Mbewe Edward, Zairemthiama Pachuau, Paul Ravi, Birbeck Gretchen L, Steiner Timothy J
Chainama College of Health Sciences, Lusaka, Zambia,
J Headache Pain. 2015;16:513. doi: 10.1186/s10194-015-0513-9. Epub 2015 Apr 29.
Three headache disorders - migraine, tension-type headache (TTH) and medication-overuse headache (MOH) - are major contributors to population ill-health. Policy-makers need local knowledge of these to guide priority-setting. Earlier we reported the prevalence of these disorders in Zambia; here we describe the burdens attributable to them.
This was a cross-sectional population-based survey of adults aged 18-65 years, selected by cluster-randomized sampling in the mostly urban Lusaka Province and mostly rural Southern Province. Interviewers visiting households used a structured questionnaire. Diagnoses made algorithmically applied ICHD-II criteria. Burden enquiry focused on the previous 3 months and the day before interview. Disability was estimated by applying disability weights (DWs) from the Global Burden of Disease Survey 2010.
From 1,134 households, 1,085 unrelated adults (450 male, 635 female) were interviewed (refusal rate 4.3%). The gender- and habitation-adjusted 1-year prevalence of migraine was 22.9%, of TTH 22.8%, of headache on ≥15 days/month 11.5%, of probable MOH (pMOH) 7.1%. Reported mean intensity of migraine attacks was 2.7, representing severe pain. People with migraine spent 10.0% of their time in the ictal state (DW: 0.433); they were therefore 4.3% disabled overall. Disability from TTH was much lower. People with pMOH (time with headache: 37.5%; DW: 0.220) were 8.3% disabled overall. Average lost productive time in the preceding 3 months for migraine was 4.1 days from work (6.3% loss) and 4.2 days (4.7% loss) from household work. Losses for pMOH were 4.8 days (7.4% loss) from work and 4.5 days (5.0% loss) from household work. In the population aged 18-65 years (effectively the working population), estimated disability from migraine was 0.98%, with 1.4% of workdays lost, and from pMOH was 0.59%, with 0.53% of workdays lost. Headache yesterday was reported by 28.3% of participants, whose average productivity yesterday was 55.9% of expectation.
Zambia loses 1.93% of GDP to headache, and action is required to mitigate this loss and the associated suffering. Structured headache services with their basis in primary care are the most efficient, effective, affordable and equitable solution. They could be implemented within the existing health-care infrastructure of Zambia. These matters require urgent political attention.
三种头痛疾病——偏头痛、紧张型头痛（TTH）和药物过量使用性头痛（MOH）——是导致人群健康不佳的主要因素。政策制定者需要了解这些疾病的当地情况，以指导优先事项的设定。此前我们报告了赞比亚这些疾病的患病率；在此我们描述它们所造成的负担。
这是一项基于人群的横断面调查，对象为18 - 65岁的成年人，通过整群随机抽样在主要为城市的卢萨卡省和主要为农村的南部省选取。访户的访谈人员使用结构化问卷。按照国际头痛疾病分类第二版（ICHD-II）标准进行算法诊断。负担调查聚焦于前3个月以及访谈前一天。通过应用2010年全球疾病负担调查中的残疾权重（DWs）来估计残疾情况。
从1134户家庭中，访谈了1085名无亲属关系的成年人（450名男性，635名女性）（拒绝率4.3%）。经性别和居住情况调整后的偏头痛1年患病率为22.9%，紧张型头痛为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）患病率为7.1%。报告的偏头痛发作平均强度为2.7，代表重度疼痛。偏头痛患者在发作期花费其10.0%的时间（残疾权重：0.433）；因此他们总体残疾率为4.3%。紧张型头痛导致的残疾率要低得多。可能的药物过量使用性头痛患者（头痛时间：37.5%；残疾权重：0.220）总体残疾率为8.3%。偏头痛患者在前3个月平均损失的生产时间为工作4.1天（损失6.3%）和家务4.2天（损失4.7%）。药物过量使用性头痛患者的损失为工作4.8天（损失7.4%）和家务4.5天（损失5.0%）。在18 - 65岁人群（实际上是工作人群）中，偏头痛导致的估计残疾率为0.98%，损失1.4%的工作日，药物过量使用性头痛导致的残疾率为0.59%，损失0.53%的工作日。28.3%的参与者报告昨天头痛，他们昨天的平均生产力为预期的55.9%。
赞比亚因头痛损失1.93%的国内生产总值（GDP），需要采取行动减轻这一损失及相关痛苦。以初级保健为基础的结构化头痛服务是最有效、高效、可负担且公平的解决方案。它们可以在赞比亚现有的医疗基础设施内实施。这些问题需要政治上的紧急关注。
