Incidence of epilepsy in rural central Ethiopia.

PURPOSE: To study the incidence of epilepsy in a rural area of Ethiopia. METHODS: A community-based study was performed in a random sample of villages with 61,686 inhabitants in a rural area of central Ethiopia. In a door-to-door survey, all inhabitants in the study area were interviewed about seizures. A standardized protocol was used. All new cases with epilepsy that had occurred since a previous study was made 3.5 years earlier were included. Fifty-three of the subjects were investigated with EEG. RESULTS: One-hundred thirty-nine incident cases were identified, corresponding to an annual incidence of 64 in 100,000 inhabitants [95% confidence interval (CI) 44-84]. The corresponding rate for males was 72 (CI 42-102); for females, it was 57 (CI 31-84). The highest age-specific incidence occurred in the youngest age groups (0-9 years); the next highest was in the group aged 10-19 years. Generalized convulsive seizures occurred in 69%, partial seizures occurred in 20%, and unclassifiable seizures occurred in 11%. Seizures occurred daily in 10% and weekly in another 14%; 33% had monthly seizures. Twenty-two percent had a family history of epilepsy. A history of head trauma was ascertained in 5.7% and was the most common possible etiologic factor identified. Thirteen percent were treated with antiepileptic drugs (AEDs). CONCLUSIONS: The incidence of epilepsy in Ethiopia is high. A high incidence in combination with a prevalence of epilepsy in the study area comparable to that in the rest of the world may be explained by a high degree of spontaneous remission of epilepsy and/or a high mortality due to epilepsy. Despite health education on epilepsy given to the community, a minority of subjects were treated with AEDs, which may reflect the inadequacies of the health services and transportation difficulties faced by the patients.

Symptomatic treatment of neurolathyrism with tolperisone HCL (Mydocalm): a randomized double blind and placebo controlled drug trial.

The efficacy and safety of oral Tolperisone HCL was evaluated in double blind, placebo-controlled, randomized trial in 72 patients with neurolathyrism in stages I, II, and III of the disease at Kolla Duba Health Centre of Dembia District of North Gondar between January and April 1995. Taken orally daily for 12 weeks, tolperisone HCL (Mydocalm) in a dose of 150 milligrams (mgs) twice daily significantly improved subjective complaints such as muscle cramps, heaviness of the legs, startle attacks, flexor spasms and repeated falls. An overall subjective improvement was observed in 75% of the patients on tolperisone HCL and 39% of the placebo group (P = 0.002). When objectively assessed spastic muscle tone in the abductors, stiffness of Achilles and spontaneous ankle clonus were significantly reduced in tolperisone HCL group (P values = 0.001, 0.04, and 0.0001, respectively). Walking ability and speed of walking was also significantly improved. The drug is most effective in relieving symptoms of stage I and stage II disease. Some adverse effects like muscle pain, generalized body weakness and dizziness were recorded in patients taking the drug but all were minor and self limited, none requiring discontinuation of treatment. It is concluded that tolperisone is a well tolerated and efficacious drug for symptomatic treatment of neurolathyrism.

Perceptions of blindness.

A study in a mainly rural area of Ethiopia has revealed that sighted, unilaterally blind and totally blind people have many misconceptions about blindness. The work of cure and prevention demands that widespread ignorance about the causes and implications of blindness be overcome.

Migraine, chronic tension-type headache, and cluster headache in an Ethiopian rural community.

Fifteen-thousand-five-hundred adults (> or = 20 years) in a rural district in Ethiopia with a population of 250,000 were studied for chronic headache. Door-to-door survey was performed by trained lay health workers using a questionnaire with a high degree or reliability and validity. The 1-year prevalence of migraine headache was 3.0% (4.2% for females and 1.7% for males) with the peak age specific rate in the fourth decade. Migraine headache was about three times more common in females than in males at any decade. Two-thirds of migraine sufferers had rather frequent attacks. The most frequent trigger factors were emotional stress (90%), changes of weather (78%), physical exhaustion (75%), and smell (70%). Migraine with aura was rare. Family occurrence of migraine in first-degree relatives was 30%. The 1-year prevalence of chronic tension-type headache was 1.7%, while cluster headache was found to be extremely rare. Compared to similarly performed surveys, the prevalence of migraine among rural Ethiopians was less than among Nigerian Africans.

Causes of visual impairment in central Ethiopia.

A survey conducted on a stable, mainly rural population of 60,820 in Central Ethiopia revealed an overall blindness prevalence of 1.1%. A follow up study was carried out to accurately determine the etiologies and causes of visual loss and impairment. A detailed ophthalmic evaluation was done on 523 out of 872 individuals identified as being visually impaired. The results showed that 194 (37%) were blind (Categories 3, 4, and 5 = maximum visual acuity less than 3/60 in the better eye). One hundred and seven (21%) (Categories 1 & 2 = maximum visual acuity better than 3/60 to less than 6/18 in the better eye using the WHO categories of visual impairment). The rest 222 (43%) were blind in one eye only. The commonest anatomical cause of blindness is corneal (32%). Cataract (25%), atrophied globe(s) (20%) and glaucoma (17%) follow as the other leading causes. Trachoma (35%), degenerative conditions (35%) and other infections (9%) were the major etiologies of blindness. Similar pattern of anatomical causation was observed in those classified under categories of visual impairment 1 and 2, referred to as "low vision". The most important etiologies of low vision were trachoma (30%), degenerative (24%), trauma (13%) and other infections (8%). Trauma was the most important etiology of monocular blindness (39%). Blindness was either preventable or curable in 74% of the cases.

Paraplegia at the Tikur Anbessa Teaching Hospital: a seven year retrospective study of 164 cases.

Admission analysis of adult non-traumatic paraplegia and paraparesis from 1981 to 1988 was carried out. Information was collected from charts of 223 consecutive admissions according to a pre-set protocol. Paraplegia or paraparesis was responsible for 164(13.4%) of all neurological admissions over the study period. The median age of the patients was 36 years with a male to female ratio of 1.7:1. Tuberculosis was the leading cause of paraplegia or paraparesis accounting for 47% of the cases. Tumours (20%), Landry-Guillain-Barre' syndrome (12.2%) and tropical spastic paraparesis (TSP) (9.8%) were important but less frequent causes in this series. Other causes like disc prolapse, transverse myelitis, spinal artery stroke and fluorosis were rarely encountered. Vertebral deformity (88.1%), vertebral tenderness (88.1%) and abnormal plain spinal X-ray (89%) were the most helpful findings in the diagnosis of tuberculous paraplegia. Nearly all cases of tuberculous paraplegia were treated medically alone. However, the outcome of treatment as judged by the treating physicians was good with a significant response recorded in 78%.

HIV infection and leprosy: a four-year survey in Ethiopia.

Between 1988 and 1992 three cross-sectional surveys for antibodies to HIV were done in 644 Ethiopian patients with histologically proven leprosy. Whereas the frequency of HIV-1 infection gradually increased from 3.2% to 6.5%, the clinical presentation, number of new patients, and frequency of relapse did not differ between HIV negative and positive patients. Thus HIV appears unlikely to have a significant impact on the incidence of leprosy in sub-Sahelian populations.

Blood pressure patterns and its correlates in schoolchildren of an Ethiopian community.

This study was undertaken to define blood pressure pattern in a sample of schoolchildren in an Ethiopian rural community. All schoolchildren below the age of 15 years in Butajira town formed the study population. Blood pressure measurement which was made according to the recommendations of the American Task Force on blood pressure control in children was found to be unimodal with almost symmetrical distribution. The mean systolic and mean diastolic blood pressure for both sexes combined was 106 +/- 14.8 and 70.5 +/- 4.5 mmHg, respectively. The mean systolic and mean diastolic blood pressures increased with age in both boys (P < 0.05) and girls (P < 0.01). Girls had significantly higher mean systolic and mean diastolic blood pressures than boys (P < 0.001). Similarly, girls had significantly higher pulse rate and arm-girth than boys which may partly explain the higher mean pressures in the girls. A multiple regression analysis showed that height, body mass index, arm-girth, and heart rate were significant in explaining the variations in systolic and diastolic blood pressures. In conclusion, except for the higher blood pressure in girls, our findings are similar to the majority of the reports from Africa and other parts of the world.

A survey of antibodies to hepatitis C virus in Ethiopia.

Antibodies to hepatitis C virus (HCV) were measured in 1,580 Ethiopian subjects representing urban and rural populations. Sera found positive by a repeated second generation enzyme immunoassay (EIA) were subjected to three additional confirmatory tests. The overall confirmed seroprevalence was 2.0%. Less than 1% were confirmed to be seropositive in rural communities, with 1.4% positive among blood donors, 1.6% positive among patients with dermatologic disorders, 3.6% among leprosy patients, and 6.0% among patients attending a University Hospital clinic for neurologic disorders. The patients in the groups with leprosy and neurologic disorders have most likely been in ill health for many years and have sought relief by traditional healers or treatment at poorly equipped clinics. This group of patients demonstrated a high prevalence of antibodies to HCV. In Ethiopia, especially in small clinics, there is a shortage of syringes and needles and they have to be reused many times often with inadequate sterilization. Therefore, these syringes and needles may be contaminated, thus being a risk factor for HCV and HIV infection.

Multiple myeloma in Ethiopians: analysis of 22 cases.

Twenty-two cases of multiple myeloma were seen in the Department of Internal Medicine, Tikur Anbessa (Black Lion) Hospital, a teaching and referral hospital in Addis Abeba, Ethiopia, from January 1983 to December 1990. The age range was 38 to 76 (mean +/- SD = 51.5 +/- 12.2) years; a third were in the fifth decade. The male:female ratio was 1.75:1. The common clinical findings were bone pain in 20 (91%), bone tenderness in 15 (68%), anaemia in 14 (64%) and spinal cord compression in 8 (36%). The erythrocyte sedimentation rate (ESR) was raised in 21. Serum protein was raised in 17 (77%) and hyperglobulinaemia was seen in 20 (91%). Serum uric acid, blood urea nitrogen (BUN) and calcium were elevated in 10, 8 and 5 patients respectively, Bence-Jones proteinuria and albuminuria were each found in 9 patients. All patients had radiological abnormalities; 9 had a combination of lytic lesions, osteoporosis and pathological fractures (41%). Ten patients presented in clinical stage III. Four patients are being followed after 3-84 (median 40.5) months; eight were lost to follow-up 1-8 (median 2.0) months after diagnosis. Ten patients have died after 1-55 (median 11) months. Multiple myeloma is not uncommon in Ethiopians. Except for a lower age at presentation, the clinical, haematological, biochemical, and radiological findings, and the response to therapy, are similar to those reported elsewhere.

Attitudes of rural people in central Ethiopia towards leprosy and a brief comparison with observations on epilepsy.

To find out public attitudes toward leprosy a door-to-door survey was carried out in 1546 sampled households in the rural farming community of Meskan and Mareko in central Ethiopia, where the prevalence of leprosy is estimated to be 1:1000. Attitudes toward leprosy were compared with attitudes to epilepsy, studied in a previously performed survey in the same community. Eighty-seven per cent of the respondents were above the age of 25, and 59.5% were females. There were slightly more Muslims (54%) than Christians. The majority of the interviewees (87%) were farmers, with an illiteracy rate of 84%. Ninety-five per cent and 83%, respectively, were not willing to employ or work with a person having the disease. Seventy-five per cent would not allow their children to associate with a playmate suffering from leprosy. Comparative analysis of attitudes in the same community showed that negative attitudes toward leprosy were stronger than those toward epilepsy, particularly with regard to matrimonial associations, sharing of accommodation, and physical contact with an affected person. The reasons for these differences appear to be the community's deeply entrenched belief that leprosy is both hereditary and contagious, expressed respectively by 48% and 53% of the respondents. In order to minimize the perpetuation of negative attitudes, there is a need to educate and impress on the population that leprosy is a treatable infectious disease which is not congenitally acquired, and that it is even curable if detected early. The study reinforces previously proposed suggestions that, in developing countries such as Ethiopia, leprosy care should be integrated into the general health services.

Rheumatic heart disease prevalence among schoolchildren of an Ethiopian rural town.

Rheumatic heart disease (RHD) is the most important cardiovascular disease in hospital practice in Ethiopia. However, the prevalence rate of RHD at the community level remains unknown. The current survey was undertaken to estimate its prevalence among schoolchildren of a central Ethiopian rural town (Butajira). Accordingly, 92.8% of the entire schoolchildren (n = 3.235) in the town were screened. Their mean age was 13.4 +/- 3.5 years. Fifteen children, accounting for a rate of 4.6/1,000, were noted to have findings consistent with RHD. Females and older children were more frequently affected. Only 2 of the 15 students were aware of their disease, and neither of them were on regular secondary prophylaxis. Our finding is consistent with the hospital-based reports that showed RHD to be a common disorder in clinical practice. At the same time, the lack of awareness about their disease noted among the cases is worrisome and deserves serious attention.

Attitudes of rural people in central Ethiopia towards epilepsy.

In the farming community of the sub-district of Meskan and Mareko in central Ethiopia, where the prevalence of epilepsy is known to be 5.2/1000, a door-to-door survey was undertaken in 1546 sampled households to find out public attitudes to epilepsy. Nearly 64% of the respondents were in the age group of 14-50 years, and 58.6% were women. The majority (86%) were illiterate, and 94% had incomes of a subsistence level; 89% had heard or witnessed seizures. Traditional views on the association of evil spirits and superstition was prevalent. By 45% of the interviewees, the disease was believed to be contagious through physical contacts during an attack. Although there was sympathetic concern in the community for the person suffering from epilepsy, negative attitudes were strong on matrimonial associations, sharing of accommodation and physical contacts with affected persons, particularly when there were obvious signs and frequent attacks by seizures. The study demonstrates that the rural community has very poor knowledge of the causes and nature of epilepsy, and this has resulted in social deprivations and at times, rejection of the sufferers.

Clinical and electroencephalographic characteristics of epilepsy in rural Ethiopia: a community-based study.

A community-based epidemiological study of neurological disorders was performed in a rural area in Ethiopia. The most prevalent neurological disorder identified was epilepsy, found in 316 persons. The prevalence of epilepsy was 5.2/1000 inhabitants at risk, 5.8 for males, 4.6 for females. The highest age-specific prevalence was found for ages 10-19 years. Generalized tonic-clonic seizures were the most common seizure type and occurred in 81%. On clinical grounds, partial seizures occurred in 20% and in 29% of these secondary generalization followed. During seizures, 8.5% had been injured by burns and 5.7% by trauma. Eighty-four percent had seizures at least monthly. Seizures occurred in 4.8% of siblings. Traditional treatment with local herbs, holy water and amulets was the most common. Only 1.6% had been treated with recognized antiepileptic drugs. Mental retardation was the most common associated disorder, found in 7.9% of the persons with epilepsy. During a period of 2 years, 8 persons died of status epilepticus and 1 from severe burns as a result of falling into a domestic fire during a seizure. EEG was recorded in 73%. Epileptiform activity occurred in 18%.

Community-based study of neurological disorders in rural central Ethiopia.

Between 1986 and 1988 a door-to-door survey was conducted on a stable rural population of 60,820 in central Ethiopia. Trained lay health workers made a complete census and identified cases with symptoms and signs of neurological disorders, using specially designed questionnaires which, in a previous pilot study, were found to have a sensitivity of 91% and specificity of 85%. Neurological disorders in the rural population were epilepsy, postpoliomyelitis paralysis, mental retardation, peripheral neuropathy (mainly due to leprosy), and deaf-mutism with prevalence rates (cases/100,000 population) of 520, 240, 170, 150 and 130, respectively. The prevalence rates of the other less common neurological disorders were 62 for hemiparesis (15 of which were for cerebrovascular accidents), 20 for cerebral palsy, 16 for optic atrophy, 12 for perceptive deafness, 10 for tropical spastic paraparesis, 7 for Parkinson's disease and 5 for motor neuron disease, ataxia and chorea/athetosis. Among related non-neurological conditions, blindness, locomotor disability and deafness were predominant. The significance and role of such a neuroepidemiological study in laying the strategies for the prevention of neurological disorders and rehabilitation of patients are discussed in the context of a developing country.

Light and electron microscopic changes in sural nerves in Ethiopian diabetics.

The light and electron microscopic morphological changes in sural nerve biopsies from 32 Ethiopian diabetics and 4 malnourished non-diabetic subjects were studied in order to determine the role of malnutrition in the development of diabetic neuropathy. The most prominent finding in diabetics with clinical neuropathy was reduction in the density of myelinated axons of all diameters especially the large ones. Affected nerves showed abundant intraneural collagen, and evidence of nerve regeneration in some cases. Demyelination, though present, was less marked. Changes in the vasa nervorum were seen in only one case. The morphological changes correlated with the duration and severity of the diabetes and with nerve conduction velocity. No changes were seen in malnourished non-diabetics and diabetics without clinical neuropathy, thus suggesting that malnutrition by itself does not contribute significantly to the development of diabetic neuropathy. Axonal degeneration appears to be the predominant feature in diabetic neuropathy.