Siewe Fodjo Joseph Nelson, Jada Stephen Raimon, Kamoen Olivia, Rovarini Jacopo Mattia, Scanagatta Chiara, Bol Yak Yak, Amaral Luís-Jorge, Colebunders Robert
Global Health Institute, University of Antwerp, Antwerp, Belgium.
Amref Health Africa, Juba, South Sudan.
Seizure. 2025 Aug;130:106-114. doi: 10.1016/j.seizure.2025.06.004. Epub 2025 Jun 6.
A 2018 study found high epilepsy prevalence and mortality in the Maridi onchocerciasis focus (South Sudan). From 2019 onward, onchocerciasis elimination measures were strengthened in Maridi, and in 2020, an epilepsy clinic was established at Maridi County Hospital with free provision of anti-seizure medication. We investigated the changes in epilepsy-related mortality following these interventions.
Repeated house-to-house surveys (2018 and 2024) in three Maridi neighbourhoods (Kazana-1, Kazana-2, Hai-Gabat). The number of deaths that occurred during the two years preceding each survey among persons known to have epilepsy (PWE) was assessed in each home via verbal reports from the household head. Mortality rates were calculated and compared between surveys using the rate-ratio test.
Between 2018 and 2024, epilepsy mortality in Maridi decreased 4.2-fold from 78.3 to 18.7 per 1000 person-years (p < 0.001). The decrease in mortality was most evident among the 11-20 year-olds: 6.9-fold reduction from 66.9 to 9.7 per 1000 person-years (p = 0.001). Age-standardized mortality ratio of epilepsy was estimated at 1.8 in 2024. Among the 184 reported deaths during the 2022-2024 observation period, the proportion of deceased PWE reduced from 9.7 % (2022) to 4.5 % (2023) to 1.8 % (2024), although without statistical significance (p = 0.175).
Strengthening onchocerciasis elimination measures and establishing an epilepsy clinic were followed by a drastic decrease in PWE mortality rate in Maridi. By preventing new-onset onchocerciasis-associated epilepsy and treating PWE with free anti-seizure medication, this two-pronged approach could mitigate the high premature mortality observed among PWE, especially adolescents. This strategy may be applicable to other onchocerciasis hotspots with high epilepsy burden.
2018年的一项研究发现，在马迪盘尾丝虫病流行区（南苏丹）癫痫患病率和死亡率很高。从2019年起，马迪加强了盘尾丝虫病消除措施，并于2020年在马迪县医院设立了癫痫诊所，免费提供抗癫痫药物。我们调查了这些干预措施后癫痫相关死亡率的变化。
在马迪的三个社区（卡扎纳-1、卡扎纳-2、海-加巴特）进行逐户重复调查（2018年和2024年）。通过户主的口头报告，评估每次调查前两年内已知患有癫痫的人（癫痫患者）中的死亡人数。计算死亡率，并使用率比检验在各次调查之间进行比较。
2018年至2024年期间，马迪的癫痫死亡率从每1000人年78.3例降至18.7例，下降了4.2倍（p<0.001）。死亡率下降在11至20岁人群中最为明显：从每1000人年66.9例降至9.7例，下降了6.9倍（p=0.001）。2024年癫痫的年龄标准化死亡率估计为1.8。在2022 - 2024年观察期内报告的184例死亡中，癫痫患者死亡比例从2022年的9.7%降至2023年的4.5%，再降至2024年的1.8%，尽管无统计学意义（p = 0.175）。
加强盘尾丝虫病消除措施并设立癫痫诊所后，马迪的癫痫患者死亡率大幅下降。通过预防新发性盘尾丝虫病相关癫痫并为癫痫患者免费提供抗癫痫药物，这种双管齐下的方法可以减轻癫痫患者中观察到的高过早死亡率，尤其是青少年。该策略可能适用于其他癫痫负担高的盘尾丝虫病热点地区。
