title: Injury deaths among people with epilepsy in rural Bangladesh: a retrospective population-based study.
abstract: BACKGROUND
  Accidental death in people with epilepsy (PWE) has been described in high income settings where the relative risk of death is known to be higher than in the standard population. Population-based studies of injury deaths among PWE in developing countries are uncommon.
  
  
  METHODS
  A population-based verbal autopsy study in Matlab, Bangladesh, performed at a health and demographic surveillance system site (mean population 223,886 in 142 villages), was used to assess the possible causes of all deaths. All cases of accidental injury (2005-2008) were evaluated and compared between people with and without a diagnosis of epilepsy.
  
  
  RESULTS
  There were 12 accidental deaths among PWE (8 females, age range 12-58 years old) out of a total of 316 deaths due to accidental injuries (3.8% of all injury deaths). Causes of mortality were drowning (n=10) and burns (n=2). The proportion of deaths due to drowning among PWE was significantly higher than that of the standard population (83% (10/12) vs. 7% (21/304), relative risk 12.6 (95% CI, 7.7-20.7, p<0.0001)). Mortality due to injury in PWE occurred at a younger age compared to people without epilepsy (mean difference 20.7 years (95% CI 6.7, 34.3), p<0.004).
  
  
  CONCLUSIONS
  There is a high proportion of accidental deaths due to drowning in PWE in Bangladesh compared to the standard population. Given the risk of seasonal flooding and low level of formal education, programs targeting water safety for PWE at all ages should be emphasized, appropriate for level of ability.
authors.affiliation: Department of International Health, The Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA. fmateen@jhsph.edu
authors.forename: Farrah J
authors.initials: FJ
authors.lastname: Mateen
authors.forename: Russell T
authors.initials: RT
authors.lastname: Shinohara
authors.forename: Nurul
authors.initials: N
authors.lastname: Alam
authors.forename: Robert E
authors.initials: RE
authors.lastname: Black
authors.forename: Peter K
authors.initials: PK
authors.lastname: Streatfield
mesh_terms: D000293:Adolescent; D000328:Adult; D001459:Bangladesh / Q000453:epidemiology; D002423:Cause of Death; D002648:Child; D018672:Community Health Planning; D003645:Death, Sudden / Q000453:epidemiology*; D004827:Epilepsy / Q000453:epidemiology* / Q000401:mortality*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012424:Rural Population / Q000706:statistics & numerical data*; D055815:Young Adult