Mortality among persons with epilepsy in onchocerciasis-endemic and non-endemic areas of sub-Saharan Africa: A systematic review and meta-analysis

•Epilepsy is an important cause of mortality in sub-Saharan Africa (SSA).•Mortality was higher in people with epilepsy in onchocerciasis foci & those with nodding syndrome.•Living in onchocerciasis foci and nodding syndrome were associated with mortality.•Better epilepsy care and preventive inte...

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Published in:Seizure (London, England) England), 2023-08, Vol.110, p.253-261
Main Authors: Siewe Fodjo, Joseph Nelson, Van Cutsem, Gilles, Amaral, Luís-Jorge, Colebunders, Robert
Format: Article
Language:English
Subjects:
Africa South of the Sahara - epidemiology
Epilepsy
Epilepsy - complications
Humans
Meta-analysis
Mortality
Nodding syndrome
Onchocerciasis
Onchocerciasis - complications
Onchocerciasis - epidemiology
Prevalence
Seizures - complications
Status Epilepticus - complications
Sub-Saharan Africa
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Summary:•Epilepsy is an important cause of mortality in sub-Saharan Africa (SSA).•Mortality was higher in people with epilepsy in onchocerciasis foci & those with nodding syndrome.•Living in onchocerciasis foci and nodding syndrome were associated with mortality.•Better epilepsy care and preventive interventions are urgently needed in SSA. To document epilepsy-related mortality in sub-Saharan Africa (SSA) and investigate possible associations with onchocerciasis endemicity. Systematic review with meta-analysis. Searches were performed in PubMed and Google Scholar (search terms: ‘epilepsy’; ‘mortality/death’; ‘sub-Saharan Africa’). Included studies were classified as high-risk or low-risk for onchocerciasis based on documented endemicity data. Pooled mortality rates and annual case fatality rates (CFR) were calculated, and risk factors for mortality among persons with epilepsy (PWE) were investigated using meta-regression analysis. The 28 eligible studies reported 30 epilepsy surveys, of which 9 (30.0%) were conducted in onchocerciasis high-risk sites. The pooled epilepsy mortality rate was 20.9 (95% CI: 5.9–74.4) per 100,000 person-years, and the pooled CFR was 36.2 (95% CI: 23.9–54.4) per 1,000 PWE per year, albeit with substantial between-study heterogeneity. Compared to onchocerciasis low-risk sites, high-risk sites had higher pooled mortality (342.9 versus 10.0 per 100,000 PY; p
ISSN:1059-1311
1532-2688
DOI:10.1016/j.seizure.2023.07.006