Premature mortality in active convulsive epilepsy in rural Kenya: causes and associated factors.
OBJECTIVE
We estimated premature mortality and identified causes of death and associated factors in people with active convulsive epilepsy (ACE) in rural Kenya.


METHODS
In this prospective population-based study, people with ACE were identified in a cross-sectional survey and followed up regularly for 3 years, during which information on deaths and associated factors was collected. We used a validated verbal autopsy tool to establish putative causes of death. Age-specific rate ratios and standardized mortality ratios were estimated. Poisson regression was used to identify mortality risk factors.


RESULTS
There were 61 deaths among 754 people with ACE, yielding a rate of 33.3/1,000 persons/year. Overall standardized mortality ratio was 6.5. Mortality was higher across all ACE age groups. Nonadherence to antiepileptic drugs (adjusted rate ratio [aRR] 3.37), cognitive impairment (aRR 4.55), and age (50+ years) (rate ratio 4.56) were risk factors for premature mortality. Most deaths (56%) were directly related to epilepsy, with prolonged seizures/possible status epilepticus (38%) most frequently associated with death; some of these may have been due to sudden unexpected death in epilepsy (SUDEP). Possible SUDEP was the likely cause in another 7%.


CONCLUSIONS
Mortality in people with ACE was more than 6-fold greater than expected. This may be reduced by improving treatment adherence and prompt management of prolonged seizures and supporting those with cognitive impairment.
From the KEMRI/Wellcome Trust Research Programme (A.K.N., G.F., E.C., R.O., E.B., C.R.N.), Centre for Geographic Medicine Research-Coast, Kilifi, Kenya; Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health (A.K.N., C.B., I.K.), London School of Hygiene and Tropical Medicine, United Kingdom; Studies of Epidemiology of Epilepsy in Demographic Surveillance Systems (SEEDS)-INDEPTH Network (A.K.N., E.B., C.R.N.), Accra, Ghana; Research Support Unit, Faculty of Health Sciences (A.K.N.), Aga Khan University (East Africa), Nairobi, Kenya; MRC Tropical Epidemiology Group, Faculty of Epidemiology and Population Health (C.B., I.K.), London School of Hygiene and Tropical Medicine, United Kingdom; Nuffield Department of Medicine (G.F.), Centre for Clinical Vaccinology and Tropical Medicine, University of Oxford, United Kingdom; Neurosciences Unit (B.N., C.R.N.), UCL Institute of Child Health, London, United Kingdom; NIHR University College London Hospitals Biomedical Research Centre, Department of Clinical and Experimental Epilepsy (J.W.S.), UCL Institute of Neurology, London, United Kingdom; Epilepsy Society (J.W.S.), Chalfont St Peter, United Kingdom; SEIN - Stichting Epilepsie Instellingen Nederland (J.W.S.), Heemstede, the Netherlands; Clinical Research Unit (C.R.N.), London School of Hygiene and Tropical Medicine, United Kingdom; and Department of Psychiatry (C.R.N.), University of Oxford, United Kingdom.
Anthony K
AK
Ngugi
Christian
C
Bottomley
Gregory
G
Fegan
Eddie
E
Chengo
Rachael
R
Odhiambo
Evasius
E
Bauni
Brian
B
Neville
Immo
I
Kleinschmidt
Josemir W
JW
Sander
Charles R
CR
Newton
D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D004827:Epilepsy / Q000453:epidemiology / Q000209:etiology* / Q000401:mortality*; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007630:Kenya / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D061213:Mortality, Premature; D011446:Prospective Studies; D012307:Risk Factors; D012424:Rural Population; D055815:Young Adult