Challenges of epidemiological research on epilepsy in resource-poor countries.

International audienceEpilepsy is one of the most common neurological disorders. Today, an estimated 50 million people live with epilepsy (PWE), 80% of whom in developing countries. The public health significance is particularly high in these settings because of its high prevalence, its seizure acuteness and frequency, and the sociological, psychosocial, and financial consequences for the households it affects

Methodological difficulties in the conduct of neuroepidemiological studies in low- and middle-income countries

The majority of people with epilepsy (PWE) live in low- and middle-income countries (LMICs). However, they remain largely untreated and the bulk of resources are used to treat patients in the developed world. This disparity constitutes a challenge for neuroepidemiological studies on a global scale. In the past, several studies have focused on diverse populations in disparate countries at various periods of time and for particular purposes. The specificity of different contexts and circumstances makes it difficult to analyse PWE as a group either qualitatively or quantitatively. Such methodological limitations are further complicated by a lack of logistical support. There is a lack of interest in conducting studies, which results in inadequate funding and, in addition, there is the considerable challenge of publishing research reports from LMICs in peer-reviewed international journals.; This paper focuses on methodological problems related to studies in LMICs and attempts to give the reasons for their limitations using epilepsy as an example.; Regional conditions and environmental factors must be given careful consideration in the research design because of the importance of understanding the challenges of living in these environments. There are further limitations to the successful implementation of studies. Existing information on epilepsy is often not readily accessible; there is a lack of census data, and migratory patterns into cities make enumeration and sampling even more challenging. As there is usually no well-developed healthcare system a door-to-door screening process is often the only way to identify those with convulsive epilepsy. The questionnaire and study design should preferably be adapted from standardized protocols, and pre-tested and validated in local conditions.; Systematic reviews and meta-analyses of studies in LMICs can provide data on the burden, risk factors, treatment and outcome of epilepsy only if the primary studies used are properly conducted using uniform and comparable methodology. The use of consistent replicable neuroepidemiological methods in primary studies and systematic reviews enable reduction of the treatment gap and better epilepsy care

Revue systématique du rôle des infirmiers concernant les maladies chroniques en Afrique

Introduction : 41 millions de décès sont liés aux maladies chroniques (MC), dont 31 millions surviennent annuellement dans les pays à faibles et moyens niveaux de revenus notamment en Afrique. Ces décès sont liés à la faible démographie médicale et aux difficultés d’accès aux soins. Face à ces problèmes majeurs de santé publique, le Conseil international des infirmières recommande de développer la prise en charge des MC par les infirmiers du fait de leurs compétences cliniques et expertises. Pourtant, leur rôle n’est pas clarifié, aucune revue systématique exhaustive n’existait sur le sujet. Objectifs : Fournir une description exhaustive du rôle des infirmiers, identifier les ressources, problèmes et lacunes auxquels les infirmiers sont confrontés dans la gestion des MC en Afrique. Méthodes : Une revue systématique en double aveugle a été réalisée interrogeant Medline, Web of science, Embase, CINALH, PyschInfo et Google Scholar, sans restriction de date ou de langue de publication. Une analyse de la qualité des publications a été réalisée. Résultats : 2120 articles étaient éligibles, 432 articles ont été lus en intégralité.  Résultats : Les résultats préliminaires montrent que les stratégies développées et le rôle des infirmiers dans les MC se rapprochent du rôle des infirmiers en pratique avancée (IPA). En effet, des stratégies de glissement de tâches sont notamment mises en œuvre pour palier la désertification médicale faisant évoluer les rôles des infirmiers vers ceux des infirmiers en pratique avancée. Des éléments tels qu’une supervision, des formations régulières et la mise à disposition de moyens matériels sont identifiés comme des éléments clés pour réussir ces stratégies de glissement de tâche. Discussion et conclusion : Reconnaitre, structurer et réglementer l’implantation d’infirmiers aux compétences élargies telle que des IPA, notamment en Afrique, serait une solution avantageuse pour faire face aux enjeux de santé concernant la prise en charge des MC.Introduction : 41 millions de décès sont liés aux maladies chroniques (MC), dont 31 millions surviennent annuellement dans les pays à faibles et moyens niveaux de revenus notamment en Afrique. Ces décès sont liés à la faible démographie médicale et aux difficultés d’accès aux soins. Face à ces problèmes majeurs de santé publique, le Conseil international des infirmières recommande de développer la prise en charge des MC par les infirmiers du fait de leurs compétences cliniques et expertises. Pourtant, leur rôle n’est pas clarifié, aucune revue systématique exhaustive n’existait sur le sujet. Objectifs : Fournir une description exhaustive du rôle des infirmiers, identifier les ressources, problèmes et lacunes auxquels les infirmiers sont confrontés dans la gestion des MC en Afrique. Méthodes : Une revue systématique en double aveugle a été réalisée interrogeant Medline, Web of science, Embase, CINALH, PyschInfo et Google Scholar, sans restriction de date ou de langue de publication. Une analyse de la qualité des publications a été réalisée. Résultats : 2120 articles étaient éligibles, 432 articles ont été lus en intégralité.  Résultats : Les résultats préliminaires montrent que les stratégies développées et le rôle des infirmiers dans les MC se rapprochent du rôle des infirmiers en pratique avancée (IPA). En effet, des stratégies de glissement de tâches sont notamment mises en œuvre pour palier la désertification médicale faisant évoluer les rôles des infirmiers vers ceux des infirmiers en pratique avancée. Des éléments tels qu’une supervision, des formations régulières et la mise à disposition de moyens matériels sont identifiés comme des éléments clés pour réussir ces stratégies de glissement de tâche. Discussion et conclusion : Reconnaitre, structurer et réglementer l’implantation d’infirmiers aux compétences élargies telle que des IPA, notamment en Afrique, serait une solution avantageuse pour faire face aux enjeux de santé concernant la prise en charge des MC

Socio-Cultural Perceptions and Representations of Dementia in Brazzaville, Republic of Congo: The EDAC Survey

Background: Dementia will concern more and more people in the developing countries, but the perception people have of dementia in these areas has not yet been studied. Method: During a general population survey (EDAC) carried out in Brazzaville (Republic of Congo), 27 elderly persons suspected of having dementia and 31 of their relatives, 90 cognitively impaired elderly persons and 92 of their relatives, as well as 33 hospital workers were interviewed according to the Explanatory Model Interview Catalogue. Results: Item prominence ratings indicate that the attention was mainly on the emotional and socio-economic consequences (scores >1.0 out of 5 points). Ageing and mental stress are the main perceived causes. Hospital workers are more aware of public stigma. Conclusion: The socio-cultural components of the dementia phenomenon have to be taken into account to enforce public health and social measures

0579: Particularities of the epidemiology of hypertension in the elderly in Central Africa: the EPIDEMCA study

BackgroundThe epidemiology of hypertension in the elderly is rarely reported in Africa and little is known about its specificities.ObjectiveTo study the prevalence of hypertension and associated factors in older people in Central Africa.MethodsIndividuals aged 65 years old and over living in two urban and two rural areas of the Republic of Congo (ROC) and the Central African Republic (CAR) were invited to participate into a comprehensive cross-sectional study assessing cognitive impairments and cardiovascular diseases. Demographic, clinical and biological data were collected. Hypertension was defined in case of self-reported on-going treatment and/or when averaged systolic blood pressure at rest was≥140mmHg and/or diastolic blood pressure was≥90mmHg.ResultsAmong 1990 participants (mean age=73 years; 62% females), the overall prevalence of hypertension was 61.1% (95% CI: 58.9-63.2), higher in ROC than in CAR (68.0% vs 53.7%, respectively; p<0.001) and higher in urban than in rural areas (64.7% vs 57.4%, respectively; p=0.001). Among hypertensive participants, 53.3% were unaware of their condition and only 17.3% received anti-hypertensive drug therapy. In multivariate analysis, increasing age and BMI, living in the ROC, the main lifetime occupation, presence of depressive symptoms and the number of meals per day remained significantly associated with an increased likelihood of hypertension. In contrast, smoking status, physical activity and an increasing number of stressful lifetime events were associated with a reduced likelihood for prevalent hypertension.ConclusionHypertension is highly prevalent in elderly people of Central Africa, and presents some particularities in relation to specific conditions in this region

Epilepsy-associated stigma in Bolivia: A community-based study among the Guarani population An International League Against Epilepsy/International Bureau for Epilepsy/World Health Organization Global Campaign Against Epilepsy Regional Project

n/

Epilepsy in Onchocerciasis Endemic Areas: Systematic Review and Meta-analysis of Population-Based Surveys

Epilepsy is particularly common in tropical areas. One main reason is that many endemic infections have neurological consequences. In addition, the medical, social and demographic burden of epilepsy remains substantial in these countries where it is often seen as a contagious condition and where the aetiology is often undetermined. For several decades, field researchers had reported some overlapping between the geographical distributions of epilepsy and onchocerciasis, a parasitic disease caused by the filarial worm Onchocerca volvulus which afflicts some 40 million persons worldwide. Here, we conducted a statistical analysis of all the data available on the relationship between the two conditions to determine whether the proportion of people suffering from epilepsy in a community could be related to the frequency of onchocerciasis. The combined results of the eight studies carried out in west, central and east Africa indicate a close epidemiological association between the two diseases. Should a causative relationship be demonstrated, onchocerciasis, which is known as “river blindness” because of its most serious sequela and the distribution of its vectors, could thus also be called “river epilepsy”. More research is needed to determine the mechanisms explaining this association and to assess the burden of onchocerciasis-associated epilepsy