@article{98403,
  keywords = {Infectious Diseases, Public Health, Environmental and Occupational Health, bi-annual community-directed treatment, Ivermectin, Tanzania},
  author = {Bhwana D and Amaral L and Mhina A and Matine P and Francis F and Siewe Fodjo JN and Mmbando BP and Colebunders R},
  editor = {Ekpo UF},
  title = {Impact of a bi-annual community-directed treatment with ivermectin programme on the incidence of epilepsy in an onchocerciasis-endemic area of Mahenge, Tanzania: A population-based prospective study},
  abstract = {<p><strong>Background:</strong> Community-directed treatment with ivermectin (CDTi) is used to eliminate onchocerciasis. However, despite 25 years of annual CDTi in Mahenge, Tanzania, the prevalence of onchocerciasis and onchocerciasis-associated epilepsy remained high in certain rural villages. Therefore, in 2019, bi-annual CDTi was introduced in the area. This study assessed the impact of the programme on the incidence of epilepsy in four villages.</p>

<p><strong>Methodology:</strong> Door-to-door epilepsy surveys were conducted prior to (2017/18) and after (2021) implementing a bi-annual CDTi program. All household members were screened for epilepsy symptoms using a validated questionnaire, and suspected cases were examined by a medical doctor to confirm/reject the diagnosis of epilepsy. The prevalence and annual incidence of epilepsy, including nodding syndrome, were calculated with 95% Wilson confidence intervals with continuity correction. The latter was also done for CDTi coverage in 2016 and 2021.</p>

<p><strong>Results</strong> Precisely 5,444 and 6,598 persons were screened for epilepsy before and after implementing the intervention. The CDTi coverage of the overall population was 82.3% (95%CI: 81.3–83.2%) in 2021 and sustained in both distribution rounds (81.5% and 76.8%). The coverage was particularly high in children and teenagers aged 6 to 18 years (93.2%, 95%CI: 92.1–94.2%). The epilepsy prevalence remained similar: 3.3% (95%CI: 2.9–3.9%) in 2017/18 versus 3.1% (95%CI: 2.7–3.5%) in 2021. However, the incidence of epilepsy declined from 177.6 (95%CI: 121.2–258.5) in 2015–2017 and 2016–2018 to 45.5 (95%CI: 22.2–89.7) in 2019–2021 per 100,000 persons-years. The incidence of probable nodding syndrome varied from 18.4 (95%CI: 4.7–58.5) to 5.1 (95%CI: 0.3–32.8). None of the nine incidence cases of epilepsy for which information on ivermectin intake was available took ivermectin in the year they developed their first seizures.</p>

<p><strong>Conclusion:</strong> A bi-annual CDTi programme should be implemented in areas with high prevalence of onchocerciasis and epilepsy. High CDTi coverage among children is particularly important to prevent onchocerciasis-associated epilepsy.</p>
},
  year = {2023},
  journal = {PLOS Neglected Tropical Diseases},
  volume = {17},
  pages = {1-13},
  publisher = {Public Library of Science (PLoS)},
  issn = {1935-2735},
  url = {https://journals.plos.org/plosntds/article/file?id=10.1371/journal.pntd.0011178&type=printable},
  doi = {10.1371/journal.pntd.0011178},
  language = {Eng},
}