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Garrez I, Teuwen DE, Sebera F, Mutungirehe S, Ndayisenga A, Kajeneza D, Umuhoza G, Kayirangwa J, Düll UE, Dedeken P, Boon PAJM. Very high epilepsy prevalence in rural Southern Rwanda: The underestimated burden of epilepsy in sub-Saharan Africa. Trop Med Int Health 2024; 29:214-225. [PMID: 38124297 DOI: 10.1111/tmi.13963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Abstract
OBJECTIVES Up to 85% of people living with epilepsy (PwE) reside in low-and middle-income countries. In sub-Saharan Africa, the lifetime prevalence of epilepsy is 16 per 1000 persons. In Northern rural Rwanda, a 47.7 per 1000 prevalence has been reported. As variations in prevalence across geographical areas have been observed, we studied the prevalence in Southern rural Rwanda using the same robust methodology as applied in the North. METHODS We conducted a three-stage, cross-sectional, door-to-door survey in two rural villages in Southern Rwanda from June 2022 to April 2023. First, trained enumerators administered the validated Limoges questionnaire for epilepsy screening. Second, neurologists examined the persons who had screened positively to confirm the epilepsy diagnosis. Third, cases with an inconclusive assessment were separately reexamined by two neurologists to reevaluate the diagnosis. RESULTS Enumerators screened 1745 persons (54.4% female, mean age: 24 ± 19.3 years), of whom 304 (17.4%) screened positive. Epilepsy diagnosis was confirmed in 133 (52.6% female, mean age: 30 ± 18.2 years) and active epilepsy in 130 persons. Lifetime epilepsy prevalence was 76.2 per 1000 (95% CI: 64.2-89.7‰). The highest age-specific rate occurred in the 29-49 age group. No gender-specific differences were noted. In 22.6% of the PwE, only non-convulsive seizures occurred. The treatment gap was 92.2%, including a diagnosis gap of 79.4%. CONCLUSION We demonstrated a very high epilepsy prevalence in Southern rural Rwanda, with over 20% of cases having only non-convulsive seizures, which are often underdiagnosed in rural Africa. In line with previous Rwandan reports, we reiterate the high burden of the disease in the country. Geographic variation in prevalence throughout Africa may result from differences in risk and aetiological factors. Case-control studies are underway to understand such differences and propose adapted health policies for epilepsy prevention.
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Affiliation(s)
- Ieme Garrez
- Department of Neurology, Ghent University Hospital, Ghent, Belgium
| | - Dirk E Teuwen
- Department of Neurology, Ghent University Hospital, Ghent, Belgium
| | - Fidèle Sebera
- Department of Neurology, Ndera Neuro-Psychiatric Teaching Hospital, Kigali, Rwanda
- Centre Hospitalier Universitaire Kigali, Kigali, Rwanda
| | | | | | | | - Georgette Umuhoza
- Department of Neurology, Ndera Neuro-Psychiatric Teaching Hospital, Kigali, Rwanda
| | | | - Uta E Düll
- Medicalized Health Center, Gikonko, Rwanda
| | - Peter Dedeken
- Department of Neurology, Ghent University Hospital, Ghent, Belgium
- Heilig Hart Ziekenhuis, Lier, Belgium
| | - Paul A J M Boon
- Department of Neurology, Ghent University Hospital, Ghent, Belgium
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Butsashvili M, Zurashvili T, Kamkamidze G, Kajaia M, Gulbiani L, Gamezardashvili A, Gvinjilia L, Kuchuloria T, Gamkrelidze A, Shadaker S, Nasrullah M, Averhoff F, Armstrong PA. Door-to-door hepatitis C screening in Georgia: An innovative model to increase testing and linkage to care. J Med Screen 2022; 29:134-136. [PMID: 35293802 PMCID: PMC10068592 DOI: 10.1177/09691413221086497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Georgia has a high prevalence of hepatitis C virus (HCV) infection. In 2015 a national HCV elimination program was launched providing free access to screening and treatment. To achieve elimination, innovative approaches to increase screening coverage and linkage to care are needed. This study estimates feasibility, acceptability, and outcomes of the door-to-door pilot HCV testing program in three cities. METHODS Households were approached by system random sampling and all members were invited for study participation. Researchers used a detailed guide for conducting door-to-door testing and served as case navigators to link anti-HCV-positive individuals to care. RESULTS Testing acceptance rate was high. In total 4804 individuals were tested and 48 (1.0%) were HCV positive. Among the entire sample of newly and previously tested individuals, overall HCV antibody prevalence was 3.6%. Through case navigation, of 48 newly identified and 26 previously identified anti-HCV-positive individuals, 42 (87.5%) and 17 (65.4%), respectively, were successfully linked to care. CONCLUSIONS Door-to-door HCV testing has potential to increase testing uptake. Such community-based approaches not only improve testing, but can also serve to increase linkage to care, which is important in achieving the goal of HCV elimination. The study provides a model for high prevalence countries aiming to eliminate hepatitis C.
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Affiliation(s)
| | | | | | - Maia Kajaia
- Health Research Union/Clinic NEOLAB, Tbilisi, Georgia
| | | | | | | | | | - Amiran Gamkrelidze
- 443716National Center for Disease Control and Public Health, Tbilisi, Georgia
| | - Shaun Shadaker
- Division of Viral Hepatitis, 1242Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Muazzam Nasrullah
- Division of Viral Hepatitis, 1242Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Francisco Averhoff
- Division of Viral Hepatitis, 1242Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Paige A Armstrong
- Division of Viral Hepatitis, 1242Centers for Disease Control and Prevention, Atlanta, GA, USA
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Batlle A, Boada I, Thió-Henestrosa S, de Sevilla MF, García-García JJ. Using a route planner to optimize door-to-door visits for a pediatric home-hospitalization program: Feasibility study. Front Pediatr 2022; 10:928273. [PMID: 35935375 PMCID: PMC9353305 DOI: 10.3389/fped.2022.928273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 05/31/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Hospital Sant Joan de Déu (Barcelona) initiated a pediatric acute home-hospitalization program. Due to high patient turnover and the health staff's lack of planning training, daily scheduling was a time-consuming task. Home-hospitalization planning is a vehicle routing problem that can be solved with a technological solution. It was therefore decided to evaluate the efficacy and necessity of the SmartMonkey.io planner. OBJECTIVES To compare traditional manual route planning with a route optimizer, and to evaluate the technical feasibility of the implementation of a route planner into a homecare program. METHODS Eight participants (experienced homecare staff and inexperienced hospital staff) were included. Personal interviews were performed to assess their eagerness to try a technological solution to the planning problem. Objective benefits including reduced travel time (time planning, distance traveled, and time traveled) were evaluated. Paired t-test, t-test, and Pearson's correlation were used to compare manual and route planner scheduling. Participants then answered a questionnaire to assess planning difficulty and the acceptance of the route planner. RESULTS Homecare staff were initially reluctant to use the technology. Significant differences (P < 0.0001) in three variables were found between manual planning and the route planner. A moderate correlation between time planning and plan difficulty (r = 0.59, P < 0.0001) was found with manual planning but not with the route planner. All route planner schedules saved time and distance. No significant differences were found between expertise and planning method. It was noted that it was easy to create plans with the route planner, while difficulty with manual planning increased as more locations were added. All participants evaluated the route planning tool favorably. CONCLUSIONS Route-planning technology saved planning time and generated better plans than manual planning. The route planner's learning curve was fast and results were obtained in the same amount of time regardless of difficulty and expertise. SmartMonkey.io also has the potential to reduce internal and environmental costs and increase staff productivity.
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Affiliation(s)
| | - Imma Boada
- Graphics and Imaging Laboratory, University of Girona, Girona, Spain
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Dedeken P, Sebera F, Mutungirehe S, Garrez I, Umwiringirwa J, Van Steenkiste F, Boon PAJM, Teuwen DE. High prevalence of epilepsy in Northern Rwanda: Exploring gender differences. Brain Behav 2021; 11:e2377. [PMID: 34661989 PMCID: PMC8613444 DOI: 10.1002/brb3.2377] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 08/12/2021] [Accepted: 09/14/2021] [Indexed: 01/27/2023] Open
Abstract
INTRODUCTION In sub-Saharan Africa (SSA), the prevalence of lifetime epilepsy varies widely between subregions and is higher in rural compared to urban regions. Observed versus expected numbers of patients with epilepsy (PwE) in the northern province of Rwanda did not match the prevalence of 49‰ reported in 2005 in Rwanda. We report a confirmatory prevalence study focused on gender-specific observations. METHODS A cross-sectional door-to-door approach was used in three rural villages. First, epilepsy screening using the Kinyarwanda version of the Limoges questionnaire was performed. Second, confirmation of epilepsy diagnosis was completed by trained physicians. RESULTS In total, 2681 persons (56.14% female) were screened. Of 168 positively screened, 128 persons were diagnosed with epilepsy confirming the prevalence of lifetime epilepsy of 47.7‰ (CI 39.8-56.8). The diagnosis gap was 62.5% with 80 newly diagnosed. The overall female:male ratio was 1.61:1.00. A male preponderance below 9 years of age inverted to a female preponderance above 20 years of age. Female PwE had an older age at first seizure, reported different reasons for not seeking care, and differed from male PwE in possible etiology. For previously diagnosed PwE, the treatment gap was more than 77%. CONCLUSION A high prevalence in rural areas was confirmed, with an observed female/male ratio among the highest of published door-to-door surveys in SSA. Gender differences in associated co-morbidities and age at first seizure warrant future research of underlying etiologies and possible survival bias. A better understanding and focus on gender-associated care-seeking patterns, education, and specific needs are recommended.
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Affiliation(s)
- Peter Dedeken
- Department of Neurology, Ghent University Hospital, Ghent, Belgium.,Department of Corporate Societal Responsibility, UCB Pharma, Brussels, Belgium.,Department of Neurology, Heilig Hart Ziekenhuis, Lier, Belgium
| | - Fidele Sebera
- Department of Neurology, Ghent University Hospital, Ghent, Belgium.,Department of Neurology, Ndera, CARAES Neuro-psychiatric Hospital, Kigali, Rwanda.,Centre Hospitalier Universitaire Kigali, Kigali, Rwanda
| | - Sylvestre Mutungirehe
- Department of Neurology, Ndera, CARAES Neuro-psychiatric Hospital, Kigali, Rwanda.,Department of Neurology, National University Hospital FANN, University of Cheikh Anta Diop, Dakar, Senegal
| | - Ieme Garrez
- Department of Neurology, Ghent University Hospital, Ghent, Belgium.,4Brain, Ghent, Belgium
| | - Josiane Umwiringirwa
- Department of Neurology, Ndera, CARAES Neuro-psychiatric Hospital, Kigali, Rwanda
| | - Frank Van Steenkiste
- Department of Neurology, Ghent University Hospital, Ghent, Belgium.,Psychiatric Center Sint-Jan-Baptist, Zelzate, Belgium
| | - Paul A J M Boon
- Department of Neurology, Ghent University Hospital, Ghent, Belgium.,4Brain, Ghent, Belgium
| | - Dirk E Teuwen
- Department of Neurology, Ghent University Hospital, Ghent, Belgium.,Department of Corporate Societal Responsibility, UCB Pharma, Brussels, Belgium.,4Brain, Ghent, Belgium
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Ko KK, Pumpaibool T, Wynn MMM, Win Y, Kyi TM, Aung PL. Door-to-Door Eye Health Education to Improve Knowledge, Attitude, and Uptake of Eyecare Services Among Elderly with Cataracts: A Quasi-Experimental Study in the Central Tropical Region, Myanmar. Clin Ophthalmol 2021; 15:815-824. [PMID: 33658757 PMCID: PMC7920616 DOI: 10.2147/opth.s287257] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 01/15/2021] [Indexed: 11/23/2022] Open
Abstract
Introduction Cataract-related blindness is routinely reported globally. This study aimed to measure the effect of door-to-door eye health education in improving knowledge and attitude toward cataracts and the use of eyecare services among the elderly residing in a rural area of Naypyitaw Union Territory, Myanmar. Methods A quasi-experimental study design that used intervention and control groups was employed in Lewe Township from November 2018 to April 2019. Stratified sampling method was used to select lists of patients diagnosed with cataracts via a township-wide prevalence survey of eye diseases. A total of 56 elderly people with cataracts were involved in each group. The intervention group received door-to-door eye health education for 3 consecutive months. The data were collected using pre- and post-intervention surveys. Descriptive statistics for general characteristics as well as Chi-squared tests and multivariate analysis of variance for significant differences between knowledge and attitude scores of the two groups were analyzed. Results Both groups represented similarities in socio-economic characteristics, pre-existing knowledge and attitude levels, and eyecare services use. During the baseline study, the mean knowledge score in the intervention group was 7.8 and after the intervention, it increased to 10.67. Attitude score increased from 4.51 to 7.55. Among the control group, the scores remained unchanged. For use of eyecare services in the intervention group, 35.7% of patients sought eyecare services before the intervention, but after, 85.7% accessed eyecare services. Among them, 78.6% were satisfied with the treatment outcome. Further, there was a significant difference in knowledge and attitude between the control group and the intervention group (p-value <0.05), representing a medium effect of the intervention on improving knowledge and attitude level. Conclusion Door-to-door eyecare education significantly increased knowledge and attitude toward cataracts and the use of eyecare services among the elderly with cataracts. Intervention might be effective in improving the use of eyecare services and reduction of avoidable blindness due to cataracts.
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Affiliation(s)
- Kyaw Ko Ko
- College of Public Health Sciences, Chulalongkorn University, Bangkok, 10330, Thailand
| | - Tepanata Pumpaibool
- College of Public Health Sciences, Chulalongkorn University, Bangkok, 10330, Thailand
| | - Maung Maung Myo Wynn
- Department of Public Health, Ministry of Health and Sports, Naypyitaw, 15032, Myanmar
| | - Ye Win
- Department of Public Health, Ministry of Health and Sports, Naypyitaw, 15032, Myanmar
| | - Tin Moe Kyi
- Ophthalmology Ward, General Hospital, Hinthada, 10061, Myanmar
| | - Pyae Linn Aung
- College of Public Health Sciences, Chulalongkorn University, Bangkok, 10330, Thailand
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Del Cimmuto A, Mannocci A, Ribatti D, Boccia A, La Torre G. Impact on knowledge and behaviour of the general population of two different methods of solid waste management: An explorative cross-sectional study. Waste Manag Res 2014; 32:556-561. [PMID: 24951552 DOI: 10.1177/0734242x14536461] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
The objectives of the present study were to evaluate knowledge among general population about the risks factors of waste management, to estimate the feeling of anxiety concerning the waste, and to compare knowledge of two different methods for collecting municipal solid waste (MSW): a street separate collection system and a door-to-door separate collection system. A cross-sectional study was performed, administering an anonymous questionnaire to 180 inhabitants in Aprilia, Latium, Italy. The study sample consisted of 183 citizens: 64 in the intervention group and 119 in the control group. The intervention was represented by a campaign of door-to-door collection. The correct implementation of separate collection of waste was 87.5% in the intervention group and 63% in the control group (p<0.001). For both groups, the favourite type of waste collection was door-to-door (p=0.013); a high difference concerning the quality of information was found (p<0.0001): in the intervention group, 84% declared to be satisfied (67% sufficient and 17.2% good), while in the control group, 21% declared to be satisfied (16.8% sufficient and 4.2% good). The advice mainly reported from the control group respondents was to increase the size of the information pack (80.7%, p=0.024). The information campaign seemed to increase people's awareness about the problem, improving the management of waste and household waste. The door-to-door collection was appreciated and preferred by both groups. The adoption of a door-to-door scheme seems to be a winning option mostly because it is supported by an information and education system for the citizens.
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Affiliation(s)
- Angela Del Cimmuto
- Department of Public Health and Infection Diseases, 'Sapienza' University of Rome, Rome, Italy
| | - Alice Mannocci
- Department of Public Health and Infection Diseases, 'Sapienza' University of Rome, Rome, Italy
| | - Domenico Ribatti
- Department of Public Health and Infection Diseases, 'Sapienza' University of Rome, Rome, Italy
| | - Antonio Boccia
- Department of Public Health and Infection Diseases, 'Sapienza' University of Rome, Rome, Italy
| | - Giuseppe La Torre
- Department of Public Health and Infection Diseases, 'Sapienza' University of Rome, Rome, Italy
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