title: Co-morbidity of epilepsy in Tanzanian children: a community-based case-control study.
abstract: OBJECTIVE
  To define the prevalence and associations of co-morbidity and school attendance in older children with epilepsy (CWE) from a rural district of Tanzania by conducting a community-based case-control study.
  
  
  METHODS
  Children aged 6-14 years old with active epilepsy (at least two unprovoked seizures in the last five years) were identified in a cross-sectional survey in Tanzania. Co-morbidities were assessed and cases were compared with age-matched controls.
  
  
  RESULTS
  Co-morbidity was very common amongst cases (95/112, 85%), with 62/112 (55%) having multiple co-morbidities. Co-morbidities consisted of cognitive impairment (72/112, 64%), behaviour disorder 68/112 (61%), motor difficulties 29/112 (26%), burns and other previous injuries (29/112, 26%). These complications were significantly more common in cases than in controls (odds ratio 14.8, 95%CI 7.6-28.6, p<0.001). Co-morbidity in CWE was associated with structural cause, abnormal electroencephalogram and early onset seizures. Cognitive impairment was very common in CWE (64%) and was not associated with Phenobarbital use but was associated with motor difficulties, early onset and recurrent seizures. Poor school attendance was found in 56/112 (50%) of CWE, but not in the controls: it was associated with the presence of multiple co-morbidities, especially with motor difficulties in CWE.
  
  
  CONCLUSIONS
  Children with epilepsy in a rural area of sub-Saharan Africa had a high level of co-morbidity. Cognitive impairment and poor school attendance were very common. These associated difficulties in CWE in the region need to be addressed to reduce the negative impact of epilepsy on these children.
authors: Kilimanjaro Christian Medical Centre, Moshi, Tanzania. kjburton@doctors.org.uk
authors: Kathryn
authors: K
authors: Burton
authors: Jane
authors: J
authors: Rogathe
authors: Roger G
authors: RG
authors: Whittaker
authors: Kshitij
authors: K
authors: Mankad
authors: Ewan
authors: E
authors: Hunter
authors: Matthew J
authors: MJ
authors: Burton
authors: Jim
authors: J
authors: Todd
authors: Brian G R
authors: BG
authors: Neville
authors: Richard
authors: R
authors: Walker
authors: Charles R J C
authors: CR
authors: Newton
mesh_terms: D000293:Adolescent; D016022:Case-Control Studies; D002648:Child; D003072:Cognition Disorders / Q000453:epidemiology; D015897:Comorbidity; D003430:Cross-Sectional Studies; D004827:Epilepsy / Q000453:epidemiology*; D005260:Female; D006801:Humans; D008297:Male; D015995:Prevalence; D013636:Tanzania / Q000453:epidemiology