Prevalence of all epilepsies in urban informal settlements in Nairobi, Kenya: a two-stage population-based study

Daniel M Mwanga; Damazo T Kadengye; Peter O Otieno; Frederick M Wekesah; Isaac C Kipchirchir; George O Muhua; Joan W Kinuthia; Thomas Kwasa; Abigael Machuka; Quincy Mongare; Samuel Iddi; Gabriel Davis Jones; Josemir W Sander; Symon M Kariuki; Arjune Sen; Charles R Newton; Gershim Asiki; EPInA Study Group

doi:10.1016/S2214-109X(24)00217-1

Prevalence of all epilepsies in urban informal settlements in Nairobi, Kenya: a two-stage population-based study

Lancet Glob Health. 2024 Aug;12(8):e1323-e1330. doi: 10.1016/S2214-109X(24)00217-1. Epub 2024 Jul 5.

Authors

Daniel M Mwanga¹, Damazo T Kadengye², Peter O Otieno³, Frederick M Wekesah⁴, Isaac C Kipchirchir⁵, George O Muhua⁵, Joan W Kinuthia⁶, Thomas Kwasa⁷, Abigael Machuka⁷, Quincy Mongare⁷, Samuel Iddi⁸, Gabriel Davis Jones⁹, Josemir W Sander¹⁰, Symon M Kariuki¹¹, Arjune Sen¹², Charles R Newton¹³, Gershim Asiki¹⁴; EPInA Study Group

Collaborators

EPInA Study Group:
Patrick Adjei, Albert Akpalu, Sabina Asiamah, Gershim Asiki, Mercy Atieno, Dan Bhwana, Mary Bitta, Neerja Chowdhary, Hellen Cross, Emmanuel K Darkwa, Timothy Denilson, Tarun Dua, Antony Godi, Simone Grassi, Samuel Iddi, Daniel Nana Yaw Abankwah, Symon M Kariuki, Joan W Kinuthia, Henrika Kimambo, Thomas Kwasa, Sloan Mahone, Gergana Manolova, William Matuja, David McDaid, Bruno Mmbando, Daniel Mtai Mwanga, Damazo T Kadengye, Dorcas Muli, Frederick M Wekesah, Vivian Mushi, Charles R Newton, Guillaume Pages, Peter O Otieno, Josemir W Sander, Arjune Sen, Cynthia Sottie, Isolide Massawe, Sonia Vallentin, Richard Walker, Stella Waruinge

Affiliations

¹ African Population and Health Research Center, Nairobi, Kenya; Department of Mathematics, University of Nairobi, Nairobi, Kenya; The Centre for Global Epilepsy, University of Oxford, Oxford, UK. Electronic address: [email protected].
² African Population and Health Research Center, Nairobi, Kenya; Department of Statistics and Economics, Kabale University, Kabale, Uganda; The Centre for Global Epilepsy, University of Oxford, Oxford, UK.
³ African Population and Health Research Center, Nairobi, Kenya; Department of Public & Occupational Health, Amsterdam Public Health Research Institute, University of Amsterdam, Amsterdam, Netherlands; The Centre for Global Epilepsy, University of Oxford, Oxford, UK.
⁴ African Population and Health Research Center, Nairobi, Kenya; Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands; The Centre for Global Epilepsy, University of Oxford, Oxford, UK.
⁵ Department of Mathematics, University of Nairobi, Nairobi, Kenya.
⁶ African Population and Health Research Center, Nairobi, Kenya; The Centre for Global Epilepsy, University of Oxford, Oxford, UK.
⁷ Department of Clinical Medicine and Therapeutics, University of Nairobi, Nairobi, Kenya; The Centre for Global Epilepsy, University of Oxford, Oxford, UK.
⁸ African Population and Health Research Center, Nairobi, Kenya; Department of Statistics and Actuarial Science, University of Ghana, Accra, Ghana; The Centre for Global Epilepsy, University of Oxford, Oxford, UK.
⁹ Oxford Epilepsy Research Group, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK; Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, UK; Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford, UK; The Centre for Global Epilepsy, University of Oxford, Oxford, UK.
¹⁰ Department of Clinical & Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, UK; Chalfont Centre for Epilepsy, Buckinghamshire, UK; Stichting Epilepsie Instellingen Nederland, Heemstede, Netherlands; Neurology Department, West China Hospital, Sichuan University, Chengdu, China; The Centre for Global Epilepsy, University of Oxford, Oxford, UK.
¹¹ Department of Psychiatry, University of Oxford, Oxford, UK; Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi, Kenya; Department of Public Health, Pwani University, Kilifi, Kenya; The Centre for Global Epilepsy, University of Oxford, Oxford, UK.
¹² Oxford Epilepsy Research Group, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK; The Centre for Global Epilepsy, University of Oxford, Oxford, UK.
¹³ Oxford Epilepsy Research Group, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK; Department of Psychiatry, University of Oxford, Oxford, UK; Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi, Kenya; The Centre for Global Epilepsy, University of Oxford, Oxford, UK.
¹⁴ African Population and Health Research Center, Nairobi, Kenya; Department of Women's and Children's Health, Karolinska Institute, Stockholm, Sweden; The Centre for Global Epilepsy, University of Oxford, Oxford, UK.

Abstract

Background: WHO estimates that more than 50 million people worldwide have epilepsy and 80% of cases are in low-income and middle-income countries. Most studies in Africa have focused on active convulsive epilepsy in rural areas, but there are few data in urban settings. We aimed to estimate the prevalence and spatial distribution of all epilepsies in two urban informal settlements in Nairobi, Kenya.

Methods: We did a two-stage population-based cross-sectional study of residents in a demographic surveillance system covering two informal settlements in Nairobi, Kenya (Korogocho and Viwandani). Stage 1 screened all household members using a validated epilepsy screening questionnaire to detect possible cases. In stage 2, those identified with possible seizures and a proportion of those screening negative were invited to local clinics for clinical and neurological assessments by a neurologist. Seizures were classified following the International League Against Epilepsy recommendations. We adjusted for attrition between the two stages using multiple imputations and for sensitivity by dividing estimates by the sensitivity value of the screening tool. Complementary log-log regression was used to assess prevalence differences by participant socio-demographics.

Findings: A total of 56 425 individuals were screened during stage 1 (between Sept 17 and Dec 23, 2021) during which 1126 were classified as potential epilepsy cases. A total of 873 were assessed by a neurologist in stage 2 (between April 12 and Aug 6, 2022) during which 528 were confirmed as epilepsy cases. 253 potential cases were not assessed by a neurologist due to attrition. 30 179 (53·5%) of the 56 425 individuals were male and 26 246 (46·5%) were female. The median age was 24 years (IQR 11-35). Attrition-adjusted and sensitivity-adjusted prevalence for all types of epilepsy was 11·9 cases per 1000 people (95% CI 11·0-12·8), convulsive epilepsy was 8·7 cases per 1000 people (8·0-9·6), and non-convulsive epilepsy was 3·2 cases per 1000 people (2·7-3·7). Overall prevalence was highest among separated or divorced individuals at 20·3 cases per 1000 people (95% CI 15·9-24·7), unemployed people at 18·8 cases per 1000 people (16·2-21·4), those with no formal education at 18·5 cases per 1000 people (16·3-20·7), and adolescents aged 13-18 years at 15·2 cases per 1000 people (12·0-18·5). The epilepsy diagnostic gap was 80%.

Interpretation: Epilepsy is common in urban informal settlements of Nairobi, with large diagnostic gaps. Targeted interventions are needed to increase early epilepsy detection, particularly among vulnerable groups, to enable prompt treatment and prevention of adverse social consequences.

Funding: National Institute for Health Research using Official Development Assistance.

MeSH terms

Adolescent
Adult
Child
Child, Preschool
Cross-Sectional Studies
Epilepsy* / epidemiology
Female
Humans
Infant
Kenya / epidemiology
Male
Middle Aged
Prevalence
Urban Population* / statistics & numerical data
Young Adult