High prevalence of epilepsy in an onchocerciasis endemic health zone in the Democratic Republic of the Congo, despite 14 years of community-directed treatment with ivermectin: A mixed-method assessment

• Published in: International journal of infectious diseases Vol. 79; pp. 187 - 194
• Main Authors: Mukendi, Deby, Tepage, Floribert, Akonda, Innocent, Siewe, Joseph Nelson Fodjo, Rotsaert, Anke, Ndibmun, Carl Nwana, Laudisoit, Anne, Couvreur, Simon, Kabutako, Blandine, Menon, Sonia, Hotterbeekx, An, Colebunders, Robert
• Format: Journal Article
• Language: English
• Published: Canada Elsevier Ltd 01.02.2019; Elsevier
• Subjects: Case–control; Epilepsy; Focus group discussion; Incidence; Ivermectin; Onchocerciasis; Prevalence; Stigma; Focus group discussion; Prevalence; Stigma; Epilepsy; Case–control; Onchocerciasis; Ivermectin; Incidence
• ISSN: 1201-9712; 1878-3511
• DOI: 10.1016/j.ijid.2018.10.021

•A high epilepsy prevalence in the Aketi health zone was observed despite 14 years of community-directed treatment with ivermectin.•The high prevalence of OV16 antibodies in children is indicative of high ongoing onchocerciasis transmission.•High onchocerciasis transmission is the consequence of high exposure to blackflies and low intake of ivermectin.•Head nodding seizures were observed in 13.8% of the persons with epilepsy.•Ivermectin coverage needs to be increased and bi-annual distribution should be considered. To investigate the reasons for the high prevalence of epilepsy (>6%) discovered in 2015 in the Aketi health zone in the north of the Democratic Republic of the Congo. Persons with epilepsy (PWE) diagnosed in a door-to-door survey in 2015 were traced and re-examined in 2017 by a neurologist. Confirmed PWE were paired with matched controls. For onchocerciasis assessment, children 7–10 years old were tested for IgG4 Onchocerca volvulus (OV16) antibodies, a rapid epidemiological mapping of onchocerciasis (REMO) study was performed, and ivermectin coverage was investigated. Forty-three (61.4%) previously diagnosed PWE were traced; the neurologist confirmed the epilepsy diagnosis in all of them. The overall OV16 positivity rate was 64.5%. Poor ivermectin coverage (55.9%) and a high prevalence of onchocercal nodules (>70%) were observed. The prevalence of epilepsy was 5.7% in Aketi rural town, with nine PWE (13.8%) experiencing head nodding seizures. A case-control study showed that PWE had lower body weight and higher ivermectin coverage in 2017 than healthy controls. The high prevalence of epilepsy in the Aketi health zone, despite 14 years of community-directed treatment with ivermectin (CDTI), was found to be associated with high onchocerciasis transmission and low ivermectin use. An awareness programme to increase ivermectin coverage and the introduction of a bi-annual CDTI programme should be considered.