Department of Paediatrics and Child Health, School of Medicine, University of Zambia, Lusaka, Zambia.
University of Zambia School of Medicine, Lusaka, Zambia.
J Headache Pain. 2022 Sep 9;23(1):118. doi: 10.1186/s10194-022-01477-x.
The Global Campaign against Headache collects data from children (6-11 years) and adolescents (12-17) to inform health and education policies and contribute to the Global Burden of Disease (GBD) study. This survey in Zambia, part of this global enquiry, was the second from sub-Saharan Africa (SSA).
Following the generic protocol, this was a schools-based cross-sectional survey. We used the child and adolescent versions of the structured Headache-Attributed Restriction, Disability, Social Handicap and Impaired Participation (HARDSHIP) questionnaire, self-completed by pupils within classes, in a total of nine schools in Lusaka (urban) and Copperbelt (semi-rural). These two of Zambia's ten provinces were selected to represent the country's urban/rural divide. Headache diagnostic questions were based on ICHD-3 except for undifferentiated headache (UdH).
Of 2,759 potential participants, 2,089 (615 children [29.4%], 1,474 adolescents [70.6%]) completed questionnaires (participating proportion 75.7%). Children were therefore under-represented (mean age 13.1 ± 2.8 years), while gender distribution (1,128 [54.0%] male, 961 [46.0%] female) was close to expectation. Observed lifetime prevalence of headache was 97.5%. Gender- and age-adjusted 1-year prevalence estimates were 85.8% for all headache, 53.2% for migraine (definite 17.5%, probable 35.7%), 12.1% for tension-type headache (TTH), 14.8% for UdH, 3.3% for all headache on ≥ 15 days/month and 0.9% for probable medication-overuse headache. Headache durations were short: only 28.6% of participants with any headache, and only 10.5% of those diagnosed as probable migraine, reported usual durations of > 2 h (the threshold for definite migraine). Of the latter, 36.6% reported < 1 h, the duration criterion for UdH. There were weak associations of migraine (definite + probable) with female gender, and of TTH and headache on ≥ 15 days/month with adolescence. Headache yesterday was reported by 22.2% of the sample, 25.5% of those with headache.
Headache disorders among young people are prevalent in Zambia. Among them, migraine is the most common, with UdH also highly prevalent. In this study there were diagnostic uncertainties, which rested to a large extent on the distinction between migraine and UdH among the many participants reporting headache of < 2 h' duration. Similar uncertainties occurred in the first study in SSA, in Ethiopia. Because of these, we conclude only that migraine affects at least 17.5% of these age groups in Zambia, which is still a large proportion, adult prevalence in an earlier study being 22.9%. Supplementary estimates of attributed burden are needed to inform public-health and educational policies in Zambia.
全球头痛防治运动从儿童（6-11 岁）和青少年（12-17 岁）收集数据，为卫生和教育政策提供信息，并为全球疾病负担（GBD）研究做出贡献。赞比亚的这项调查是该全球调查的一部分，来自撒哈拉以南非洲（SSA）的第二次调查。
遵循通用方案，这是一项基于学校的横断面调查。我们使用儿童和青少年版本的结构化头痛归因的限制、残疾、社会障碍和受损参与（HARDSHIP）问卷，由班级内的学生自我填写，总共在卢萨卡（城市）和铜带（半农村）的九所学校进行。赞比亚的十个省份中有两个被选中，以代表该国的城乡差距。头痛诊断问题基于 ICHD-3，除了未分化头痛（UdH）。
在 2759 名潜在参与者中，有 2089 人（615 名儿童[29.4%]，1474 名青少年[70.6%]）完成了问卷（参与比例为 75.7%）。因此，儿童的代表性不足（平均年龄 13.1±2.8 岁），而性别分布（1128 名[54.0%]男性，961 名[46.0%]女性）接近预期。观察到的终生头痛患病率为 97.5%。性别和年龄调整的 1 年患病率估计为所有头痛 85.8%，偏头痛（确诊 17.5%，可能 35.7%）53.2%，紧张型头痛（TTH）12.1%，UdH 14.8%，所有头痛每月≥15 天 3.3%，可能药物滥用性头痛 0.9%。头痛持续时间短：只有 28.6%的任何头痛患者和只有 10.5%的可能偏头痛患者报告通常持续时间>2 小时（偏头痛的确诊阈值）。后者中，36.6%报告<1 小时，这是 UdH 的持续时间标准。偏头痛（确诊+可能）与女性性别之间存在弱关联，而 TTH 和每月≥15 天的头痛与青春期之间存在弱关联。昨天有头痛的报告率为 22.2%，有头痛的报告率为 25.5%。
赞比亚年轻人的头痛障碍很普遍。其中，偏头痛最常见，UdH 也很常见。在这项研究中，存在诊断不确定性，在许多报告头痛持续时间<2 小时的参与者中，很大程度上依赖于偏头痛和 UdH 之间的区别。在 SSA 的第一项研究，即埃塞俄比亚的研究中，也存在类似的不确定性。由于这些原因，我们只能得出结论，偏头痛至少影响了赞比亚这些年龄段的 17.5%，这仍然是一个很大的比例，之前的一项研究中成年人的患病率为 22.9%。需要补充的负担归因估计数，以告知赞比亚的公共卫生和教育政策。
