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Cysticercosis and epilepsy in rural Tanzania: a community-based case-control and imaging study

Lookup NU author(s): Dr Daniel Birchall, Dr Margaret Jackson, Professor Richard Walker

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Abstract

ObjectiveTo assess the contribution of neurocysticercosis (NCC) to the burden of epilepsy in a rural Tanzanian population.MethodsWe identified adult people with epilepsy (PWE) in a door-to-door study in an established demographic surveillance site. PWE and community controls were tested for antibodies to Taenia solium, the causative agent of NCC, and all PWE were offered a computed tomography (CT) head scan. Data on household occupancy and sanitation, pig-keeping and pork consumption were collected from PWE and controls and associations with epilepsy were assessed using chi-square or Fisher's exact tests.ResultsSix of 218 PWE had antibodies to T.solium (2.8%; 95% CI 0.6-4.9), compared to none of 174 controls (Fisher's exact test, P=0.04). Lesions compatible with NCC were seen in eight of 200 CT scans (4.0%; 95% CI 1.3-6.7). A total of 176 PWE had both investigations of whom two had positive serology along with NCC-compatible lesions on CT (1.1%; 95% 0.3-4.0). No associations between epilepsy and any risk factors for NCC were identified.ConclusionsNeurocysticercosis is present in this population but at a lower prevalence than elsewhere in Tanzania and sub-Saharan Africa. Insights from low-prevalence areas may inform public health interventions designed to reduce the burden of preventable epilepsy.ObjectifEvaluer la contribution de la neurocysticercose (NCC) a la charge de l'epilepsie dans une population rurale de la Tanzanie.MethodesNous avons identifie les personnes adultes souffrant d'epilepsie (PSE) dans une etude de porte-a-porte dans un site etabli de surveillance demographique. Les PSE et des temoins communautaires ont ete testes pour les anticorps de Taenia solium, l'agent causal de la NCC et toutes les PSE ont ete offertes une tomodensitometrie (TDM) de la tete. Les donnees sur l'occupation des menages et l'assainissement, l'elevage et la consommation de porc ont ete recueillies chez les PSE et les temoins et les associations avec l'epilepsie ont ete evaluees en utilisant les tests Exacts de Fisher ou de Chi-carre.ResultatsSix des 218 PSE avaient des anticorps de T. Solium (2,8%; IC95%: 0,6 a 4,9) compares a aucun des 174 temoins (test Exact de Fisher, p = 0,04). Les lesions compatibles avec la NCC ont ete observees dans 8 des 200 TDM (4,0%; IC95%: 1,3 a 6,7). Les deux investigations ont ete menees chez 176 PSE, dont deux avaient une serologie positive ainsi que des lesions compatibles avec la NCC sur la TDM (1,1%; IC95%: 0,3 a 4,0). Aucune association entre l'epilepsie et les facteurs de risque categorises pour la NCC n'a ete identifiee.ConclusionsLa NCC est presente dans cette population, mais a un taux de prevalence plus faible qu'ailleurs en Tanzanie et en Afrique subsaharienne. Les donnees des zones a faible prevalence pourraient eclairer les interventions de sante publique visant a reduire la charge evitable de l'epilepsie.ObjetivoEvaluar la contribucion de la neurocisticercosis (NCC) a la carga de epilepsia entre la poblacion rural de Tanzania.MetodosIdentificamos a adultos con epilepsia (ACE) en un estudio puerta-a-puerta, en un lugar con vigilancia demografica establecida. A los ACE y a los controles comunitarios se les realizaron pruebas en busca de anticuerpos contra Taenia solium, el agente causal de la NCC, y a todos los ACE se les ofrecio una tomografia computarizada de la cabeza (TC). Se recolectaron los datos sobre ocupacion del hogar y saneamiento, la crianza y consumo del cerdo de los ACE y de los controles, y se evaluaron las asociaciones con la epilepsia utilizando las pruebas del Chi-cuadrado y de Fisher.ResultadosSeis de 218 PCE tenian anticuerpos contra T. solium (2.8%; IC 95% 0.6 a 4.9), comparado con ninguno de los 174 controles (prueba de Fisher, p=0.04). Las lesiones compatibles con la NCC se observaron en ocho de 200 TC (4.0%; IC95% 1.3 a 6.7). A 176 ACE se les realizaron ambas pruebas, y de estos, dos tenian una serologia positiva junto con lesiones compatibles con NCC en la TC (1.1%; 95% 0.


Publication metadata

Author(s): Hunter E, Burton K, Iqbal A, Birchall D, Jackson M, Rogathe J, Jusabani A, Gray W, Aris E, Kamuyu G, Wilkins PP, Newton CR, Walker R

Publication type: Article

Publication status: Published

Journal: Tropical Medicine & International Health

Year: 2015

Volume: 20

Issue: 9

Pages: 1171-1179

Print publication date: 01/09/2015

Online publication date: 26/05/2015

Acceptance date: 05/05/2015

ISSN (print): 1360-2276

ISSN (electronic): 1365-3156

Publisher: Wiley-Blackwell

URL: http://dx.doi.org/10.1111/tmi.12529

DOI: 10.1111/tmi.12529


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