Neuroepidemiology Findings As Contributors For Epilepsy Due To Neurocysticercosis At Mngceleni Location, South Africa

Abstract

Introduction: Eighty two people were interviewed in the Mngceleni area. The survey involved the general information about the community's demographics, living environment, and health status, but mainly about neurocysticercosis and epilepsy. Aim: To perform a research in the Mngceleni area to evaluate the prevalence and knowledge about neurocysticercosis and epilepsy. Methodology: A group of 14 students conducted a descriptive study of the community, using a random sample survey (Appendix 1) of 82 households. Results: The prevalence of epilepsy and neurocysticercosis was found to be 6% and 4% respectively. While only 3% of the population had a good knowledge for both the diseases. Conclusion: The high prevalence's of both the diseases were attributed to poor sanitation and living standards, as well as a lack of education. The research revealed a need to build toilets, to educate the people about these diseases and about the major risk factors present. INTRODUCTION Following the Community Based Education and Service (COBES) system of the Walter Sisulu University, the students set out on a research of the Mngceleni area, which is located in Sidwadweni. This community consists of approximately 3000 people, whom are served by Mhlakulo Health Centre for their medical attention. The COBES system has been created in order to introduce to students to the community and to motivate them into helping the people of these communities. Based on the community and the people of the community, students are able to get a unique insight on the living conditions and health status, which opens gateways to offer help and find solutions to their difficulties. The research that took place involved finding out general information about the community, such as their housing, occupation, health status, financial status, hygiene and demographics. The specific task at hand was to find out about the communities knowledge and health status on epilepsy and neurocysticercosis (NCC). Neurocysticercosis is a parasitic infection of the CNS caused by the larval stage of Taenia solium, the pig tape worm. This is the most common helminth to produce CNS infection in humans. NCC may remain asymptomatic for months too years and sometimes its diagnosis is made incidentally when neuroimaging is performed. NCC is the most common cause of epilepsy in the developing world. Most patients are administered phenytoin Neuroepidemiology Findings As Contributors For Epilepsy Due To Neurocysticercosis At Mngceleni Location, South Africa 2 of 8 or carbamazepine, which effectively controls their seizures. It is important to inform the people that NCC can be PREVENTED! With proper sanitation and food cooking, there's no need to fear the disease. Signs and symptoms are related both to the parasite and to the inflammatory immunological response of the host. Typical manifestations are subcutaneous cyst presenting as nodules that tend to be asymptomatic. The natural history of the infection is unknown, but it is known that cysticercus's complete there development within two to four months after the larval entry. Location of infestation, according to frequency, is the CNS; subcutaneous tissues; striated muscle, eyeball, heart and then other tissues. The may remain alive in these locations from months up to years. Human cysticercosis is acquired after eating food contaminated with fertilized eggs excreted in the faeces from taenia carriers. It is well known that people eating infected pork meat acquire TAENIASIS as opposed to CYSTICERCOSIS. The latter is acquired from Taenia solium eggs, that auto-infect patients that are harbouring the adult parasite in their intestines. The cysts can develop anywhere, but have a predilection for the CNS. Factors that contribute to the high prevalence in the Eastern Cape include free range farming, unsanitary toilet facilities, use of Taenia solium segments by self taught healers (to heal worm infestations) and also malevolent use of Taenia solium by angry women to punish unfaithful partners (added to beer). Epilepsy is a chronic condition/illness that is characterised by attacks of seizures that vary from simple partial seizures to strong generalized seizures. The cause of epilepsy is often not found, but common causes are cysticercosis, trauma to the head, stroke, vascular malformations and alcohol or benzodiazepine withdrawal. Living with epilepsy creates many problems, such as inability to drive or to operate machinery; therefore many patients cannot work and earn a living. Another problem is that patients live with a constant fear, fear of when their next seizure will be or of sudden death. There is also a psychosocial aspect if living with epilepsy, for example the impact that the disease will have on the individual's family. They will be on alert all the time, worrying about the patient's well being, or the nagging stress about whether or not the patient has taken their medication for today. Patients are only administered drugs for epilepsy if there is proof (eye witness) of more than one seizure/fit. However, if the patient only has about one seizure every two years, then it should be discussed with the patient that they may want to deal with the risk rather than taking drugs every day, particularly if the patient has no need to drive or operate machinery. Drugs used for the treatment of epilepsy are carbamazepine; sodium valproate and phenytoin. AIM To evaluate the prevalence and the knowledge base of epilepsy and neurocysticercosis. OBJECTIVES To analyse the effect that these diseases have on the community To know about other epidemiological aspects and risk factors (water, sanitation, lifestyle) that can affect the health of the community. To form, submit and discuss a comprehensive report of the results to the District Health and the provincial DOH. To promote health education and disease prevention To make recommendations if any problems are identified METHODOLOGY A group of 14 students from Walter Sisulu University (WSU) of the medical faculty were assigned to Mhlakulo Health Centre. Under the supervision of Community Medicine, the students conducted a descriptive study of the Mngceleni community. With the community leaders permission, the students investigated by conducting a random sample survey (Refer to Appendix 1), door to door. Eighty two households were interviewed using the questionnaire formulated by the faculty. All the objectives of the research and the questionnaires were checked by and given the go-ahead by the students, matrons of the health centre and the community leader. Also the CHESP members were informed about this research project. The community leader and matrons agreed to help the students with there study and compilation of there Neuroepidemiology Findings As Contributors For Epilepsy Due To Neurocysticercosis At Mngceleni Location, South Africa 3 of 8 important learning activity. The students were taken into the community by transport provided by WSU. The questionnaire included specific questions related to epilepsy, neurocysticercosis and other indicators (demographics, lifestyle, sanitation and environmental factors). [Appendix 1 is a sample of the questionnaire] During the interviews, the students interacted with the population (health promotion), explaining the main risk factors and preventative measures for diseases. This included explaining the Taenia solium life cycle and the importance of well-cooked pork. Language barriers were taken into account for the interview and for the informed consent, therefore the interview was conducted in the native language, isiXhosa. Afterwards, the results were graphically represented, analysed and interpreted. Links were found between lifestyle, habits, knowledge, environment and the diseases. Finally, this report was compiled using Microsoft word and excel. Added information was obtained from the internet and text books, referred to in the bibliography. The presentation will be done using Microsoft Power Point. DEFINITION OF TERMS COBES Community Based Education and Service Community The people living in the same area, or a group of people with similar interests or origins Epilepsy – A disorder of brain function characterized by recurrent seizures that have a sudden onset Health Centre – A building, owned or leased by a community trust or a Health Authority, that houses personnel and/or services from one or several sections of the National Health Service. Services provided by local authorities, such as social services, may also operate from such a centre Incidence Rate – A measure of morbidity based on the number of new episodes of illness arising in a population over a period of time Neurocysticercosis – A disease caused by the presence of tapeworm larvae, of the species Taenia solium, in the brain. Where they cause symptoms of mental deterioration, epileptic attacks, convulsions, paralysis and giddiness Population – A group of living things of the same type living in the same area, inhabitants Prevalence Rate – A measure of morbidity based on current sickness in a population, estimated either at a particular time or over a stated period Survey – A general look at something. LOCATION Mhlakulo Health Centre is located 30km east of Mthatha on the N2, in the Eastern Cape Province. Mngceleni is the area next to the health centre. RESULTS AND DISCUSSION Figure 1 Graphic 1: Demographics of adults in the community From this representation of the males and females, it is evident that there are much more females than males in this population. The major reason for this is that the males leave the community to find jobs elsewhere. By emigrating for work, they are able to support their families at home. Figure 2 Graph 2: Percentage of children in the different age groups Neuroepidemiology Findings As Contributors For Epilepsy Due To Neurocysticercosis At Mngceleni Location, South Africa 4 of 8 Demographics: Chilrden ( below age 16 years) In this analytical representatio