The functional status of people with epilepsy in rural sub-Saharan Africa

Purpose: Little data is available regarding the impact of epilepsy on the functional status of people with epilepsy (PWE) in developing countries. In sub-Saharan Africa, limited medical services and social stigmatization subject PWE to substantial physical, psychological and social deprivation. To better delineate the overall burden and distribution of epilepsy-associated disability in sub-Saharan Africa, we assessed the functional status of PWE in a rural, population-based sample and made comparisons to published reports from urban Zimbabwe. Methods: A population-based survey of PWE with epilepsy in rural Zambia utilizing WHO questionnaires. Results: Among 86 PWE in 3 rural Zambian communities, 67% participated in the interviews. Only 62% of PWE were receiving treatment. Five to seven percent of rural PWE reported problems with basic hygiene and 9-14% were unable to fulfill work demands, attend social events or enjoy leisure activities. In contrast, 95% of urban PWE denied any problems with social functioning, work performance or relationships. Compared to the urban population, rural PWE had a greater seizure burden (2.3/month vs. 1/month, p=0.007) and reported more difficulties with activities of daily living, including problem solving (70% vs. 54%, p = 0.02), speed of thinking (70% vs. 59%, p = 0.02) and relationships with co-workers (68% vs. 26%, p less than or equal to 0.005). Conclusions: A significant proportion of PWE in rural sub-Saharan Africa report problems fulfilling both social and professional functions. These results also suggest that rural PWE may have poorer functional status than their urban counterparts. (C) 2003 Elsevier Science B.V All rights reserved.