By Sarah Namulondo
Scientists say focus should be on malnutrition, poor antenatal care
Scientists from the International Network for the Demographic Evaluation of Populations and their Health (INDEPTH) have released a report showing for the first time, the link between malnutrition, poor antenatal, and convulsive epilepsy.
The report titled “Parasites and antenatal care are the main causes of epilepsy in sub-Saharan Africa” was released on Feb. 1 in the Lancet Neurology journal. The findings it reports are from studies done in Kenya, Tanzania, South Africa and Ghana between February 2, 2009 and October 30, 2009.
Epilepsy has previously been linked with various parasitic infections but this is the first study of over half a million people in five countries to reveal the extent of the problem and the impact of the different risk factors.
Active convulsive epilepsy is one of the most common neurological conditions worldwide and it is well known that it is significantly more prevalent in poorer countries and rural areas.
The study covered a total of 586,607 individuals of whom 1,711 were diagnosed as having active convulsive epilepsy. These individuals, along with 2,033 who did not have epilepsy, were involved in a three stage screening process before the researchers arrived at a conclusion that malnutrition and poor antenatal care were related to causes of convulsive epilepsy.
In Uganda, the study was done in Mayuge district in eastern Uganda and established a link between the main staple; cassava, and malnutrition, and convulsive epilepsy. Cassava consumption was positively associated with epilepsy. In the research, malnutrition was prevalent at all centres and 10-36% of participants were malnourished.
In adults, the interaction was significant for a history of seizures in the families that consumed cassava, pork, and alcohol.
With the exception of women who delivered their babies at home and participants who ate cassava or were malnourished, the proportion of participants exposed to non-parasitic risk factors for epilepsy was generally low, less than 10% across all five centres.
Researchers said that even other epidemiological studies have reported positive associations between epilepsy and malnutrition.
In there reports they talk about how biochemical mechanisms of malnutrition where protein malnutrition could lower the seizure threshold, but then they harmonise the debate by saying that malnutrition is more likely to be a result of epilepsy than a cause.
Antenatal difficulties were highly associated with pediatric epilepsy in most of these areas. A district like Mayuge has only one hospital, two HCIV and they serve 469 villages and 69 parishes.
Problems of birth asphyxia are bound to happen which is both a risk factor for epilepsy and neonatal mortality. Such cases can, therefore, be prevented.
The researchers quoted a 2005 review of simple interventions aimed at low-income countries, and showed that 43-73% of neonatal deaths in Africa could be prevented with implementation of a package of interventions to improve antenatal and perinatal care.
The implementation of these interventions would probably affect the prevalence of epilepsy in this region.
Dr David Basangwa a psychiatrists at Butabika mental health referral hospital said that he agrees with the report because if a child does not get enough oxygen at birth (birth asphyxia) the brain is bound to get an injury which is one of the causes of epilepsy.
He also noted that cassava can be a serious implication because it fits in well with malnutrition in a developing brain that needs lots of nutrients (mainly proteins) to develop well which a diet of cassava alone cannot provide.
Some of the other antenatal problems cited by participants in the cause of active convulsive epilepsy were severe abdominal pain, vaginal bleeding, or infection during pregnancy and perinatal events. Those are known to cause after birth effects of difficulties in breathing, feeding, or crying after birth which can easily cause active convulsive epilepsy.
“This study demonstrates that many cases of epilepsy could be entirely preventable with elimination of parasites in Africa, some of which for example onchocerciasis have been controlled in some areas”, said Professor Charles Newton from the Wellcome Trust programme at the Kenyan Medical Research Institute (KEMRI) and the Department of Psychiatry at Oxford University, who led the study.
He added that in some areas the incidence of epilepsy could be reduced by 30-60% with appropriate control measures.
The team found that adults who had been exposed to parasitic diseases were 1.5-3 times more likely to have epilepsy than those who had not. Other causes cited were consumption of alcohol and use of recreational drugs by mothers.
Professor Newton added that the non-existence of facilities for treating Epilepsy in many poor countries only leaves citizens to follow some of these simple steps to ensure prevention of as many cases of this debilitating disease as possible.
The study was funded by the Wellcome Trust, with support from the University of the Witwatersrand and the South African Medical Research Council.