•Epilepsy misconceptions are highly prevalent in rural sub-Saharan Africa.•General population in rural communities still consider epilepsy as a mental illness or as a contagious ...disorder.•Understanding misconceptions is essential to develop culturally appropriate interventional programs.•Campaigns to raise awareness are needed in urban and rural population to reduce misconception and combat stigmatization.
To describe sociocultural representations of epilepsy in a sub-Saharan Africa rural community using a population-based approach.
A cross-sectional door-to-door survey was underway on a rural community of the Central African Republic in 2015. A two-stage stratified sampling was performed. Trained care personnel performed individual face-to-face interviews. A standardized questionnaire was used to assess epilepsy. We collected sociodemographic data and cultural representations toward epilepsy in general population.
Overall, 1023 participants were interviewed. Epilepsy prevalence was 11.7 (95%CI 6.7–20.4) per 1000 people. In the rural community, epilepsy was identified as a supernatural disease related to bad luck (40.4%), witchcraft (31.3%) or a curse (28.3%). Epilepsy was confused with a mental disorder in 75.9% of subjects. Three quarters of participants (75.3%) considered epilepsy as a contagious disease. Saliva was mainly mentioned as a means of transmission in 63.8%. More than half of participants preferred or recommended traditional treatments. Only 24.8% believed in the efficacy of medical treatment for epilepsy.
Epilepsy misconceptions are highly prevalent in rural sub-Saharan Africa. Understanding misrepresentations is an essential phase to develop culturally appropriate interventional programs in order to improve medical treatment adherence, quality of life, and to decrease stigma. Campaigns to raise awareness are needed in urban and rural population to reduce misconception and combat stigmatization.
Background The term Nodding Syndrome (NS) refers to an atypical and severe form of childhood epilepsy characterized by a repetitive head nodding (HN). The disease has been for a long time limited to ...East Africa, and the cause is still unknown. The objective of this study was to confirm the existence of NS cases in Central African Republic (CAR). Methodology/Principal findings This was a cross-sectional descriptive study in the general population. The identification of NS cases was conducted through a door-to-door survey in a village near Bangui along the Ubangui River. Based on Winkler's 2008 and the World Health Organization (WHO)'s 2012 classifications, the confirmation of cases was done by a neurologist who also performed the electroencephalograms. No laboratory tests were done during this investigation. Treatment was offered to all patients. A total of 6,175 individuals was surveyed in 799 households. After reviewing the cases, we identified 5 NS cases in girls aged between 8 and 16. The age of onset of the seizures was between 5 and 12 years of age. Two cases were classified as "HN plus" according to Winkler's 2008 classification. Four NS cases were classified as probable and one as confirmed according to the WHO's 2012 classification. Three of them presented with developmental delay and cognitive decline, and one had an abnormally low height-for-age z-score. Electroencephalographic abnormalities were found in four patients. Conclusions/Significance Nodding Syndrome cases were described in CAR for the first time. Despite certain peculiarities, these cases are similar to those described elsewhere. Given that only a small part of the affected area was investigated, the study area along the Ubangui River needs to be expanded in order to investigate the association between Onchocerca volvulus and NS and also evaluate the real burden of NS in CAR.
Background/Aims: Dementia is an emerging public health problem in sub-Saharan Africa (SSA). In SSA, the stigma suffered by people with dementia (PWD) can be strongly linked to pejorative social ...representations, interfering in social relationships with informal caregivers. The objective of the study was to analyze the consequences of social representations of PWD in social interactions with informal caregivers. Methods: A qualitative study was conducted in Republic of Congo among 93 interviewees. Nondirectional interviews were conducted in local languages and complemented by participating observations. The collected data were transcribed literally, synthesized, and then coded to allow extraction and organization of text segments. Results: Informal caregivers, daughters-in-laws, were considered as abusers and granddaughters as benevolent. The leaders of syncretic churches and traditional healers were the first therapeutic itineraries of PWD, due to pejorative social representations of disease. Of these, some PWD have appeared at front of a customary jurisdiction for accusations of witchcraft. Dementia, perceived as a mysterious disease by informal caregivers, wasn’t medicalized by leaders of syncretic churches, traditional healers, nurses, or general practitioners. Conclusion: Stigma, generated by social representations, can change the patient’s behavior and the one of informal caregivers, leading to time delay in the search for appropriate help.
Recently, there were anecdotal reports of a high number of persons with epilepsy, including children with nodding seizures in the Landja Mboko area located about 9 km from the capital city Bangui, ...Central African Republic. We suspected the area to be endemic for onchocerciasis, and that the alleged increase in the number of epilepsy cases was due to ongoing
transmission. However, ivermectin mass drug distribution (MDA) had never been implemented in the area. Therefore we performed an Ov16 antibody prevalence study among children, aged 6-9 years, using the biplex rapid diagnostic test (SD Bioline Oncho/LF biplex IgG4 RDT). The overall Ov16 seroprevalence was 8.9%, and that of lymphatic filariasis (LF) was 1.9%. Ov16 seropositivity was highest in Kodjo (20.0%), a village close to rapids on the river. Our study shows that there is ongoing
transmission in the Landja Mboko area. We recommend that the extent of this onchocerciasis focus should be mapped, and the introduction of ivermectin MDA should be considered in these communities.
L’épilepsie est une maladie neurologique très fréquente. En Afrique et en centrafrique en particulier, cette pathologie est moins documentée nous faisant craindre une stigmatisation des patients qui ...en sont victimes.
Les auteurs rapportent les résultats d’une étude CAP en population générale en vue d’évaluer les connaissances sur cette affection et l’ampleur de l’épilepsie en vue de la sortir de l’ombre.
Il s’agissait d’une étude transversale prospective et descriptive de type porte-à-porte qui s’était déroulée sur une période de trois mois, de janvier à mars 2017, au sein de la population rurale d’une commune située à 600km de Bangui à l’ouest de la République centrafricaine. Ont été inclus dans l’étude les sujets de deux sexes, âgés d’au moins 10 ans, pouvant s’exprimer verbalement, qu’ils soient souffrant ou non d’épilepsie, et ayant donné leur consentement éclairé.
Sur 1023 personnes interviewées, 12 étaient épileptiques soit une prévalence de 11,7 %. L’âge moyen était de 45 ans. Les antécédents familiaux d’épilepsie chez 12 % de l’échantillon. Au total, 74,8 % connaissaient la maladie surtout crise tonico-clonique généralisée. La notion de contagiosité était de 75,3 % des cas. La contamination salivaire était évoquée dans 63,8 % des cas. Un total de 52,9 % avaient cité une lésion du cerveau et 43,2 % une cause héréditaire. Au total, 71,9 % des enquêtés souhaitaient ne pas utiliser les objets d’un épileptique.
C’est la première étude réalisée en République centrafricaine en population générale en vue d’évaluer l’ampleur de la maladie épileptique. Elle démontre une prévalence élevée, et confirme la méconnaissance de la population des autres formes de l’épilepsie. Il y a nécessité de mener des compagnes de sensibilisation afin de mieux faire connaitre cette affection pour espérer une prise en charge efficiente.
L’étude nous a permis de déterminer la prévalence de l’épilepsie en milieu rural centrafricain. Elle montre que l’épilepsie reste une maladie ignorée dont les victimes souffrent en douceur sans assistance.
L’épilepsie est associée à des troubles cognitifs, des difficultés affectives et des troubles de la personnalité.
Évaluer la perception de l’épilepsie dans le milieu enseignant dans la ville de ...Bouar.
Étude transversale menée de novembre 2019 à avril 2020, chez les enseignants exerçant dans les établissements scolaires publics et privés, de la maternel jusqu’au lycée dans la ville de Bouar.
L’âge moyen était de 38,5 ans. La tranche d’âge de 20 à 29 ans était la plus représentée. Le principal facteur déclenchant l’épilepsie était l’arrêt du traitement (33,3 %). Parmi les répondants, 70,4 % étaient d’avis que l’épilepsie est curable. Les élèves épileptiques seraient victimes de stigmatisation (61 %). Les conséquences de cette affection étaient le retard scolaire (28 %) et l’abandon scolaire (19 %).
La tranche d’âge de 20 à 39 ans était la plus représentée. Ce résultat corrobore les données des études réalisées en Afrique. La principale source d’information provenait des causeries (72 %). Ce résultat est superposable aux précédentes études réalisées en Centrafrique dans la population générale.
La majorité des enseignants connaissent l’épilepsie. Mais, ces connaissances restent erronées et basées sur les préjugés. Ceci a un impact négatif sur le devenir des élèves épileptiques.
between 2011 and 2012, we carried out a study of dementia prevalence in central Africa throughout the EPIDEMCA (Epidemiology of Dementia in Central Africa) programme.
to assess dementia-related ...mortality among Congolese older people from the EPIDEMCA study after 2 years of follow-up.
longitudinal population-based cohort study.
Gamboma and Brazzaville, Republic of Congo.
older participants were traced and interviewed in rural and urban Congo annually between 2012 and 2014. DSM-IV and NINCDS-ADRDA criteria were required for dementia diagnosis. Data on vital status were collected throughout the follow-up. Cox proportional hazards model was used to assess the link between baseline dementia diagnosis and mortality risk.
of 1,029 participants at baseline, 910 (88.4%) have a complete cognitive diagnosis. There were 791 participants (76.87%) with normal cognition, 56 (5.44%) with MCI and 63 (6.12%) with dementia. After 2 years of follow-up, 101 (9.8%) participants had died. Compared with participants with normal cognition, patients with dementia had 2.5 times higher mortality risk (HR = 2.53, 95% CI 1.42-4.49, P = 0.001). Among those with dementia, only clinical severity of dementia was associated with an additional increased mortality risk (HR = 1.91; CI 95%, 1.23-2.96; P = 0.004). Age (per 5-year increase), male sex and living in an urban area were independently associated with increased mortality risk across the full cohort.
among Congolese older adults, dementia is associated with increased mortality risk. Our results highlight the need for targeted health policies and strategies for dementia care in sub-Saharan Africa (SSA).
Data on peripheral artery disease in Africa are sparse and limited to urban areas. Given the urban/rural socio-economical gradient in these countries, we sought to determine the prevalence and risk ...factors of peripheral artery disease in urban and rural areas of two countries in Central Africa.
Individuals ≥65 years old living in two urban and rural areas of the Republic of Central Africa (ROC) and the Central African Republic (CAR) were invited. Demographic, clinical and biological data were collected. Ankle-brachial index ≤0.90 defined peripheral artery disease.
Among the 1871 participants (age 73 years, 62% female) the prevalence of peripheral artery disease was 14.8%, higher in ROC than in CAR (17.4% vs. 12.2%, p = 0.007) and higher in females than males (16.6% vs. 11.9%, p = 0.012). The prevalence of peripheral artery disease increased with age, respectively at 10.9%, 14.9%, 15.1% and 22.2% for age bands of 65-69, 70-74, 75-79 and 80+years (p < 0.001). Higher rates of peripheral artery disease were found in urban areas in ROC (20.7% vs. 14.4% in rural areas, p = 0.011), but not in CAR (11.5% vs. 12.9%, p = NS). In multivariate analysis, peripheral artery disease was significantly associated with age (odds ratio (OR): 1.03; p = 0.004), dyslipidaemia (OR: 1.88; p = 0.003), smoking (OR: 1.78; p = 0.003), obesity (OR: 1.98; p = 0.034) and underweight (OR: 1.49; p = 0.023). Regular alcohol drinking was associated with decreased risk of peripheral artery disease (OR: 0.73; p = 0.044).
The prevalence of peripheral artery disease in the elderly is high in Africa, especially in females. In ROC, with a higher urban-rural socio-economic gradient, peripheral artery disease is more frequent in the urban areas.
Aβ-related cerebral amyloid angiopathy (CAA) is a major cause of primary non-traumatic brain hemorrhage. In families with an early onset of the disease, CAA can be due to amyloid precursor protein ...(APP) pathogenic variants or duplications. APP duplications lead to a ~1.5-fold increased APP expression, resulting in Aβ overproduction and deposition in the walls of leptomeningeal vessels. We hypothesized that rare variants in the 3'untranslated region (UTR) of APP might lead to APP overexpression in patients with CAA and no APP pathogenic variant or duplication. We performed direct sequencing of the whole APP 3'UTR in 90 patients with CAA and explored the functional consequences of one previously unreported variant. We identified three sequence variants in four patients, of which a two-base pair deletion (c.*331_*332del) was previously unannotated and absent from 175 controls of same ethnicity. This latter variant was associated with increased APP expression in vivo and in vitro. Bioinformatics and functional assays showed that the APP c.*331_*332del variant affected APP messenger RNA (mRNA) structure and binding of two microRNAs (miR-582-3p and miR-892b), providing a mechanism for the observed effects on APP expression. These results identify APP 3'UTR sequence variants as genetic determinants of Aβ-CAA.
L’anencéphalie est une malformation congénitale dont la prévalence est comprise entre 1 cas pour 2000. Des variations géographiques attribuables à des patrimoines génétiques différents ont été ...décrites.
Il s’agit d’un nouveau-né à J0 de vie, de sexe féminin et pesant 1250 grammes, reçu le 4 mai 2018 pour syndrome poly-malformatif congénital. Elle est née d’une mère âge de 36 ans, deuxième geste dixième pare. Il n’y avait pas de notion de consanguinité. Sur le plan général on notait une hypothermie à 34,9°C, une bradycardie à 80 battements/min. L’examen neurologique, notait un état d’éveil altéré, des réflexes archaïques absents, une hypotonie axiale et périphérique. On avait noté un syndrome de détresse respiratoire avec désaturation à 55 %. L’examen dysmorphologique avait noté, une absence totale de la voûte crânienne laissant entrevoir une petite partie de matière cérébrale. La base du crâne est toute recouverte par une masse informe de tissu angiomateux plus ou moins étendue. Les os de la face présentaient une diminution des diamètres transversaux. Les os frontaux sont absents au-dessus des orbites avec des arcades sourcilières proéminentes et des yeux globuleux et bombants. Le cou était court, les oreilles étaient bas implantées et mal ourlées, la langue était saillante comme s’il s’agissait d’un fœtus d’âge avancé.
Les troubles de fermeture du tube neural constituent la plus grande part des malformations du système nerveux central, qui sont elles-mêmes les anomalies congénitales les plus fréquentes, suivi des malformations cardiaques. L’anencéphalie représente la forme la plus sévère de ces troubles ; uniformément létale dans le période néonatale, elle est l’une des plus létales parmi les malformations congénitales.
La présentation attire l’attention des obstétriciens et du personnel en charge de suivi en soins maternels/infantiles des pays en voies de développement sur la nécessité d’un bon diagnostic prénatal.
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