Population-based prevalence of epilepsy in Uganda: A nationwide cross-sectional survey

Abstract

Objective: Establishing the prevalence of epilepsy in Uganda is crucial to inform interventions and public policy. We conducted a nationwide survey to determine epilepsy prevalence. Methods: From January 2019 to July 2022, a door-to-door survey was conducted across all four regions of Uganda, targeting a nationally representative sample of households. Trained field teams identified and interviewed heads of households to obtain demographic information, and three household members were randomly selected for epilepsy screening. A two-part survey, adapted from a validated standardized epilepsy questionnaire in low- and middle-income countries, was used for screening. To ensure the accuracy of the prevalence estimates, a subset of screened individuals underwent clinical validation by a qualified neurologist. Epilepsy was defined per the International League Against Epilepsy (ILAE) criteria. We employed Monte Carlo simulation to extrapolate prevalence estimates. Results: We identified and screened 35 055 participants (53.5% female). The ages ranged from 1 month to 108 years, with a mean age of 20.7 years. The overall crude epilepsy prevalence was estimated at 16.9 per 1000 persons, with an age- and sex-adjusted prevalence rate of 17.8 per 1000. The differences in sex-specific prevalence rates were not statistically significant. The highest agespecific prevalence rate of 25.0 per 1000 occurred in the 20- to 39 -year age group. There was a substantial variation in epilepsy prevalence across the various regions, with the highest prevalence recorded in the eastern region and the lowest in the northern region. Significance: Our study underscores the high epilepsy burden in Uganda, particularly among adults, and reveals age, gender, and geographical variation likely arising from disparities in the underlying determinants. Identification of these factors is crucial for addressing treatment gaps and reducing epilepsy prevalence. KEYWORDS epilepsy, population-based, prevalence, Uganda