Prevalence and incidence of nodding syndrome and other forms of epilepsy in onchocerciasis-endemic areas in northern Uganda after the implementation of onchocerciasis control measures

Infectious Diseases of Poverty

Nolbert Gumisiriza¹  Richard Idro²  Martin Mbonye Kayitale³  Robert Colebunders⁴  Joseph Nelson Siewe Fodjo⁴  An Hotterbeekx⁴  Frank Mubiru⁵  Bernard Opar⁶  Tom Lakwo⁶  Issa Makumbi⁶  Joice Kaducu⁶  Joseph Francis Wamala⁷ 

[1] Busitema University;Department of Paediatrics and Child Health, College of Health Sciences, Makerere University;Department of Population Studies, School of Statistics, Makerere University;Global Health Institute, University of Antwerp;Infectious Disease Institute, Makerere University;Ministry of Health;World Health Organization;

关键词: Nodding syndrome;    Epilepsy;    Onchocerciasis;    Prevalence;    Incidence;    Ivermectin;   

DOI  :  10.1186/s40249-020-0628-3

来源: DOAJ

【 摘 要 】

Abstract Background Around 2007, a nodding syndrome (NS) epidemic appeared in onchocerciasis-endemic districts of northern Uganda, where ivermectin mass distribution had never been implemented. This study evaluated the effect of community-directed treatment with ivermectin (CDTI) and ground larviciding of rivers initiated after 2009 and 2012 respectively, on the epidemiology of NS and other forms of epilepsy (OFE) in some districts of northern Uganda. Methods In 2012, a population-based community survey of NS/epilepsy was carried out by the Ugandan Ministry of Health in Kitgum and Pader districts. In August 2017, we conducted a new survey in selected villages of these districts and compared our findings with the 2012 data. In addition, two villages in Moyo district (where CDTI was ongoing since 1993) served as comparative onchocerciasis-endemic sites in which larviciding had never been implemented. The comparison between 2012 and 2017 prevalence and cumulative incidence were done using the Fisher’s and Pearson’s Chi-square tests at 95% level of significance. Results A total of 2138 individuals in 390 households were interviewed. In the selected villages of Kitgum and Pader, there was no significant decrease in prevalence of NS and OFE between 2012 and 2017. However, the cumulative incidence of all forms of epilepsy decreased from 1165 to 130 per 100 000 persons per year (P = 0.002); that of NS decreased from 490 to 43 per 100 000 persons per year (P = 0.037); and for OFE from 675 to 87 per 100 000 persons per year (P = 0.024). The median age of affected persons (NS and OFE) shifted from 13.5 (IQR: 11.0–15.0) years in 2012 to 18.0 (IQR: 15.0–20.3) years in 2017; P <  0.001. The age-standardized prevalence of OFE in Moyo in 2017 was 4.6%, similar to 4.5% in Kitgum and Pader. Conclusions Our findings support the growing evidence of a relationship between infection by Onchocerca volvulus and some types of childhood epilepsy, and suggest that a combination of bi-annual mass distribution of ivermectin and ground larviciding of rivers is an effective strategy to prevent NS and OFE in onchocerciasis-hyperendemic areas.

【 授权许可】

Unknown