Cerebral Palsy as a Co-morbid Condition Among Children with Previously Untreated Epilepsy in Northern Nigeria
Abstract number :
3.4
Submission category :
13. Health Services (Delivery of Care, Access to Care, Health Care Models)
Year :
2022
Submission ID :
2205126
Source :
www.aesnet.org
Presentation date :
12/5/2022 12:00:00 PM
Published date :
Nov 22, 2022, 05:28 AM
Authors :
Aminu Abdullahi, MBBS, MSc – Aminu Kano Teaching Hospital & Bayero University Kano; Halima Adamu, MBBS – Aminu Kano Teaching Hospital & Bayero University Kano; Hafsat Ahmad, MBBS – Ahmadu Bello University; Muktar Aliyu, MBBS, DrPH – Vanderbilt Institute for Global Health, Vanderbilt University Medical Center; Lawal Habiba, MBBS – Ahmadu Bello University; Aliyu Ibrahim, MBBS – Aminu Kano Teaching Hospital & Bayero University Kano; Jamila Ibrahim, MBBS – Aminu Kano Teaching Hospital & Bayero University Kano; Folorunsho Nuhu, MBBS – Federal Neuropsychiatric Hospital, Kaduna; Fajimolu Olubenga, MBBS – Federal Neuropsychiatric Hospital, Kaduna; Umar Sabo, MBBS, MSc, MPH – Aminu Kano Teaching Hospital & Bayero University Kano; Auwal Salihu, MBBS, MSc – Aminu Kano Teaching Hospital & Bayero University Kano; Zubairu Iliyasu, MBBS, PhD – Aminu Kano Teaching Hospital & Bayero University Kano; Edwin Trevathan, MD, MPH – Amos Christie Chair in Global Health, Professor of Pedaitrics and Neurology, Vanderbilt Institute for Global Health, Vanderbilt University Medical Center
This abstract has been invited to present during the Broadening Representation Inclusion and Diversity by Growing Equity (BRIDGE) poster session
Rationale: Little is known of the co-morbid conditions, such as cerebral palsy (CP), suffered by children with previously untreated (and often undiagnosed) epilepsy in low- and middle-income countries (LMICs) in Africa, where 60% to 90% of all children with epilepsy are untreated. An understanding of the co-morbid conditions associated with previously untreated epilepsy in Africa’s LMICs is an essential prerequisite to the development of a system of care to both identify and treat these children.
Methods: Bridging the Childhood Epilepsy Treatment Gap in Africa (BRIDGE) is a non-inferiority cluster randomized clinical trial (cRCT) being conducted in northern Nigeria to evaluate task-shifting epilepsy care to epilepsy-trained community health workers (CHWs) as a possible system for addressing the childhood treatment gap in Africa. Sixty primary healthcare centers (PHCs), each serving a defined local community, were randomly selected for participation in the BRIDGE project, and then each PHC was randomly assigned to either deliver epilepsy care provided by epilepsy-trained community health workers or epilepsy care provided by local community physicians. Children were identified with previously untreated epilepsy via screening for epilepsy in community-based door-to-door surveys, in pediatric clinics, and in schools in 3 cities (Kaduna, Kano, and Zaria) in northern Nigeria from June 2022 through September 2021, using a previously validated epilepsy screening and seizure classification tool in the local language (Hausa), followed by clinical evaluations for those who screened positive. Children identified with previously untreated epilepsy were assigned to receive epilepsy care at the PHC participating in the BRIDGE project closest to their home. Outcomes are determined by blinded physicians, who determine study outcomes while blinded to the source of the children’s epilepsy care. Blinded physicians also performed evaluations of children for the presence or absence of cerebral palsy (CP), using standard definitions and classifications of CP.
Results: A total of 41,625 children were screened for epilepsy. 1706 of the 1767 children with active were untreated, and 1684 children with untreated active epilepsy were enrolled in the BRIDGE project. As of June 2, 2022, 361 of the 1551 children (23%) with previously untreated epilepsy, who completed evaluations for CP by blinded physicians, were diagnosed with CP. Among these 361 children with CP and epilepsy, 108 had spastic quadraplegia (30%), 26 had spastic diplegia (7%), 143 had spastic hemiparesis (40%), 6 had dyskinetic CP (2%), 1 had ataxic CP (< 1%), and 59 were classified by the physicians as having hypotonic CP (16%). Over the next 18 months these children will undergo further evaluation, but at present the etiologies for most of these children’s CP are unknown.
Health Services (Delivery of Care, Access to Care, Health Care Models)