肯尼亚内罗毕城市非正规居住区所有癫痫的患病率:一项基于人口的两阶段研究。

IF 19.9 1区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH Lancet Global Health Pub Date : 2024-08-01 Epub Date: 2024-07-05 DOI:10.1016/S2214-109X(24)00217-1
Daniel M Mwanga, Damazo T Kadengye, Peter O Otieno, Frederick M Wekesah, Isaac C Kipchirchir, George O Muhua, Joan W Kinuthia, Thomas Kwasa, Abigael Machuka, Quincy Mongare, Samuel Iddi, Gabriel Davis Jones, Josemir W Sander, Symon M Kariuki, Arjune Sen, Charles R Newton, Gershim Asiki
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引用次数: 0

摘要

背景:世卫组织估计,全球有 5000 多万人患有癫痫,其中 80% 的病例发生在低收入和中等收入国家。非洲的大多数研究都集中在农村地区的活动性惊厥性癫痫,但城市环境中的数据却很少。我们的目的是估算肯尼亚内罗毕两个城市非正式居住区所有癫痫的发病率和空间分布情况:我们分两个阶段对肯尼亚内罗毕两个非正规居住区(Korogocho 和 Viwandani)的人口监测系统中的居民进行了基于人口的横断面研究。第一阶段使用有效的癫痫筛查问卷对所有家庭成员进行筛查,以发现可能的病例。在第 2 阶段,那些被确认可能有癫痫发作的人和一部分筛查结果为阴性的人被邀请到当地诊所接受神经科医生的临床和神经学评估。根据国际抗癫痫联盟的建议对癫痫发作进行分类。我们使用多重归因法对两个阶段之间的自然减员进行了调整,并用筛查工具的灵敏度值除以估计值对灵敏度进行了调整。我们还使用对数回归法来评估参与者社会人口统计学方面的患病率差异:第一阶段(2021 年 9 月 17 日至 12 月 23 日)共筛查了 56425 人,其中 1126 人被归类为潜在癫痫病例。在第二阶段(2022 年 4 月 12 日至 8 月 6 日),共有 873 人接受了神经科医生的评估,其中 528 人被确认为癫痫患者。由于自然减员,253 个潜在病例未接受神经科医生的评估。在 56 425 人中,30 179 人(53-5%)为男性,26 246 人(46-5%)为女性。年龄中位数为 24 岁(IQR 11-35)。经自然减员调整和敏感性调整后,各类癫痫的患病率为每千人 11-9 例(95% CI 11-0-12-8),惊厥性癫痫为每千人 8-7 例(8-0-9-6),非惊厥性癫痫为每千人 3-2 例(2-7-3-7)。分居或离婚者的总体患病率最高,为每千人 20-3 例(95% CI 15-9-24-7),失业者为每千人 18-8 例(16-2-21-4),未受过正规教育者为每千人 18-5 例(16-3-20-7),13-18 岁青少年为每千人 15-2 例(12-0-18-5)。癫痫诊断差距为 80%:解释:癫痫在内罗毕城市非正规居住区很常见,诊断差距很大。需要采取有针对性的干预措施,增加癫痫的早期发现率,尤其是在弱势群体中,以便及时治疗和预防不良的社会后果:资金来源:国家卫生研究所利用官方发展援助。
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Prevalence of all epilepsies in urban informal settlements in Nairobi, Kenya: a two-stage population-based study.

Background: WHO estimates that more than 50 million people worldwide have epilepsy and 80% of cases are in low-income and middle-income countries. Most studies in Africa have focused on active convulsive epilepsy in rural areas, but there are few data in urban settings. We aimed to estimate the prevalence and spatial distribution of all epilepsies in two urban informal settlements in Nairobi, Kenya.

Methods: We did a two-stage population-based cross-sectional study of residents in a demographic surveillance system covering two informal settlements in Nairobi, Kenya (Korogocho and Viwandani). Stage 1 screened all household members using a validated epilepsy screening questionnaire to detect possible cases. In stage 2, those identified with possible seizures and a proportion of those screening negative were invited to local clinics for clinical and neurological assessments by a neurologist. Seizures were classified following the International League Against Epilepsy recommendations. We adjusted for attrition between the two stages using multiple imputations and for sensitivity by dividing estimates by the sensitivity value of the screening tool. Complementary log-log regression was used to assess prevalence differences by participant socio-demographics.

Findings: A total of 56 425 individuals were screened during stage 1 (between Sept 17 and Dec 23, 2021) during which 1126 were classified as potential epilepsy cases. A total of 873 were assessed by a neurologist in stage 2 (between April 12 and Aug 6, 2022) during which 528 were confirmed as epilepsy cases. 253 potential cases were not assessed by a neurologist due to attrition. 30 179 (53·5%) of the 56 425 individuals were male and 26 246 (46·5%) were female. The median age was 24 years (IQR 11-35). Attrition-adjusted and sensitivity-adjusted prevalence for all types of epilepsy was 11·9 cases per 1000 people (95% CI 11·0-12·8), convulsive epilepsy was 8·7 cases per 1000 people (8·0-9·6), and non-convulsive epilepsy was 3·2 cases per 1000 people (2·7-3·7). Overall prevalence was highest among separated or divorced individuals at 20·3 cases per 1000 people (95% CI 15·9-24·7), unemployed people at 18·8 cases per 1000 people (16·2-21·4), those with no formal education at 18·5 cases per 1000 people (16·3-20·7), and adolescents aged 13-18 years at 15·2 cases per 1000 people (12·0-18·5). The epilepsy diagnostic gap was 80%.

Interpretation: Epilepsy is common in urban informal settlements of Nairobi, with large diagnostic gaps. Targeted interventions are needed to increase early epilepsy detection, particularly among vulnerable groups, to enable prompt treatment and prevention of adverse social consequences.

Funding: National Institute for Health Research using Official Development Assistance.

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来源期刊
Lancet Global Health
Lancet Global Health PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH-
CiteScore
44.10
自引率
1.20%
发文量
763
审稿时长
10 weeks
期刊介绍: The Lancet Global Health is an online publication that releases monthly open access (subscription-free) issues.Each issue includes original research, commentary, and correspondence.In addition to this, the publication also provides regular blog posts. The main focus of The Lancet Global Health is on disadvantaged populations, which can include both entire economic regions and marginalized groups within prosperous nations.The publication prefers to cover topics related to reproductive, maternal, neonatal, child, and adolescent health; infectious diseases (including neglected tropical diseases); non-communicable diseases; mental health; the global health workforce; health systems; surgery; and health policy.
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