African Journal of Neurological Sciences Pan African Association of Neurological Sciences ISSN: 1015-8618 Vol. 20, Num. 1, 2001, pp. 39

African Journal of Neurological Sciences, Vol. 20, No. 1, 2001, pp. 39

FACTORS INFLUENCING THE PRESENCE OF A TREATMENT BY ANTI-EPILEPTIC DRUGS IN 811 EPILEPTIC PATIENTS FROM SIX AFRICAN COUNTRIES

Pierre-Marie Preux^1,2, Michel Druet-Cabanac^1,2, W Farid^2,3, Hamidou Traore^2,4, Louis Dongmo^2,5, Caroline Debrock^1,2, Dismand Houinato^2,6, Micel Dumas^1,2

1-Institute of Neuroepidemiology and Tropical Neurology, 2 rue du Dr Marcland, 87025 Limoges Cedex, France
2-Sub-saharan Africa Epilepsy Network
3-Department of Neuropsychiatry, Alexandria General Hospital Ras Etin, Alexandria, Egypt
4-Department of Neurology, Neuropsychiatric Center, Nouakchott, Mauritania
5-Department of Neurology, Faculty of Medicine, Yaoundé, Cameroon
6-Department of Neurology, Faculty of Medicine, Cotonou, Benin
Corresponding author: Pierre-Marie Preux, Institut d'Epidémiologie Neurologique et de Neurologie Tropicale, Faculté de Médicine, 2, rue du Docteur Marcland, 87 025 Limoges. FRANCE. E-mail: preux@unilim.fr

Code Number: ns02011

A few studies about treatment by anti-epileptic drugs (AED) in Africa are available. Furthermore, studies could not be compared because of the absence of standardisation of the data collection phase. Threatment issues were assessed in 811 epileptic patients included in six studies performed in Africa using the same standardised Questionnaire for Investigation of Epilepsy in Tropical Countries, set up by the Limoges Institute of Neuroepidemiology and Tropical Neurology and the Pan African Association of Neurological Sciences (3). A part of this Questionnaire is dedicated to the assessment of the treatment in a patient. The studies comprised of two prevalence studies in Benin (1) and Cameroon (unpublished observations), two case-control studies in Central African Republic (2) and Kenya (unpublished observations), and two hospital based studies in Egypt (unpublished data) and Mauritania (4) The statistical tests used were Pearson Chi-square, Fisher exact test, and Mann-Whitney test.

The mean age of the patients was 24 ± 13 years. 54 % were males. 30% were born in the study area. 80 % had a professional activity; among them 50 % were farmers. A past history of epilepsy in the family was found in 25 % of the patients. The epilepsy was categorized as symptomatic in 60 % of the cases. 20 % of all the 811 patients were non treated by AED. This figure varies greatly among the studies, higher in rural areas and in community surveys: 70 % in Benin, 50 % in Central African republic, 20 % in Cameroun, 3 % in Kenya and Mauritania and 0.5 % in Egypt. 60 % of the cases were treated by AED only and 20 % were treated by one drug, mainly phenobarbitone. The regularity of AED treatment was good in 70 % of the cases. The principle reasons for irregularity were transient inavailabilty (50 %) and lack of money (35 %). The efficacy of teh drugs was very good as judged by patients and their family. 20 % reported mild side effects from which 50 % of drowsiness.

The factors influencing whether a patient was treated by AED or not, were as follows: high income (p<0.001), high level of education (p<0.001), living in an urban area (P<0.001, to have had a status epilepticus (p<0.001), an encephalitis (p<0.004) or a cranial trauma with loss of consciousness (p<0.05), lead to an higher probability of treatmetn. Certain professional activities, in particular being a farmer, are related to a decreasead probability of AED treatment (p<0.001).

Despite the fact that the studies had various designs and were performed in different areas, the power in the search of determining factors, is increased by the inclusion of a high number of patients using the same data collection tool. These results could help to understand the reasons of the huge treatment gap in epilepsy in Africa.

References

1. DEBROCK, C, PREUX PM, HOUINATO D, DRUET-CABANAC M, KASSA F, ADJIEN C et al. Estimation of the prevalence of epilepsy in the Benin region of Zinvié using capture-recapture method. Int J Epidemiol, 2000; 29:330-335.
2. DRUET-CABANCA M, PREUX PM, BOUTEILLE B, BERNET-BERNADY P, DUNAND J, HOPKINS A, et al. Onchocerciasis and epilepsy: a matched case-control study in Central African Republic. Am J Epidemiol 1999; 149:565-70.
3. PREUX PM, DRUET-CABANAC M, DEBROCK C, TAPIE, DUMAS M et le Comité de recherche sur l'Epilepsie de l'Institut de Neurologie Tropicale de Limoges. Questionnaire d'Investigation de l'Epilepsie en zone tropicale. Bull Soc Pathol Exot. 2000; 93:276-278 et Suppl. 4.
4. TRAORE H, DIAGANA M, DEBROCK C, BA A, AZQARD B, PREUX PM Approche socio-culturelle de l'épilepsie en Mauritanie. Méd Trop 1998; 58365-8.

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