title: Incidence, Remission and Mortality of Convulsive Epilepsy in Rural Northeast South Africa.
abstract: BACKGROUND
  Epilepsy is one of the most common neurological conditions globally, estimated to constitute 0.75% of the global burden of disease, with the majority of this burden found in low- and middle- income countries (LMICs). Few studies from LMICs, including much of sub-Saharan Africa, have described the incidence, remission or mortality rates due to epilepsy, which are needed to quantify the burden and inform policy. This study investigates the epidemiological parameters of convulsive epilepsy within a context of high HIV prevalence and an emerging burden of cardiovascular disease.
  
  
  METHODS
  A cross-sectional population survey of 82,818 individuals, in the Agincourt Health and Socio-demographic Surveillance Site (HDSS) in rural northeast South Africa was conducted in 2008, from which 296 people were identified with active convulsive epilepsy. A follow-up survey was conducted in 2012. Incidence and mortality rates were estimated, with duration and remission rates calculated using the DISMOD II software package.
  
  
  RESULTS
  The crude incidence for convulsive epilepsy was 17.4/100,000 per year (95%CI: 13.1-23.0). Remission was 4.6% and 3.9% per year for males and females, respectively. The standardized mortality ratio was 2.6 (95%CI: 1.7-3.5), with 33.3% of deaths directly related to epilepsy. Mortality was higher in men than women (adjusted rate ratio (aRR) 2.6 (95%CI: 1.2-5.4)), and was significantly associated with older ages (50+ years versus those 0-5 years old (RR 4.8 (95%CI: 0.6-36.4)).
  
  
  CONCLUSIONS
  The crude incidence was lower whilst mortality rates were similar to other African studies; however, this study found higher mortality amongst older males. Efforts aimed at further understanding what causes epilepsy in older people and developing interventions to reduce prolonged seizures are likely to reduce the overall burden of ACE in rural South Africa.
authors.affiliation: Studies of Epidemiology of Epilepsy in Demographic Surveillance Systems (SEEDS)-INDEPTH Network, Accra, Ghana; MRC/Wits Rural Public Health & Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Epidemiology and Public Health Sciences, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden; Department of Pharmacology and Clinical Neurosciences, Umeå University, Umeå, Sweden.
authors.forename: Ryan G
authors.initials: RG
authors.lastname: Wagner
authors.affiliation: Studies of Epidemiology of Epilepsy in Demographic Surveillance Systems (SEEDS)-INDEPTH Network, Accra, Ghana; Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom; MRC Tropical Epidemiology Group, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom.
authors.forename: Christian
authors.initials: C
authors.lastname: Bottomley
authors.affiliation: Studies of Epidemiology of Epilepsy in Demographic Surveillance Systems (SEEDS)-INDEPTH Network, Accra, Ghana; Research Support Unit, Faculty of Health Sciences, Aga Khan University-East Africa, Nairobi, Kenya.
authors.forename: Anthony K
authors.initials: AK
authors.lastname: Ngugi
authors.affiliation: KEMRI/Wellcome Trust Research Programme, Centre for Geographic Medicine Research-Coast, Kilifi, Kenya.
authors.forename: Fredrick
authors.initials: F
authors.lastname: Ibinda
authors.affiliation: MRC/Wits Rural Public Health & Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; INDEPTH Network, Accra, Ghana.
authors.forename: F Xavier
authors.initials: FX
authors.lastname: Gómez-Olivé
authors.affiliation: Studies of Epidemiology of Epilepsy in Demographic Surveillance Systems (SEEDS)-INDEPTH Network, Accra, Ghana; MRC/Wits Rural Public Health & Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Epidemiology and Public Health Sciences, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden; INDEPTH Network, Accra, Ghana.
authors.forename: Kathleen
authors.initials: K
authors.lastname: Kahn
authors.affiliation: Studies of Epidemiology of Epilepsy in Demographic Surveillance Systems (SEEDS)-INDEPTH Network, Accra, Ghana; MRC/Wits Rural Public Health & Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Epidemiology and Public Health Sciences, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden; INDEPTH Network, Accra, Ghana.
authors.forename: Stephen
authors.initials: S
authors.lastname: Tollman
authors.affiliation: Studies of Epidemiology of Epilepsy in Demographic Surveillance Systems (SEEDS)-INDEPTH Network, Accra, Ghana; MRC/Wits Rural Public Health & Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; KEMRI/Wellcome Trust Research Programme, Centre for Geographic Medicine Research-Coast, Kilifi, Kenya; Neurosciences Unit, UCL Institute of Child Health, London, United Kingdom; Clinical Research Unit, London School of Hygiene and Tropical Medicine, London, United Kingdom; Department of Psychiatry, University of Oxford, Oxford, United Kingdom.
authors.forename: Charles R
authors.initials: CR
authors.lastname: Newton
authors.forename: Ryan
authors.initials: R
authors.lastname: Wagner
authors.forename: Rhian
authors.initials: R
authors.lastname: Twine
authors.forename: Myles
authors.initials: M
authors.lastname: Connor
authors.forename: Mark
authors.initials: M
authors.lastname: Collinson
authors.forename: Honratio
authors.initials: H
authors.lastname: Masanja
authors.forename: Alexander
authors.initials: A
authors.lastname: Mathew
authors.forename: Angelina
authors.initials: A
authors.lastname: Kakooza
authors.forename: George
authors.initials: G
authors.lastname: Pariyo
authors.forename: Stefan
authors.initials: S
authors.lastname: Peterson
authors.forename: Donald
authors.initials: D
authors.lastname: Ndyo-mughenyi
authors.forename: Rachael
authors.initials: R
authors.lastname: Odhiambo
authors.forename: Eddie
authors.initials: E
authors.lastname: Chengo
authors.forename: Martin
authors.initials: M
authors.lastname: Chabi
authors.forename: Evasius
authors.initials: E
authors.lastname: Bauni
authors.forename: Gathoni
authors.initials: G
authors.lastname: Kamuyu
authors.forename: Victor Mung'ala
authors.initials: VM
authors.lastname: Odera
authors.forename: James O
authors.initials: JO
authors.lastname: Mageto
authors.forename: Ken
authors.initials: K
authors.lastname: Ae-Ngibise
authors.forename: Bright
authors.initials: B
authors.lastname: Akpalu
authors.forename: Albert
authors.initials: A
authors.lastname: Akpalu
authors.forename: Francis
authors.initials: F
authors.lastname: Agbokey
authors.forename: Patrick
authors.initials: P
authors.lastname: Adjei
authors.forename: Seth
authors.initials: S
authors.lastname: Owusu-Agyei
authors.forename: Immo
authors.initials: I
authors.lastname: Kleinschmidt
authors.forename: Victor C K
authors.initials: VC
authors.lastname: Doku
authors.forename: Peter
authors.initials: P
authors.lastname: Odermatt
authors.forename: Brian
authors.initials: B
authors.lastname: Neville
authors.forename: Josemir W
authors.initials: JW
authors.lastname: Sander
authors.forename: Steve
authors.initials: S
authors.lastname: White
authors.forename: Thomas
authors.initials: T
authors.lastname: Nutman
authors.forename: Patricia
authors.initials: P
authors.lastname: Wilkins
authors.forename: John
authors.initials: J
authors.lastname: Noh
mesh_terms: D000293:Adolescent; D000328:Adult; D002423:Cause of Death; D002648:Child; D003430:Cross-Sectional Studies; D004827:Epilepsy / Q000453:epidemiology* / Q000401:mortality; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D009026:Mortality; D011159:Population Surveillance; D012307:Risk Factors; D012424:Rural Population; D013019:South Africa / Q000453:epidemiology; D055815:Young Adult