Deby Mukendia, Floribert Tepageb, Innocent Akondac, Joseph Nelson Fodjo Siewed, Anke Rotsaertd, Carl Nwana Ndibmune, Anne Laudisoitd,f, Simon Couvreurd,
Blandine Kabutakog, Sonia Menond, An Hotterbeekxd, Robert Colebundersd,*

a Neuropsychopathologic Centre of Mont Amba, University of Kinshasa, Kinshasa, Congo
b Ministry of Health, Bas-Uélé, Congo
c Aketi Health Zone, Bas-Uélé, Congo
d Global Health Institute, University of Antwerp, Antwerp, Belgium
e Department of Statistics, University of Hasselt, Hasselt, Belgium
f EcoHealth Alliance, New York, USA
g School of Medicine, Bel-Campus Technological University, Kinshasa, Congo

A B S T R A C T

Objectives: To investigate the reasons for the high prevalence of epilepsy (>6%) discovered in 2015 in the Aketi health zone in the north of the Democratic Republic of the Congo.
Methods: Persons with epilepsy (PWE) diagnosed in a door-to-door survey in 2015 were traced and reexamined in 2017 by a neurologist. Confirmed PWE were paired with matched controls. For onchocerciasis assessment, children 7–10 years old were tested for IgG4 Onchocerca volvulus (OV16) antibodies, a rapid epidemiological mapping of onchocerciasis (REMO) study was performed, and ivermectin coverage was investigated.
Results: Forty-three (61.4%) previously diagnosed PWE were traced; the neurologist confirmed the epilepsy diagnosis in all of them. The overall OV16 positivity rate was 64.5%. Poor ivermectin coverage (55.9%) and a high prevalence of onchocercal nodules (>70%) were observed. The prevalence of epilepsy was 5.7% in Aketi rural town, with nine PWE (13.8%) experiencing head nodding seizures. A case-control study showed that PWE had lower body weight and higher ivermectin coverage in 2017 than healthy controls.
Conclusions: The high prevalence of epilepsy in the Aketi health zone, despite 14 years of communitydirected treatment with ivermectin (CDTI), was found to be associated with high onchocerciasis transmission and low ivermectin use. An awareness programme to increase ivermectin coverage and the introduction of a bi-annual CDTI programme should be considered.

International Journal of Infectious Diseases

journal home page: www.elsevier.com/locat e/ijid

https://doi.org/10.1016/j.ijid.2018.10.021