Taenia solium metacestode preparation in rural areas of sub-Saharan Africa: a source for diagnosis and research on cysticercosis.

BACKGROUND: Taenia solium metacestodes/cysts obtained from pig carcasses constitute a primary source for diagnostic tools used for the detection of human cysticercosis. Data on T. solium cyst preparation in Africa is still scarce but required to establish independent reference laboratories. OBJECTIVES: The aim of the present study is a) to present the likely yield of T. solium cyst material by the use of two different preparation methods in the field and b) to investigate its suitability for immunodiagnosis of human cysticercosis. METHODS: In Zambia, Uganda and Tanzania 670 pigs were screened for T. solium infection. Cysts were prepared by 'shaking method' and 'washing method'. Generated crude antigens were applied in a standard western blot assay. RESULTS: 46 out of 670 pigs (6.9%) were found positive for T. solium (Zambia: 12/367, 3.3%; Uganda: 11/217, 5.1%; Tanzania 23/86, 26.7%). Mean values of 77.7 ml whole cysts, 61.8 ml scolices/membranes and 10.9 ml cyst fluid were obtained per pig. Suitability of collected material for the use as crude antigen and molecular diagnostic techniques was demonstrated. CONCLUSION: This study clearly shows that T. solium cyst preparation in African settings by simple field methods constitutes an effective way to obtain high quality material as source for diagnostic tools and research purposes.

MRI findings in people with epilepsy and nodding syndrome in an area endemic for onchocerciasis: an observational study.

BACKGROUND: Onchocerciasis has been implicated in the pathogenesis of epilepsy. The debate on a potential causal relationship between Onchocerca volvulus and epilepsy has taken a new direction in the light of the most recent epidemic of nodding syndrome. OBJECTIVE: To document MRI changes in people with different types of epilepsy and investigate whether there is an association with O. volvulus infection. METHODS: In a prospective study in southern Tanzania, an area endemic for O. volvulus with a high prevalence of epilepsy and nodding syndrome, we performed MRI on 32 people with epilepsy, 12 of which suffered from nodding syndrome. Polymerase chain reaction (PCR) of O. volvulus was performed in skin and CSF. RESULTS: The most frequent abnormalities seen on MRI was atrophy (twelve patients (37.5%)) followed by intraparenchymal pathologies such as changes in the hippocampus (nine patients (28.1%)), gliotic lesions (six patients (18.8%)) and subcortical signal abnormalities (three patients (9.4%)). There was an overall trend towards an association of intraparenchymal cerebral pathologies and infection with O. volvulus based on skin PCR (Fisher's Exact Test p=0.067) which was most pronounced in children and adolescents with nodding syndrome compared to those with other types of epilepsy (Fisher's Exact Test, p=0.083). Contrary to skin PCR results, PCR of CSF was negative in all patients. CONCLUSION: The observed trend towards an association of intraparenchymal cerebral pathological results on MRI and a positive skin PCR for O. volvulus despite negative PCR of CSF is intriguing and deserves further attention.

Prevalence of migraine headache in a rural area of northern Tanzania: a community-based door-to-door survey.

Our aim was to assess the 1-year prevalence of migraine headache in a rural population within the catchment area of the Haydom Lutheran Hospital in northern Tanzania. From December 2003 until June 2004 a community-based door-to-door survey was carried out, using a questionnaire based on the criteria of the International Headache Society, including 1192 households with 7412 individuals selected by multistage cluster-random sampling. The overall 1-year prevalence of migraine headache was found to be 4.3% [316/7412, 95% confidence interval (CI) 3.8, 4.7] with an age-adjusted rate of 6.0% and a male : female ratio of 1:2.94 (P < 0.001). Of these individuals, 132 did not fulfil all criteria for migraine headache, hence, these patients had to be classified as migrainous disorders with a crude prevalence rate of 1.8% (132/7412. 95% CI 1.5, 2.1). The remaining 184 patients met all criteria for migraine resulting in a 1-year prevalence of 2.5% (184/7412, 95% CI 2.1, 2.9) and a male : female ratio of 1:2.51 (P < 0.001). The present survey shows that migraine headache is not uncommon in northern Tanzania. The recorded prevalence of migraine headache is located within the median of previous African prevalence surveys, which confirms the trend of lower migraine frequencies in rural Africa compared with western countries.

The prevalence of headache with emphasis on tension-type headache in rural Tanzania: a community-based study.

The aim of the study was to assess the prevalence of headache with special attention to tension-type headache (TTH) in a rural area in northern Tanzania. A door-to-door study was performed using a standardized and validated questionnaire. A total of 7412 participants were screened. The total headache prevalence during the past year was 12.1%; the overall 1-year prevalence of TTH was 7%; 5% reported episodic TTH and 0.4% chronic TTH. Borderline cases (International Headache Society code 2.3) were described in 1.6%. The prevalence of headache was highest in the 41-50-year-old group in women and in the 61+ age group in men. This is the first account of the prevalence of TTH in a rural Tanzanian population, and shows that headache in general and, more specifically, TTH are prevalent disorders that deserve attention. However, the prevalence of primary headache seems to be lower than in Western countries.

Motor and non-motor features of Parkinson's disease.

BACKGROUND: Parkinson's disease (PD) is a common neurodegenerative brain disease in developed countries where population of the elderly is high. PD is increasingly being documented in developing countries where there are rapid demographic changes. Motor features of PD have been documented in Africans in previous studies. However non-motor features such as depression and sleep disturbance have not been well documented. OBJECTIVE: To study the motor and non-motor features of idiopathic Parkinson's disease in Tanzania. DESIGN: A descriptive consecutive referral of patients to the national tertiary care hospital. SETTING: Neurology clinic at Muhimbili National Hospital a major teaching and national referral hospital. RESULTS: Forty two of 1,908 (2.2%) new referralpatients over four years of study satisfied the criteria for idiopathic PD. Of these 25 (59.5%) were males and 17 females. There was no significant difference between sex, in demographic and clinical features. Nevertheless females tended to be older; and the majority of whom were housewives. Three male patients were in advanced stage five and six or UPDRS above 61/108. Thirty nine (92.8%) patients completed BDI and none of these had a BDI score of more than ten. Insomnia was reported in 14(33%) of patients. There was no significant difference between age, sex, clinical stage or UPDRS score. However 12 (28.6%) of 42 patients had been noted to have at least one sleep behaviour disorder and all had mild to moderate disease at stages one to three or UPDRS score of 60/108 or less. CONCLUSION: Idiopathic Parkinson's disease is increasingly being seen in Tanzania due to the ageing population. Majority of patients in this series were in early stage of disease. Depression was conspicuously absent. However sleep behaviour disorder, which is potentially harmful to the patient, bed partners and requires different management, was a common feature that was elicited by direct enquiry in patients with Parkinson's disease.

Stroke subtypes in Black Tanzanians: a retrospective study of computerized tomography scan diagnoses at Muhimbili National Hospital, Dar es Salaam.

Limited data are available on the stroke subtypes in Tanzania and sub-Saharan Africa. The present study was aimed at determining retrospectively the pattern of confirmed strokes in all patients in our hospital who had been given a computerized tomography (CT) brain scan during the study period (April 2001 to May 2002). Over the 12-month period 371 CT brain scans were taken, of which 148 showed stroke, 89 (60.1%) showed haemorrhage and 59 (39.9%) showed infarcts (P<0.05). Among the haemorrhagic group 48 (53.9%) were men and 41 (46.1%) women, while 31 (52.5%) men and 28 (47.5%) women had infarction. We concluded that there were relatively more cases of cerebral haemorrhage than infarction. Hypertension and diabetes mellitus were common risk factors in both subtypes of stroke.

Admission diagnosis of cerebral malaria in adults in an endemic area of Tanzania: implications and clinical description.

BACKGROUND: Cerebral malaria is commonly diagnosed in adults in endemic areas in Africa, both in hospitals and in the community. This presents a paradox inconsistent with the epidemiological understanding that the development of immunity during childhood confers protection against severe disease in adult life. AIM: To establish the contribution of Plasmodium falciparum infection in adults admitted with neurological dysfunction in an endemic area, to assess the implications of an admission clinical diagnosis of 'cerebral malaria' on the treatment and clinical outcome, and to describe the clinical features of patients with malaria parasitaemia. DESIGN: Prospective observational study. METHODS: We studied adult patients admitted with neurological dysfunction to Muhimbili National Hospital, Dar-es-Salaam, Tanzania from October 2000 to July 2001. A full blood count was done and serum creatinine, blood glucose and P. falciparum parasite load were measured. RESULTS: Of 199 patients (median age 34.6 years), 38% were diagnosed as 'cerebral malaria' on admission, but only 7.5% had detectable parasitaemia, giving a positive predictive value of 13.3%. Only 1% fulfilled the WHO criteria for cerebral malaria. The prevalence of parasitaemia (7.5%) was less than that observed in a group of asymptomatic controls (9.3%), but distribution of parasite densities was higher in the patients. Mortality was higher in patients with no parasitaemia (22.3%) than in those with parasitaemia (13%). DISCUSSION: Cerebral malaria was grossly overdiagnosed, resulting in unnecessary treatment and insufficient investigation of other possible diagnoses, which could lead to higher mortality. Extension of this misperception to the assessment of cause of death in community surveys may lead to an overestimation of the impact of malaria in adults.

Risk factors for epilepsy in a rural area in Tanzania. A community-based case-control study.

BACKGROUND AND METHODS: The high prevalence of epilepsy detected in rural Tanzania by Dr. Jilek-Aall since 1960, was verified by the World Health Organization (WHO) survey on neurological and seizure disorders. Neurologists and psychiatrists further interviewed both patients and controls using standard methods. The presence of possible risk factors was complemented by corroborative evidence through interviewing close relatives and scrutinizing medical records. Seizures were classified based on clinical symptoms and the use of EEG. RESULTS: A family history of epilepsy in first-degree relatives was found in 46.6% of patients, but in only 19.6% of controls. The odds ratio for family history with epilepsy was 3.52 (95% confidence interval, CI 2.4-5.74, p < 0.001). A past history of febrile convulsion was found in 44% of patients in comparison to 23% of the control group which was significant (odds ratio 2.4, 95% CI 1.5-3.8; p < 0.001). A history of intrapartum complications was found in 12.1% of patients and 1.8% of controls (odds ratio 7.3, 95% CI 2.5-25.2; p < 0.002). Head injury was not a significant risk factor for epilepsy in this rural community. CONCLUSION: The results indicated a strongly independent association between four factors and the risk of developing epilepsy. It would seem more likely that previous brain insults/diseases play a significant major role in the cause of epilepsy in the Mahenge area. However, a genetic predisposition to low threshold for convulsions cannot be excluded.

Incidence and characteristics of Myasthenia gravis in Dar Es Salaam, Tanzania.

OBJECTIVE: To ascertain the annual incidence and characterise the clinical features of Myasthenia gravis in Dar es Salaam, Tanzania during a ten-year period from 1st January 1988 to 31 December 1998. DESIGN: Prospective cumulative registration at a major urban hospital of all patients with newly diagnosed Myasthenia gravis who were resident in Dar es salaam. SETTING: Muhimbili Medical Centre Teaching Hospital, Dar es Salaam, Tanzania. SUBJECTS: Forty seven patients, twenty males, twenty seven females satisfied the criteria for the diagnosis of Myasthenia gravis (MG). RESULTS: The annual incidence of MG of both sexes was 3 per 1,000,000 population of all age groups (95% CI 2.0 to 3.6). The incidence per 1,000,000 population was lowest in those aged below ten years 2.2 (95% CI 1.4 to 3.4) which was statistically significant. The incidence per 1,000,000 per year was higher in females but this was not statistically significant. The clinical presentation of MG in Tanzania was localised disease accounting for 47% ocular type and 53% was mild to moderately severe generalised type MG. Twenty per cent of patients with generalised MG presented with bulbar features. Single fibre electromyography was the most sensitive test. CONCLUSION: Myasthenia gravis is fairly rare in Tanzania as is in other sub-Saharan countries and presents in similar way to European in terms of age, sex, and clinical features. Ocular Myasthenia gravis was more prevalent in Tanzania than in Europe.

Evaluation of risk factors for Alzheimer's disease in elderly east Africans.

A number of biological risk factors have been implicated for Alzheimer's disease (AD). The investigation of prevalence rates of AD in crosscultural populations has much potential in validating these factors. We previously assessed brain amyloid beta (A beta) protein deposition and other lesions associated with AD as possible markers for preclinical AD in elderly nondemented East Africans. In further analysis, we demonstrate that 17-19% of elderly East African subjects without clinical neurological disease exhibited neocortical A beta deposits and minimal neurofibrillary changes at necropsy that was qualitatively and quantitatively similar to that in an age-matched elderly control sample from Cleveland, OH. A beta deposits varied from numerous diffuse to highly localized neuritic plaques and were predominantly reactive for the longer A beta 42 species. In parallel studies, we evaluated another recently implicated factor in AD, the apolipoprotein E genotype. We found relatively high frequencies of the apolipoprotein E-epsilon 4 allele in elderly nondemented East Africans. The frequencies were comparable to those in other African populations but higher than in subjects from developed countries. Our limited study suggests that elderly East Africans acquire cerebral lesions found in AD subjects but the apolipoprotein E-epsilon 4 allele may not be a highly specific factor for the disease among East Africans.

Apolipoprotein E polymorphism in elderly east Africans.

Current advances have shown the apolipoprotein E (APOE)-epsilon 4 allele to be highly associated with late-onset familial and sporadic Alzheimer's disease (AD) in Western populations. The association of APOE allele frequencies and dementia remain unknown in populations from developing countries. We recently initiated a project to examine APOE frequencies in non-demented and demented elderly East Africans. Blood DNA collected from two hospital-based populations showed that the APOE allele frequencies in a group of non-demented 67 Tanzanians over the age of 65 years were found to be 14% for epsilon 2, 61% for epsilon 3 and 25% for epsilon 4. By comparison, the frequency of APOE-epsilon 4 in an age-matched demented group was also 25%. Assessment of APOE genotypes in the group of elderly Kenyan subjects from Nairobi also revealed high frequencies of the epsilon 4 allele with no clear difference in frequency between demented and non-demented subjects. Our preliminary observations suggest that elderly East Africans with no apparent clinical AD possess relatively high APOE-epsilon 4 allele frequencies compared to normal ageing subjects from Western countries including African-Americans. These results appear similar to those reported in a recent study in Nigerian Africans where a lack of correlation between APOE-epsilon 4 allele frequency and Alzheimer type of dementia was noted, and imply that APOE-epsilon 4 allele may not necessarily be a risk factor in some populations of Africa.

Cerebral amyloid beta protein deposits and other Alzheimer lesions in non-demented elderly east Africans.

There is little knowledge of the existence of Alzheimer disease (AD) or Alzheimer type of dementia in indigenous populations of developing countries. In an effort to evaluate this, we assessed the deposition of amyloid beta (A beta) protein and other lesions associated with AD in brains of elderly East Africans. Brain tissues were examined from 32 subjects, aged 45 to 83 years with no apparent neurological disease, who came to autopsy at two medical Institutions in Nairobi and Dar es Salaam. An age-matched sample from subjects who had died from similar causes in Cleveland was assessed in parallel. Of the 20 samples from Nairobi, 3 (15%) brains exhibited neocortical A beta deposits that varied from numerous diffuse to highly localized compact or neuritic plaques, many of which were also thioflavin S positive. Two of the cases had profound A beta deposition in the prefrontal and temporal cortices and one of these also exhibited moderate to severe cerebral amyloid angiopathy. Similarly, 2 of the 12 samples from Dar es Salaam exhibited diffuse and compact A beta deposits that were also predominantly reactive for the longer A beta 42 species compared to A beta 40. We also noted that A beta plaques were variably immunoreactive for amyloid associated proteins, apolipoprotein E, serum amyloid P and complement C3. Tau protein reactive neurofibrillary tangles (NFT) were also evident in the hippocampus of 4 subjects. By comparison, 4 (20%) of the 20 samples from randomly selected autopsies performed in Cleveland showed A beta deposits within diffuse and compact parenchymal plaques and the vasculature. These observations suggest A beta deposition and some NFT in brains of non-demented East Africans are qualitatively and quantitatively similar to that in age-matched elderly controls from Cleveland. While our small scale study does not document similar prevalence rates of preclinical AD, it suggests that elderly East Africans are unlikely to escape AD as it is known in developed countries.

Nature of referrals to the psychiatric unit at Muhimbili Medical Centre, Dar es Salaam.

During a 24-month period, 205 consecutive new referrals to Muhimbili psychiatric unit were studied. Their socio-demographic characteristics, sources of referral, types of treatment received before referral and the nature of their clinical problems were identified. Their neuropsychiatric disorders were classified according to ICD-10. The ratio of males to females was found to be 1.6:1. The average age was 29.3 years. 23.4% of adult patients were unemployed, two fifths of all patients were single and 70% of all subjects had less than eight years of formal education. Whereas 42.9% of all referrals were from other departments of Muhimbili hospital, the remaining were largely from parastatal dispensaries, district and regional hospitals within Dar es Salaam city. At least a fifth of all patients had consulted traditional healers prior to referral and antimalarials had been given inappropriately to 34 patients with mental problems. Mental disorders consisted of functional psychosis, 36.6% of which three quarters were schizophrenia, neurosis (19.5%), seizures (16.6%), substance abuse (8.8%), organic mental disorders (5.3%), headache (4.9%), sexual dysfunction (2.9%). The rest had conduct disorders and pseudocyesis. Seventeen percent of all cases had concomitant physical disorders. Most patients had delayed to seek medical help.

Headache in a nonclinical population in Dar es Salaam, Tanzania. A community-based study.

Headache is a common symptom that constitutes a major health problem to all countries in the world with a variable prevalence from about 20.2% in the African population to about 80% in populations of the civilized world. Community-based studies in African populations are still scanty, and the impact on health facility utilization and sickness absence from work is unknown. After a simple random selection, 1540 urban workers and students of higher education completed a standardized self-administered questionnaire on headache. A total of 815 (52%), (620 (51%) men, 195 (60%) women) admitted to having suffered a headache requiring medication or medical consultation in the last year. Of these, 366 (23.7%) had recurrent headache not attributable to systemic disease. Of the total with recurrent headache, there was a significant preponderance of women over men with sex prevalence of 28.9% and 22.4%, respectively (X2 P = 0.0001). Combined vascular-muscular-type of headache exceeded all types of headache, accounting for 35.8% of cases, followed by migraine accounting for 30.8% of cases. Organic disease was rare, accounting for 8.5% of cases, and psychogenic causes of headache were even rarer at less than 1.2% of cases. Within 2 months of onset of recurrent headaches, over 32% of sufferers had utilized the health facility at their place of work or study. A significant number of cases (175) had an average of 11.3 lost work days per year in comparison to a control group of 154 persons with an average of 5.7 lost work days per year for reasons other than headache (X2 P = 0.0005).(ABSTRACT TRUNCATED AT 250 WORDS)

Electroencephalographic findings in epileptic patients in Tanzania.

Electroencephalogram (EEG) of 524 Tanzanian epileptic patients seen between 1985 and 1988 were reviewed after a description and classification of seizures. Over two thirds were young patients between the age of five and thirty. The majority (86%) had abnormal records. Of these, 89% of abnormal records had focal abnormality and 11% had centrencephalic abnormality. Grand mal seizures did not imply centrencephalic abnormality, only 13% had such abnormality. Absence seizures are rare and over one third of these had temporal focal abnormality. Partial seizures were associated highly with focal abnormality. However, complex partial seizures did not imply temporal focal abnormality. Implications of EEG findings to correlation with epileptic seizures is discussed.

The elderly patients as seen at Muhimbili Medical Centre, Tanzania.

Ageing is fast developing in Tanzania like in most developing countries against a background of many unsolved infrastructural problems. Persons aged 60 years and over constituted only about one percent of the total population in 1961 to 4% of 23.2 million people in 1988. Ageing is a process associated with chronic and disabling diseases. A two year hospital based study at the teaching hospital revealed five major diseases, similar to those in the western world, except for infectious diseases which accounted for a sixth of the total diagnoses. Socio-medical interview of 100 elderly patients uncovered that widowhood among females was ten times more than among males. A large proportion of elderly patients especially women had less than 4 years of education. Most elderly patients lived in extended family structures. Over 40% females and 32% males suffered from a multiplicity of chronic diseases. Physical disabilities increased rapidly with advancing age in both sexes. Capacity for self-care was worse in females than in males. The nature of diseases and disabilities in the elderly in Tanzania are difficult to ignore, particularly in the light of expected rapid progression of an ageing population. The need for systematic planning to meet the needs of the elderly is highlighted in the discussion.

Knowledge, attitude and practice (KAP) towards epilepsy in secondary school students in Tanzania.

Persons with epilepsy are shunned and discriminated against in education, employment, and marriage in Africa, because epilepsy is seen as a highly contagious and shameful disease in the eyes of the public. These observations come from many studies carried out in Africa including recent ones in Nigeria and Liberia. The KAP towards epilepsy among school children in Tanzania has not been studied and this information is essential before a health education programme on epilepsy can be designed for incorporation into the school curriculum. Therefore a study was carried out on 426 secondary school children in Mahenge to find out their KAP towards epilepsy. Forty six pc (193 of 420, students attributed epilepsy to heredity, brain injury, brain infection and witchcraft in that order. About 60 pc (186 of 331) considered epilepsy to be contagious through physical contact, saliva, and breath. Hospital treatment was considered by 62.7 pc (248 of 395) students and 80 pc (346 of 422) considered epilepsy to be controllable. Over 90 pc (385 of 414) of the students believed an epileptic person to be mentally subnormal and considered this a major reason for not sending an epileptic child to school. Their belief in the contagiousness of epilepsy was a major reason for discriminating against an epileptic child or person playing with other children; going to school; sharing the same plate or bed and as a marriage partner and this was significantly more so in the lower than upper classes.(ABSTRACT TRUNCATED AT 250 WORDS)

Knowledge, attitude, and practice toward epilepsy among rural Tanzanian residents.

Before a health education program can be established, one must first know what the target population believes and does with respect to the disease in question. Therefore, we performed a study among Tanzanian rural inhabitants to identify their knowledge, attitude, and practice (KAP) toward epilepsy: 3,256 heads of households (mean age 40.2 years, range 15-90 years; M/F ratio 1:1) were interviewed. Of the respondents, 32.9% said they had never seen a seizure; 67.7% said they did not know the cause of epilepsy; 33.3% mentioned various causes including heredity, witchcraft, infection of the spinal cord, hernia; 40.6% believed epilepsy was infectious through physical contact, flatus, breath, excretions, sharing food; 36.8% believed epilepsy could not be cured and 17.1% believed it could not even be controlled; 45.3% believed epilepsy could be treated by traditional healers, and only 50.8% believed hospital drugs were of any use; and 62.7% of the respondents would not allow an epileptic child to go to school for various reasons, including mental subnormality (54.0%), fear of the child falling while alone (65.9%), and fear that the epileptic child would infect other children (11.2%). Concerning what is to be done when a seizure occurs, 33.5% of the respondents would keep away and not touch the person; 16.5% would take some potentially harmful measure such as forcing a mouth gag or forcing a drink such as water (1 even mentioned urine); 5.2% would take unnecessary measures such as rushing the patient to a hospital. Only 35.7% of respondents would perform at least some of the currently recommended first-aid measures.(ABSTRACT TRUNCATED AT 250 WORDS)

Electroencephalographic findings in Tanzanian epileptic patients.

Electroencephalogram (EEG) of 524 Tanzanian epileptic patients seen between 1985 and 1987 were reviewed. Over two thirds were young patients between the ages of five and thirty. Four hundred and fifty (86%) had abnormal records. Eighty nine per cent of abnormal records had focal abnormality and 11% had centrencephalic abnormality. Grand mal seizures did not imply centrencephalic abnormality, only 13% had such abnormality. Petit mal seizures are rare, over one third of these had temporal focal abnormality. Partial seizures were associated highly with focal abnormality. However, complex partial seizures did not imply temporal focal abnormality. Implications of EEG findings to correlation with epileptic seizures is discussed.

Prevalence and incidence of epilepsy in Ulanga, a rural Tanzanian district: a community-based study.

A random cluster sample survey of approximately 18,000 people in 11 villages was performed in Ulanga, a Tanzanian district with a population of approximately 139,000 people. Well-instructed fourth-year medical students and neurologic and psychiatry nurses identified persons with epilepsy using a screening questionnaire and sent them to a neurologist for detailed evaluation. Identified were 207 subjects (88 male, 119 female) with epilepsy; of these, 185 (89.4%) (80 male, 105 female) had active epilepsy. The prevalence of active epilepsy was 10.2 in 1,000. Prevalence among villages varied, ranging from 5.1 to 37.1 in 1,000 (age-adjusted 5.8-37.0). In a 10-year period (1979-1988) 122 subjects living in the 11 villages developed epilepsy, with an annual incidence of 73.3 in 100,000. Generalized tonic-clonic seizures (GTCS) accounted for 58% and partial seizures accounted for 31.9%, whereas in 10.1% seizures were unclassifiable. Of the partial seizures, secondarily generalized seizures were the most common. Possible etiologic or associated factors were identifiable in only 25.3% of cases. Febrile convulsions were associated in 13.4 of cases. Other associated factors included unspecified encephalitis (4.7%), cerebral malaria (1.9%), birth injury (1.4%), and other (3%). In 38% of the cases, there was a positive family history of epilepsy.