title: The social and economic impact of epilepsy in Zambia: a cross-sectional study.
abstract: BACKGROUND
  Among the 40 million people with epilepsy worldwide, 80% reside in low-income regions where human and technological resources for care are extremely limited. Qualitative and experiential reports indicate that people with epilepsy in Africa are also disadvantaged socially and economically, but few quantitative systematic data are available. We sought to assess the social and economic effect of living with epilepsy in sub-Saharan Africa.
  
  
  METHODS
  We did a cross-sectional study of people with epilepsy concurrently matched for age, sex, and site of care to individuals with a non-stigmatised chronic medical condition. Verbally administered questionnaires provided comparison data for demographic characteristics, education, employment status, housing and environment quality, food security, healthcare use, personal safety, and perceived stigma.
  
  
  RESULTS
  People with epilepsy had higher mean perceived stigma scores (1.8 vs 0.4; p<0.0001), poorer employment status (p=0.0001), and less education (7.1 vs 9.4 years; p<0.0001) than did the comparison group. People with epilepsy also had less education than their nearest-age same sex sibling (7.1 vs 9.1 years; p<0.0001), whereas the comparison group did not (9.4 vs 9.6 years; p=0.42). Housing and environmental quality were poorer for people with epilepsy, who had little access to water, were unlikely to have electricity in their home (19%vs 51%; p<0.0001), and who had greater food insecurity than did the control group. During pregnancy, women with epilepsy were more likely to deliver at home rather than in a hospital or clinic (40%vs 15%; p=0.0007). Personal safety for people with epilepsy was also more problematic; rape rates were 20% among women with epilepsy vs 3% in the control group (p=0.004).
  
  
  CONCLUSIONS
  People with epilepsy in Zambia have substantially poorer social and economic status than do their peers with non-stigmatised chronic medical conditions. Suboptimum housing quality differentially exposes these individuals to the risk of burns and drowning during a seizure. Vulnerability to physical violence is extreme, especially for women with epilepsy.
authors.affiliation: Michigan State University's International Neurologic and Psychiatric Epidemiology Program, East Lansing, MI 48824-1313, USA. gretchen.birbeck@ht.msu.edu
authors.forename: Gretchen
authors.initials: G
authors.lastname: Birbeck
authors.forename: Elwyn
authors.initials: E
authors.lastname: Chomba
authors.forename: Masharip
authors.initials: M
authors.lastname: Atadzhanov
authors.forename: Edward
authors.initials: E
authors.lastname: Mbewe
authors.forename: Alan
authors.initials: A
authors.lastname: Haworth
mesh_terms: D000328:Adult; D017668:Age of Onset; D000368:Aged; D003430:Cross-Sectional Studies; D003695:Delivery of Health Care / Q000191:economics / Q000706:statistics & numerical data; D004493:Education; D004651:Employment; D004777:Environment; D004827:Epilepsy / Q000191:economics* / Q000453:epidemiology*; D005190:Family; D005260:Female; D005523:Food Supply; D019538:Health Care Surveys; D006798:Housing; D006801:Humans; D008297:Male; D017533:Marital Status; D008875:Middle Aged; D011287:Prejudice; D012449:Safety; D012737:Sex Factors; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D015024:Zambia