Prevalence and risk factors for epilepsy in Cameroon

This project was designed to ascertain the prevalence and risk factors for epilepsy in a rural health district in the North-West Region of Cameroon. A community-based epilepsy screening targeted all inhabitants, six years and older, in all 16 health areas in the Batibo Health District. During door-to-door visits, fieldworkers used a validated questionnaire to interview consenting heads of households about the possibility of epilepsy in eligible residents of the house. All people with suspected epilepsy were subsequently assessed by a physician who confirmed or refuted the epilepsy diagnosis after clinical assessment. People with epilepsy and randomly selected healthy subjects were interviewed by a nurse who obtained relevant demographic details and information on exposure to risk factors for epilepsy. Out of 39,527 permanent residents screened, 546 had active epilepsy. The age-standardised prevalence of active epilepsy was 3.5% (95% CI: 3.2-3.9). The prevalence of active epilepsy varied widely between health areas, ranging between 1.2% and 7.7%. The peak age-specific prevalence was in the 20-29 age group. Epilepsy was focal in 59% of people, and the median age at first seizure was 11 years (Interquartile range: 8-15). The 1-year incidence of epilepsy was estimated to be 171/100,000 (95%CI: 114.0-254.6). About 81% of people with epilepsy were either untreated or receiving inappropriate treatment. Family history of epilepsy was the main factor associated with epilepsy after multivariate analysis (OR: 6.8; 95% CI: 3.2-14.1). The characteristics of active epilepsy in this Cameroonian population, mainly the geographical heterogeneity and the pattern of the age-specific prevalence suggest that cysticercosis and/or onchocerciasis may be involved. These and other risk factors for epilepsy need to be further investigated through robust case-control and prospective studies in this population. We briefly discuss public health strategies that may useful in redressing the burden of epilepsy in Cameroon

Dementia and cognitive impairment in French-speaking Sub-Saharan Africa: a comprehensive review on moving out of the shadows of neglect

Dementia is a global public health problem with increasing prevalence and incidence worldwide. The African continent is expected to bear the biggest brunt of the burden of dementia by 2050 because of the rapid demographic changes, including rapid population growth, an increase in life expectancy, and ageing. However, French-speaking Sub-Saharan African (FS-SSA) countries are underrepresented in research on dementia in Africa. While the reasons are diverse and complex, linguistic and cultural barriers to research, disproportionately affect these countries and may be significant factors. Any efforts, therefore, to redress the burden of dementia in Africa must consider the specific demographic, cultural, and linguistic characteristics of FS-SSA countries. This scoping review explores the current state of knowledge in dementia and cognitive impairment in Sub-Saharan Africa, highlighting research gaps and specific patterns unique to FS-SSA Africa. We identify pathways for research to bridge the knowledge gaps on dementia in FS-SSA as part of the global endeavor to tackle dementia worldwide

Neurolupus with multiple cerebral vascular infarctions and postpartum psychosis manifestations: A diagnostic and therapeutic challenge

Background: Neurolupus is mediated by inflammation and autoimmunity in the nervous system. Its initial presentation as psychosis is rare, posing diagnostic and therapeutic challenges. Case presentation: A 36-year old woman presented at four weeks postpartum with acute psychosis, depression and cognitive dysfunction. Three months later, cerebrovascular involvement was suspected due to aphasia. Brain MRI showed multifocal infarctions, and autoimmune antibodies fulfilled criteria of Systemic Lupus Erythematosus. Outcome: She was treated successfully with corticosteroids and immunosuppressors, and is on azathioprine as maintenance therapy. Conclusion: Acute psychosis in postpartum period can be due to organic causes, there should be a high index of suspicion of autoimmune disease as neurolupus.   English title: Neurolupus avec infarctus cérébraux multiples et psychose postpartum: Difficultés diagnostiques et thérapeutiques  Introduction: Le neurolupus englobe les manifestations neurologiques centrales et psychiatriques au cours du lupus érythémateux systémique, qui sont dues à une atteinte auto-immune et une inflammation chronique du système nerveux. La présentation initiale du neurolupus comme psychose en période postpartum est rare et pose des difficultés diagnostiques et thérapeutiques pouvant retarder la prise en charge. Présentation du cas: Nous présentons le cas d`une femme de 36 ans sans antécédents précédents de lupus érythémateux dissémine ni de troubles psychiatriques, qui a quatre semaines postpartum à présente une psychose aigue associe à une dépression et des troubles cognitifs. Au bout de trois mois, elle a présenté de façon brutale une aphasie faisant évoquer une atteinte cérébrovasculaire. Un bilan a la recherche d`une cause organique a objectivé a l`IRM cérébrale de multiples lésions d`infarctus dissémines en plusieurs territoires vasculaires. Le dosage des anticorps antinucléaires, d’anticorps anti-ADN natif, anticorps anti-Sm était anormales. Devant ce tableau clinique, immunologique et l`imagerie, nous avons évoqué le diagnostic de neurolupus. Evolution: La patiente a bénéficié d’un traitement immunosuppresseur à base de corticoïdes, ensuite relayé avec du cyclophosphamide, puis Azathioprine. Elle a également été traitée par administration de la risperidone et de l’aspirine à 100mg/jour pour prévenir un éventuel accident vasculaire cérébral secondaire. L`évolution a été favorable, marquée par la disparition des symptômes psychotiques et neurologiques au bout de quelques mois, si bien qu’elle a repris ses activités normales. Conclusion: Les troubles psychotiques aiguées associées à des troubles neurologiques en postpartum peuvent être due aux causes organiques. Devant une forte suspicion d`auto-immunité, le neurolupus doit être évoqué

Health service provision for people with epilepsy in sub-Saharan Africa: A situational review

Background Epilepsy is a public health issue in sub-Saharan Africa (SSA) where many people with the condition receive no treatment. Health-care services for epilepsy in this region have not been comprehensively assessed. We examined key features of epilepsy health services provided in SSA. Methodology This was a scoping review conducted using pre-specified protocols. We implemented an electronic search strategy to identify relevant citations using PUBMED, EMBASE, Web of Science, Scopus, Cumulative Index to Nursing and Allied Health Literature (CINAHL), African Index Medicus (AIM), Open Grey, Cochrane database, and Google Scholar. Articles eligible for full-text review were screened and data of interest were reported. Result The search identified 81 eligible articles, forty-nine from East Africa, 19 from West Africa, 8 from South Africa, and 5 from Central Africa. A variety of care services were identified, with reporting of rural epilepsy care in 75% of retrieved articles mainly from East and South African countries. The majority of the rural epilepsy clinics were health worker- or nurse-led, reporting good seizure control in about two-thirds of patients using phenobarbital as the most commonly prescribed antiepileptic drug. Funding for rural epilepsy care came mainly from external donor agencies. Conclusion We attempted to provide a ‘snapshot’ of epilepsy care services in SSA. The successes achieved in some of the centers are due to the use of existing primary health-care systems and employing non-physician health-care personnel. The true picture of epilepsy care coverage is not apparent due to the lack of data and proper health system structure in most parts of SSA. As more individuals begin to receive care, the long-term funding for epilepsy care in African countries will depend on the commitment of their respective governments. Watila, Musa M., et al. "Health service provision for people with epilepsy in sub-Saharan Africa: A situational review." Epilepsy & Behavior 70 (2017): 24-32. © 2017. This manuscript version is made available under the CC-BY-NC-ND 4.0 license

Fear and depression during the COVID-19 outbreak in Cameroon : a nation-wide observational study

Abstract Background The COVID-19 pandemic has been associated with significant psychological and social distress worldwide. We investigated fear and depression among adults in Cameroon during different phases of the COVID-19 outbreak. Methods An online survey was conducted in Cameroon from June–December 2020 using a structured questionnaire. Socio-demographic data and information regarding COVID-19 history were obtained. Fear and depressive symptoms were assessed using the Fear of COVID-19 score (FCV-19S) and the Patient Health Questionnaire (PHQ-9), respectively. Responses were clustered in weeks to better appreciate their evolution over time. Results Overall, 7381 responses from all ten regions of Cameroon were analysed (median age: 30 years, 73.3% male). The prevalence of depression (PHQ-9 score ≥ 10) was 8.4%, and that of high fear of COVID-19 (FCV-19S scores ≥19) was 57.4%. These rates were similar across genders, age-groups, and region of residence. While mean weekly PHQ-9 scores remained fairly stable throughout the study period (range: 2.53–3.21; p = 0.101), mean FCV-19S scores were highest during the early weeks but decreased significantly thereafter (from 20.31 to 18.34; p <  0.001). Multivariate analyses revealed that having a postgraduate degree, a history of quarantine, flu-like symptoms during the past 14 days, and higher FCV-19S scores were associated with more severe depressive symptoms, while obtaining COVID-19 information from various sources reduced the odds for depression. Conclusion Depression amidst the COVID-19 crisis is less prevalent in Cameroon than in other countries. Prompt and widespread dissemination of adequate COVID-19 information may reduce the risks for depression by dispelling fear and anxiety among Cameroonians