case-control study was conducted in 180 villages with the highest number of suspicious epilepsy cases (SECs) in the six study HDs. The SECs were observed as part of a Phase 1 screening conducted by community health workers. 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 a 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, preterm 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.
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‰), a hypo-endemic-
onchocerciasis HD. Age (adjusted odds ratio [aOR] = 1.02 [95% confidence intervals [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.
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 2,000. 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 optimizing prenatal and obstetrical care need to be implemented to reduce incidence.