Mbewe Edward, Zairemthiama Pachuau, Yeh Hsueh-Han, Paul Ravi, Birbeck Gretchen L, Steiner Timothy J
Chainama College of Health Sciences, Lusaka, Zambia,
J Headache Pain. 2015;16:515. doi: 10.1186/s10194-015-0515-7. Epub 2015 Apr 2.
Little is known of the epidemiology of primary headache disorders in sub-Saharan Africa. We performed a population-based survey in Zambia using methods previously tested in multiple other countries.
This cross-sectional survey was conducted by visiting households unannounced, using cluster-randomized sampling, in the mostly urban Lusaka Province and mostly rural Southern Province. Within clusters, households were selected randomly, as was one adult member (18-65 years old) of each selected household. A structured questionnaire, translated into the local languages, was administered face-to-face by trained interviewers. Demographic enquiry was followed by diagnostic questions based on ICHD-II criteria. A random sub-sample of participants were invited for subsequent physician-interview to validate the diagnostic part of the questionnaire.
Of 1,134 eligible household members contacted, 1,085 (450 male, 887 urban) consented to interview (refusal rate 4.3%). Others who had been selected but remained unavailable on three visits were not counted as refusals since their reasons were unknown, but gave rise to gender biases, being mostly male in urban areas and mostly female in rural areas. Statistical correction was applied. Adjusted for gender and habitation (urban/rural), the 1-year prevalence of any headache was 61.6%, of migraine 22.9%, of tension-type headache (TTH) 22.8%, of headache on ≥15 days/month 11.5% and of probable medication-overuse headache (pMOH) 7.1%. The adjusted point-prevalence of any headache (headache yesterday) was 19.1%. There was a small proportion (5.3%) of unclassified headache, some of which may have been secondary. The overwhelmingly strong association was between urban dwelling and pMOH (OR: 8.6; P=0.0001), with an urban prevalence of 14.5% (gender-adjusted). Validation of the questionnaire was limited by participants' reluctance to present for physician review, substantial delays in doing so and major self-selection bias among those who did. These were unavoidable problems in resource-limited Zambia.
Primary headache disorders, common in high-income countries, are at least as prevalent in Zambia, a sub-Saharan African country. The selectively urban problem of pMOH seems likely to reflect ready availability of non-prescription analgesics, without easy access to professional health care for headache or any focused public-health education regarding correct usage of analgesics or the dangers of their overuse.
撒哈拉以南非洲地区原发性头痛疾病的流行病学情况鲜为人知。我们在赞比亚开展了一项基于人群的调查，采用了此前在其他多个国家经过测试的方法。
这项横断面调查通过不事先通知就走访家庭的方式进行，采用整群随机抽样，调查地点主要在城市为主的卢萨卡省和农村为主的南部省。在各个群组中，随机选择家庭，并且从每个被选中的家庭中随机选择一名成年成员（18 - 65岁）。由经过培训的访谈人员面对面发放一份翻译成当地语言的结构化问卷。在进行人口统计学询问之后，根据国际头痛疾病分类第二版（ICHD-II）标准提出诊断问题。随机抽取一部分参与者进行后续的医生访谈，以验证问卷中的诊断部分。
在联系的1134名符合条件的家庭成员中，1085人（450名男性，887名城市居民）同意接受访谈（拒绝率4.3%）。其他被选中但在三次走访后仍无法联系到的人未被算作拒绝，因为原因不明，但这导致了性别偏差，城市地区以男性居多，农村地区以女性居多。进行了统计校正。经性别和居住环境（城市/农村）调整后，任何头痛的1年患病率为61.6%，偏头痛为22.9%，紧张型头痛（TTH）为22.8%，每月≥15天头痛的患病率为11.5%，可能的药物过量使用性头痛（pMOH）为7.1%。任何头痛（昨天头痛）的校正点患病率为19.1%。有一小部分（5.3%）头痛未分类，其中一些可能是继发性的。城市居住与pMOH之间存在极强的关联（比值比：8.6；P = 0.0001），城市患病率为14.5%（经性别调整）。问卷的验证受到参与者不愿接受医生复查、复查存在严重延迟以及接受复查者存在重大自我选择偏差的限制。在资源有限的赞比亚，这些是不可避免的问题。
原发性头痛疾病在高收入国家很常见，在撒哈拉以南非洲国家赞比亚至少同样普遍。pMOH这种有选择性的城市问题似乎可能反映出非处方镇痛药容易获取，而头痛患者难以获得专业医疗服务，或者缺乏关于镇痛药正确使用方法或过度使用危害的针对性公共卫生教育。
