title: Epilepsy, poverty and early under-nutrition in rural Ethiopia.
abstract: OBJECTIVE
  The incidence of epilepsy in Ethiopia is high compared with industrialised countries, but in most cases the cause of epilepsy is unknown. Childhood malnutrition remains widespread. We performed a case-control study to determine whether epilepsy is associated with poverty and markers of early under-nutrition.
  
  
  METHODS
  Patients with epilepsy (n=112), aged 18-45years, were recruited from epilepsy clinics in and around two towns in Ethiopia. Controls with a similar age and gender distribution (n=149) were recruited from patients and relatives attending general outpatient clinics. We administered a questionnaire to define the medical and social history of cases and controls, and then performed a series of anthropometric measurements. Unconditional logistic regression was used to estimate multivariate adjusted odds ratios. Multiple linear regression was used to estimate adjusted case-control differences for continuously distributed outcomes.
  
  
  RESULTS
  Epilepsy was associated with illiteracy/low levels of education, odds ratio=3.0 (95% confidence interval: 1.7-5.6), subsistence farming, odds ratio=2.6 (1.2-5.6) and markers of poverty including poorer access to sanitation (p=0.009), greater overcrowding (p=0.008) and fewer possessions (p<0.001). Epilepsy was also associated with the father's death during childhood, odds ratio=2.2 (1.0-4.6). Body mass index was similar in cases and controls, but patients with epilepsy were shorter and lighter with reduced sitting height (p<0.001), bitrochanteric diameter (p=0.029) and hip size (p=0.003). Patients with epilepsy also had lower mid-upper arm circumference (p=0.011) and lean body mass (p=0.037).
  
  
  CONCLUSIONS
  Epilepsy in Ethiopia is strongly associated with poor education and markers of poverty. Patients with epilepsy also had evidence of stunting and disproportionate skeletal growth, raising the possibility of a link between early under-nutrition and epilepsy.
authors.affiliation: London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK.
authors.forename: Nidhi
authors.initials: N
authors.lastname: Vaid
authors.forename: Sintayehu
authors.initials: S
authors.lastname: Fekadu
authors.forename: Shitaye
authors.initials: S
authors.lastname: Alemu
authors.forename: Abere
authors.initials: A
authors.lastname: Dessie
authors.forename: Genale
authors.initials: G
authors.lastname: Wabe
authors.forename: David I W
authors.initials: DI
authors.lastname: Phillips
authors.forename: Eldryd H O
authors.initials: EH
authors.lastname: Parry
authors.forename: Martin
authors.initials: M
authors.lastname: Prevett
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D016022:Case-Control Studies; D004827:Epilepsy / Q000191:economics / Q000208:ethnology* / Q000503:physiopathology; D005002:Ethiopia / Q000208:ethnology; D005260:Female; D006801:Humans; D008297:Male; D044342:Malnutrition / Q000191:economics / Q000208:ethnology* / Q000503:physiopathology; D008875:Middle Aged; D009752:Nutritional Status / Q000502:physiology; D011203:Poverty / Q000191:economics / Q000208:ethnology*; D012424:Rural Population; D012959:Socioeconomic Factors; D055815:Young Adult