Epidemiology of epilepsy in rural Benin: prevalence, incidence, mortality, and follow-up.
OBJECTIVE
Epilepsy is a major clinical and social issue in Africa. This study was conducted to estimate the prevalence, incidence, mortality, and therapeutic outcome in rural Djidja in Benin.


METHODS
This was a two-phase study with a cross-sectional phase and 18 months of follow-up. In the first phase, information was obtained using door-to-door surveys, reports from key informants, and medical sources. People were interviewed using a validated screening questionnaire for epilepsy in tropical regions. The diagnosis of epilepsy was confirmed by a neurologist. We used a capture-recapture method to estimate the number of people with epilepsy (PWE). PWE were followed every month for 18 months after the cross-sectional survey. We asked the health services, the general population, and village leaders in the study area to identify suspected cases of epilepsy occurring during the follow-up. New cases were updated every month after confirmation. Antiepileptic drugs were prescribed to PWE.


RESULTS
We surveyed 11,668 subjects (male-to-female ratio 0.9) and identified 123 PWE, yielding a prevalence of 10.5 per 1,000 (95% confidence interval (CI) 8.8-12.6/1,000). Combining the three sources, we found 148 PWE and a prevalence of 12.7 per 1,000 (95% CI 10.7-14.9/1,000). After application of the capture-recapture method, the prevalence was estimated to be as high as 38.4 per 1,000 (95% CI 34.9-41.9/1,000). The cumulative incidence was 104.2 per 100,000 and the mean annual incidence was 69.4 per 100,000. The mean annual mortality was 20.8 per 1,000. After treatment, 45% of PWE had total seizure remission and 35% had a decrease in the number of seizures.


CONCLUSIONS
This study shows that door-to-door survey findings could be improved by using information from other sources. The follow-up suggests that epilepsy could be controlled. Continuous drug delivery and regular follow-up are key.
Department of Neurology, School of Health Sciences, University of Abomey Calavi, Cotonou, Benin.
Dismand
D
Houinato
Luce-Perrine
LP
Yemadje
Ghislaine
G
Glitho
Constant
C
Adjien
Gilbert
G
Avode
Michel
M
Druet-Cabanac
Pierre-Marie
PM
Preux
D000293:Adolescent; D000328:Adult; D000368:Aged; D000927:Anticonvulsants / Q000627:therapeutic use; D001541:Benin / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D004827:Epilepsy / Q000453:epidemiology* / Q000401:mortality / Q000628:therapy; D005006:Ethnicity; D005260:Female; D005500:Follow-Up Studies; D006306:Health Surveys; D006801:Humans; D015994:Incidence; D007223:Infant; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D012424:Rural Population; D012737:Sex Factors; D012959:Socioeconomic Factors; D016896:Treatment Outcome; D055815:Young Adult
D000927:Anticonvulsants