Publications (4)15.19 Total impact

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    ABSTRACT: To assess the contribution of NCC to the burden of epilepsy in a rural Tanzanian population. We identified adult people with epilepsy (PWE) in a door-to-door study in an established demographic surveillance site. PWE and community controls were tested for antibodies to Taenia solium, the causative agent of NCC, and all PWE were offered a computerised tomography (CT) head scan. Data on household occupancy and sanitation, pig-keeping and pork consumption were collected from PWE and controls and associations with epilepsy were assessed using Chi-square or Fisher's Exact tests. Six of 218 PWE had antibodies to T. Solium (2.8%; 95% CI 0.6 to 4.9), compared to none of 174 controls (Fisher's exact test, p=0.04). Lesions compatible with NCC were seen in eight of 200 CT scans (4.0%; 95% CI 1.3 to 6.7). 176 PWE had both investigations, of whom two had positive serology along with NCC-compatible lesions on CT (1.1%; 95% 0.3 to 4.0). No associations between epilepsy and any categorical risk factors for NCC were identified. NCC is present in this population, but at a lower prevalence than elsewhere in Tanzania and SSA. Insights from low-prevalence areas may inform public health interventions designed to reduce the burden of preventable epilepsy. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.
    Tropical Medicine & International Health 05/2015; 20(9). DOI:10.1111/tmi.12529 · 2.33 Impact Factor
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    ABSTRACT: Objectives The prevalence of dementia is predicted to increase rapidly in developing countries. Vascular risk factors may contribute to this rise. Our aim was to estimate the proportions of Alzheimer's disease (ADD) and vascular dementia (VAD) in a prevalent cohort of dementia cases in rural Tanzania. Design A two-stage door-to-door dementia prevalence study. Setting Hai district, Tanzania Participants In Phase I, the Community Screening Instrument for Dementia (CSI-D) was used to screen 1198 community-dwelling people for dementia. In Phase II, 168/184 (91.3%) of those with poor performance, 56/104 (53.8%) of those with intermediate performance and 72/910 (7.9%) of those with good performance on CSI-D were interviewed and diagnoses were made using the DSM-IV criteria. Measurements For subtype diagnosis, DSM-IV dementia criteria plus NINCDS-ADRDA criteria were used for ADD and NINDS-AIREN criteria for VAD. Other dementias were diagnosed by international consensus criteria. Diagnoses were confirmed or excluded by computerised tomography where clinically appropriate. Results Of 78 dementia cases, 38 (48.7%) were ADD and 32 (41.0%) were VAD. The crude prevalence of ADD was 3.7% (95% CI 2.5 to 4.9) and of VAD was 2.9% (95% CI 1.9 to 3.9). The age-adjusted prevalence was 3.0% (95% CI 1.8 to 4.2) for ADD and 2.6% (95% CI 1.6 to 3.6) for VAD. A previous diagnosis of diabetes mellitus was independently associated with greater odds of having VAD than ADD. Conclusions VAD accounted for a greater proportion of dementia cases than expected. Further investigation and treatment of risk factors is required in this setting.
    The American journal of geriatric psychiatry: official journal of the American Association for Geriatric Psychiatry 02/2014; 22(12). DOI:10.1016/j.jagp.2014.02.004 · 4.24 Impact Factor
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    ABSTRACT: To estimate the prevalence of active epilepsy in adults in an established demographic surveillance site in rural Tanzania. To describe the clinical characteristics of epilepsy and to estimate the treatment gap in this population. A pilot study established that a previously validated screening questionnaire was sensitive for detecting cases of epilepsy in a Kiswahili-speaking Tanzanian population. A door-to-door census of the adult population (total 103,026) used the screening questionnaire to identify possible cases of epilepsy, who were then assessed by a research doctor to establish a diagnosis of epilepsy or otherwise. The prevalence of active epilepsy in this population was estimated with age-standardisation to the WHO standard population. Seizure types and epilepsies were classified according to current recommendations of the International League Against Epilepsy. The treatment gap for epilepsy was estimated based on antiepileptic drug use as reported by cases. Two hundred and ninety-one cases of active epilepsy, all with convulsive seizures, were identified. The age-standardised prevalence was 2.91/1000 adults (95% CI 2.58-3.24); the crude prevalence adjusted for non-response was 3.84/1000 adults (95% CI 3.45-4.20). Focal-onset seizures accounted for 71.5% of all cases identified. The treatment gap was 68.4% (95% CI 63.0-73.7). This is one of the largest community-based studies of the prevalence of epilepsy in adults conducted in sub-Saharan Africa to date. We identified a lower prevalence than has previously been described in this region. The high proportion of focal onset seizures points to a large burden of acquired, and possibly preventable, epilepsy in this population. A treatment gap of 68.4% confirms that interventions to raise awareness of the treatable nature of epilepsy are warranted in this and similar populations.
    Seizure 08/2012; 21(9):691-8. DOI:10.1016/j.seizure.2012.07.009 · 1.82 Impact Factor

  • Journal of Neurology Neurosurgery & Psychiatry 02/2012; 83(3):e1-e1. DOI:10.1136/jnnp-2011-301993.89 · 6.81 Impact Factor