ORIGINAL

Niger J Paed 2014; 41 (1):22 –27

Eseigbe EE

Nuhu FT

Sheikh TL

Adama SJ

Eseigbe P

Aderinoye AA

Adebayo O

Gazali KY

Factors associated with treatment

gap in children and adolescents with

epilepsy in a rural Nigerian

community.

DOI:http://dx.doi.org/10.4314/njp.v41i1,4

Accepted: 18th August 2013

Abstract Background: The cam-

paign against epilepsy is ham-

pered by the difference between

those with the active disorder and

the number of them receiving

appropriate treatment (treatment

gap) in sub-Saharan Africa. Iden-

tifying the determinants of this

gap is crucial to providing and

achieving optimal care.

14.3±4.7 years). Most were males

(82.6%) and adolescents (78.3%).

Seizures were mostly generalized

(95.7%) and occurred most fre-

quently daily. Current treatment

modalities were use of traditional

medication (100%) and prayers

(34.8%).None was currently on

orthodox medical therapy (ETG,

100%) but 5(21.7%) had utilized

orthodox medical therapy in the

past. The main determinants of the

ETG were strong cultural belief,

weakness in the health system to

epilepsy treatment and low socio-

economic status. Fever was the

commonest other health complaint

and use of orthodox medical ther-

apy was significantly (p˂ 0.05) the

main (16, 69.6%) treatment option

utilized.

Eseigbe EE⁽

)

Department of Paediatrics,

Ahmadu Bello University Teaching

Hospital, Shika-Zaria,

Nigeria.

Email: eeeseigbe@yahoo.com

Nuhu FT, Sheikh TL, Adebayo O

Federal Neuropsychiatric hospital,

Kaduna, Nigeria

Objective: To identify the deter-

minants of epilepsy treatment gap

Adama SJ

Department of Paediatrics,

(

ETG) in children and adolescents

Subjects) with epilepsy in a rural

4

4 Nigeria Army Reference Hospital

community.

(44 NARH), Kaduna, Nigeria

Methods: Subjects were identified

through a community house to

house survey. Information ob-

tained from Subjects and their

care givers included: socio-

demographic characteristics, type

and frequency of epileptic sei-

zures, current and past treatment

options utilized, reasons for treat-

ment options used, and treatment

options utilized for other health

complaints.

Eseigbe P

Department of Family Medicine,

Ahmadu Bello University Teaching

Hospital, Shika-Zaria,

Nigeria.

Conclusion: Cultural belief, weak

health system and low socio-

economic status were determinants

of an absolute ETG. It highlights

the need to strengthen initiatives

that enhance accessibility to stan-

dard epilepsy treatment.

Aderinoye AA, Gazali KY

Maternal and Child Health Practitioners

Association (MACHPA), Kaduna,

Nigeria

Results: Twenty three Subjects

(

6.4/1000 of the child and adoles-

cent population) were identified

as having epilepsy. Their age

range was 4-19 years (mean

Key words: Epilepsy treatment

gap, determinants, children,

adolescents, rural community

Introduction

of time, expressed as percentage. This definition in-

2,3

cludes diagnostic and therapeutic deficits’. Poor data

collection and documentation of health statistics result-

ing from weakness in the health systems of most suscep-

tible LMICs coupled with the stigma associated w_-₄ith

Epilepsy affects 70million people worldwide and over

5

ods of life. Majority of persons with epilepsy live in

low and middle income countries (LMICs) and have

0% of its in_,₂cidence is in the child and adolescent peri-

1

2

epilepsy makes estimation of ETG highly variable. In

2

limited access to effective treatment. The resultant epi-

LMICs such as Nigeria, Togo, Zambia, and Pakistan, the

ETG in active epilepsy is commonly between 75-

lepsy treatment gap (ETG) has been defined as ‘The

difference between the number of people with active

epilepsy and the number whose seizures are being ap-

propriately treated in a given population at a given point

1

,4

100%. In the high income countries (HICs) such as the

United States, United Kingdom and Japan it is 10% or

1

,4

less. The ETG from lifetime epilepsy also ranges from

2

3

six to 100% with gaps estimated from lifetime preva-

lence larger than those estimated from active epilepsy

prevalence with exceptions in reports from India and

The members of the community are mainly petty traders

16

and farmers. Spoken languages are mainly Adara,

Hausa and English. Administratively the community is

made up of two districts, Katari North and South, each

comprising of 20 and 18 villages respectively. Each dis-

trict is administered by a District Head who is assisted

by the village heads. Epilepsy is called ‘Itohu’ in the

community. It is believed to be a mysterious disease

caused by an evil spirit and characterized by unpredict-

ability and falling to the ground. It is thought to affect

those who come into contact with the body fluids of

those with the disease or who share common utilities

with those affected. It is also thought to be an affliction

of those engaged in witchcraft. Traditional healers are

thought to possess medicinal antidotes to its occurrence.

There is at least one of such traditional healers in each of

the villages. Orthodox medical facilities available in the

community include six patent medicine shops, a primary

health care centre, two privately owned health clinics

and a government general hospital that is located 30km

away from the community.

4

Pakistan. Furthermore in the LMICs the ETG is gener-

ally higher in the rural than the urban areas. However,

treatment gaps have been noted to vary widely between

and within countries. Factors identified as contributing

to ETG in sub Saharan African countries like Nigeria

include traditional beliefs, social stigma, inadequate

supplies of anti-epilepti₂c drugs (AEDs), and limited ac-

cess to health facilities.

In most LMICs, child and adolescent care is mainly de-

pendent on what the family system offers unlike in the

HICs where there is a strong statutory social support

5

system that also oversees family care. In these LMICs

the limited socio-economic resources are stretched over

a variety of family needs which could sometimes be at

the expense of child and adolescent needs.Children and

adolescents with epilepsy (CAWE) in this context are

quite vulnerable to the enumerated risk factors for ETG.

This is even more worrisome considering the fact that

there is a high age specific incidence of epilepsy in the

Definition of study population and terms

2

,6

first two decades of life. The occurrence of ETG re-

sults in negative epilepsy outcomes. These outcomes are

detrimental to CAWE and ominous for succeeding adult

populations with epilepsy. They include stigma, malnu-

trition, depression, poor quality of life an₇_-d₁₃higher risk of

The study population comprised of all persons aged 19

years and below whose ages were ascertained by evi-

dence of birth records or corroborated oral evidence.

According to the International League Against Epilepsy

(ILAE) and the International Bureau for Epilepsy (IBE)

an epileptic seizure is a transient occurrence of signs

and/or symptoms due to abnormal excessive or synchro-

nous neuronal activity in the brain while epilepsy is a

disorder of the brain characterized by an enduring pre-

disposition to generate epileptic seizures and by the

neurobiologic, cognitive, ps₁y₇chological, and social con-

sequences of this condition. The definition of epilepsy

requires the occurrence of at least one epileptic seizure.

For epidemiological surveys, and in this study, epilepsy

was defined as recurrent unprovoked seizures occurring

at least 24 hours apart while active epilepsy was defined

as occurrence of unprovoked epilept₆i_,c₁₈s_,₁e₉izures on differ-

ent days in the preceding five years.

mortality than the general population.

Furthermore

there is increased economic and psychosocial burden,

with their attendant counterproductive consequences, on

other me₁m₄_,₁b₅ ers of the family and caregivers of those

affected.

The World Health Organization Mental Health Gap Ac-

tion Programme (WHO/mhGAP) and the Global Cam-

paign Against Epilepsy (GCAE) are some interventional

initiatives that have been created to bridge the

1,2

ETG. Most studies concerning ETG from the LMICs

2

,4

have focused on entire populations. For these and other

programmes to be effective in bridging the ETG it is

important to continually appraise treatment of epilepsy

among vulnerable populations, such as the CAWE popu-

lations, in susceptible communities. The aim of the

study was to assess the ETG among CAWE in a rural

Nigeria community.

A determinant of the ETG was defined as any factor that

caused, contributed to or influenced lack of, inappropri-

ate or inadequate treatment of epilepsy among the study

population.

Conduct of study

Subjects and Methods

The study was conducted in two phases between August

and December 2012. In the first phase the authors and

research assistants met with the District and Village

Heads of Katari community. At the meeting the aim of

the study was presented and communal consent sought.

In the second phase a house to house survey was con-

ducted and the research group was divided into four

research teams. All members of the group could speak

one of the traditional languages fluently.

Each team comprised of a Consultant (who had under-

gone specialty training in epilepsy care), one Registrar,

one community health extension worker (CHEW), and

one representative of the respective Village Head.

The study was conducted in Katari community which is

9

5km away from and south of the Federal Neuro Psychi-

atric Hospital (FNHP) in Kaduna, capital of Kaduna

state in Northwest Nigeria. The community was ran-

domly selected from the number of communities from

which a high number of patients with seizure related

disorders visit the FNPH Kaduna. The FNPH has a

Child and Adolescent Mental Health (CAMH) Unit that

is headed by a Consultant child psychiatrist and runs a

weekly neurology clinic with a Consultant paediatric

neurologist in attendance.

2

4

Villages were assigned randomly to the research teams

until all the villages were surveyed. During the survey

members of the study population with a recurrent history

of the following characterist₁ic₉ s and adapted from a

previous study by Dent et al

(Table 1). All the subjects were distributed only in the

lower social classes of IV (n=6, 26.1%) and V (n=17,

7

3.9%).

Table 1: Age and Sex Distribution of the 23 Subjects

Age (years)

Sex

Total Percent of

Total

(

a) Sudden unprovoked fall to the ground;

b) Sudden loss of consciousness;

c) Sudden loss of consciousness and / or sudden fall

with associated stretching or jerking movements of

parts of the body; and

d) Unprovoked, unconscious and uncontrollable move-

ment of a part of the body, were identified and as-

sessed for epilepsy.

M

F

≤ 10

4(21.1) 1(25)

5

21.7

17.4

8.7

1

1 – 13

4 – 16

7 – 19

4(21.1)

2(10.5)

0

4

(

2

9(47.3) 3(75)

19(100) 4(100)

12

23

52.2

100

Each research team administered a structured question-

naire to the subjects, controls and their parents or care-

givers independently and as applicable. Parameters

assessed using the structured questionnaire included:

Age, Sex, Social Class, Clinical features of epilepsy,

Treatment options utilized and Reasons for using the

treatment options. Social class clas₂s₀ification was accord-

ing to Ogunlesi et al classification.

Total

Clinical features of epilepsy

Epilepsy was generalized tonic-clonic in 22 (95.6%) and

partial in 1 (4.4%) of the subjects respectively. There

was a positive family history in 9(39.1%) of the subjects

among whom 2 (8.9%) were siblings. Seizures fre-

quency was daily, weekly, monthly and yearly in 8

All those identified as having active epilepsy were

provided with a month’s dose of the AED phenobarbi-

tone and referred to the child and adolescent mental unit

of FNPH. In addition they and their families were intro-

duced to a non-governmental organization that supports

the management of persons with epilepsy and their fami-

lies. Ethical approval for the study was obtained from

the Research and ethics committee of the FNPH Ka-

duna. Consent was equally obtained from the District

and Village Heads, and heads of all households in Katari

community.

(

34.8%), 7(30.4%), 6(26.1%) and 2(8.7%) subjects

respectively.

Modalities of treatment and epilepsy treatment gap

All (100%) were on oral traditional herbal medication at

the time of the study. In addition 8(35%) were receiving

special religious prayers as part of treatment. Belief in

its efficiency, cheap cost and availability of tradition

were the major reasons for choosing the current treat-

ment option while ignorance about orthodox medical

therapy was the least common reason (Table 2). Five

Data analysis

(

21.7%) subjects had visited an orthodox health facility

Epi Info version 3.5.3 statistical package was used in

data analysis. Chi square test, with Yates’ correction

where applicable, was used in determining the relation-

ship between ETG, clinical features of epilepsy and

socio-demographic variables of the subjects. A p value

less than 0.05 was regarded as significant.

for treatment of epilepsy where they received an oral

AED. All five later defaulted from visits to the health

facility and treatment. Cost of transport to the facility

and that of the drugs in addition to perceived failure of

drug therapy to control seizures were the reasons ad-

duced by all for default. Consequently epilepsy treat-

ment gap in the subjects was 100% and mainly contrib-

uted to by a diagnostic gap (Fig 1). Fever was the com-

monest other health complaint indicated by all the sub-

jects. The current treatment option for fever in the sub-

jects was the utilization of orthodox medical treatment

in 16 (69.6%) subjects and tradition herbal medication

alone in 7(30.4%) of the subjects respectively. The pref-

erential use of traditional medication for epilepsy was

Results

The total community population was 6,572 out of which

3

,613(55%) constituted the child and adolescent popula-

tion. Of the latter population, 23(Subjects) representing

.5 per 1000of the entire community population and 6.4

3

2

significant (ᵪ =21.6, df =1, p=0.000).

per 1000 of the child and adolescent population, had

epilepsy.

Fig 1:

Epilepsy

treatment

gap in the

23 subjects

Age, sex and social class distribution of subjects

The age range of the subjects was 4 to 19 years

(

mean 14 + 4.7 years). There was a male preponder-

ance (n=19, 82.6%) with a Male: Female ratio of 4.8:1.

Most (n=18, 78.3%) of the subjects were adolescents

2

5

Table 2: Main reasons for current choice of treatment

modality in the 23 Subjects

emphasized. These factors include strong cultural

perspectives, low socio-economic status, high cost of

accessing care, poor knowledge of epilepsy and its care,

stigma, discrimination and health systems that are weak

Reason (s)

No of

Percent of

Total

Subjects

2

,3

in epilepsy management. The negative impact of strong

cultural perspectives on the management and wellbeing

of CAWE is prevalent in many LMICs particularly the

Belief in efficacy of Traditional

Medication

23

100

2

,3

Availability of Traditional Medica-

tion

23

100

sub-Saharan African countries. In these countries there

is a strong association of evil spirits or witchcraft with

the etiology of epilepsy and a strong conviction in the

efficacy of traditional medication over orthodox medical

treatment in the management of epilepsy. Such beliefs

often result inthe alienation of those with the disorder in

utilizing or sharing common communal facilities, the

refusal of those with epilepsy to come out and the use of

health facilities for epilepsy treatment even where avail-

Cheap cost of Traditional Medication 23

100

87

Cost of accessing Orthodox Therapy

20

17

Distance of definitive health facility

from community

73.9

2

,3

Family pressure

13

5

56.5

21.7

able. In this study belief in the efficacy of traditional

medication from the cultural perspective significantly

influenced its use as a preferential treatment option for

epilepsy and this was buttressed by the observed signifi-

cant use of orthodox medical treatment for another ail-

ment in the same subjects. These outcomes of a strong

cultural perspective contribute to the widening of the

ETG.

Failure of Orthodox Medical Ther-

apy

Ignorant on how to access Orthodox

Medical Therapy

4

17.4

The health systems of a number of countries with the

highest burden of epilepsy are weak and this weakness

is often reflected in epilepsy management. Poor infra-

Discussion

2

structure for health services, deficiency in trained man-

power, provision of poor health services, and lack of

AEDs characterize such settings. These could lead to an

Epilepsy was active in all the subjects with a treatment

gap of 100% and the major determinants were a strong

cultural perspective, weakness of the health system to-

wards epilepsy treatment and a low socio-economic

status. Also the prevalence of epilepsy in the child and

adolescent population which was6.4/1000 is higher than

the WHO world standard of 2.69/1000 but lower than

reports from other LMICs such as Turkey

2

increase in the incidence of epilepsy from preventable

conditions such as complicated meningitis and oncho-

cerciasis, increase cost of accessing care in equipped

health institutions that are further away from the com-

munity, inhibit those who have epilepsy and are willing

to come out for, or continue with, appropriate therapy

and encourage patronage of less efficacious, non scien-

tific and potentially hazardous options.

21-

8.6/1000),Brazil (8.7/100) and India(7.0/1000).

(

2

3

Absolute(100%) ETG has been reported in several

rural communities with similar characteristics as the

3

The comparatively high prevalence of epilepsy in the

studied population could have been a function of a weak

health system that is inefficient in dealing with epilepsy

predisposing conditions. Katari is in the Northwest re-

gion of Nigeria, a region that has one of the highest

childhood morbidity and mortality statistics in a country

study population. However a lesser ETG has been re-

ported in CAWE in rural Kenyan (70.₂3₄%_-₂₆), Tanzanian

(

69%) and Indian (40%) communities.

Much lower

ETG values have been recorded in semi-urban and urban

3

settings for CAWE. The social and health systems in

these latter settings were more sensitive to epilepsy

management than was observed in the study popula-

tion.The treatment gap in this study was contributed

mainly to by a diagnostic deficit. This deficit is indica-

tive of factors that either prevent use of orthodox health

services such as strong cultural perspective and cost of

accessing treatment, or absence of such a health service

in a specific locality. These factors have been reported

2

7

which has also poor child health indices. The weakness

was particularly evident in the lack of orthodox medical

services against epilepsy in the community. Increased

cost of accessing care and use of alternative care option

were offshoots of this deficiency and were determinants

of the observed ETG. The perceived failure of orthodox

medical treatment, another observed ETG determinant,

could also be a function of a weak health system. It

could have resulted from poor counseling on the modus

of drug therapy or lack of facilities for making a correct

diagnosis and prescribing the appropriate drug.

2

,3

commonly from rural settings such as Katari. They

could also account for a therapeutic deficit which is

indicative of a lack of sustained access to appropriate

treatment or absence of specific therapeutic modality

such as neurosurgery.

Low socio-economic status has been associated with: a

limited capacity to access health services; poor access to

information that could influence understanding and atti-

tude towards conditions like epilepsy and their manage-

ment; and increased incidence of infectious diseases

A number of factors have been identified severally as

determinants of the ETG in LM_,₃ICs particularly in the

2

sub-Sahara African countries. In bridging the ETG,

identifying the roles ofthese factors cannot be over

2

6

2

including tho₂₈s_,₂e₉ that have been identified in the etiology

of epilepsy. Ignorance on how to access orthodox

institutions. Finally, there should be collaboration and

integration with already existing global initiatives in

order to bridge this gap. Such initiatives include the

GCAE whose aim include improvement in accept₂ability,

access to services, preventive and quality of care.

medical treatment and inability to afford orthodox medi-

cal treatment where available, both attributable to the

subjects’ socio-economic status, were determinants of

ETG in the study. Further more, the total dependence of

child and adolescent populations in most LMICs on

adults in family settings and the lack of statutory social

Another is the WHO/mhGAP initiative which aims at

scaling up services f₀or conditions, including epilepsy,

3

especially in LMICs. It has been opined that the WHO/

5

support system as observed in several HICs makes the

mhGAP guidelines with local adaptation, could facilitate

a sustained reduction in ETG₁and improve quality of

care in resource limited settings.

CAWE in the LMICs even more susceptible to the iden-

tified ETG determinants and more. In such settings the

CAWE, such as observed in the study population, are

subjected to the beliefs and capacities of the adults how-

ever appropriate or optimal. In addition, the lack of

statutory guidelines for epilepsy care makes the CAWE

susceptible to abuse and neglect.

Limitation

The diagnosis of epilepsy in this study was devoid of the

use of the electro encephalogram (EEG). Children and

adolescents with more subtle epileptic seizures could

have been missed.

This study has demonstrated that in rural settings where

determinants of ETG are in existence active epilepsy is

associated with a widened, mainly diagnostic, ETG.

Disabling stigma, discrimination, poor quality of life

and an increased risk of mortality are some of the dire

consequences of epilepsy that could be obviated by

bridging the ETG. Addressing issues that culminate in

ETG and its consequences requires a multidimensional

Conclusion

This study highlights the presence of a widened ETG in

a rural setting characterized by strong cultural perspec-

tive on epilepsy, a weak health system with regards to

epilepsy treatment and a low socio economic status. It

underscores the need for renewed promotion of commu-

nity awareness and cultural reorientation on views on

epilepsy, developing health and related systems to be

more sensitive to epilepsy management, and improving

the standard of living in rural settings of LMICs.

2

approach. The first step should be to assess the magni-

tude of the problem. This should include identification

and documentation of all with a history of epilepsy and

the capacity to provide treatment for this population at

community and national levels. Secondly the develop-

ment of capacity for provision of treatment and care in

the health and related systems is essential. Training of

neurologists and that of other health care providers such

as community health extension workers (CHEWs) and

school health teachers should be given top priority. Ad-

ditionally there should be institutionalization of social

support programmes that also protect the rights of

CAWE.

Conflict of Interests: None

Funding: None

These would improve the amount and quality of epi-

lepsy care services available. Thirdly more robust com-

munity based, culturally sensitive awareness and support

initiatives should be instituted in communities with

negative cultural perspectives on epilepsy and CAWE.

In line with the African declaration on epilepsy such

community oriented programmes should allay suspicion

and foster cooperation with existing traditional health

Acknowledgement

The authors would like to thank the following: Bilikisu

Iliya and Hauwa Ibrahim both of the Maternal and Child

Health Practitioners Association (MACHPA) Kaduna,

the district heads and entire members of the Katari

community for their supportive role in the data

collection.

References

3

.

Chin JH. Epilepsy treatment in sub

Saharan African: closing the gap.

African Health Science 2012:12

2); 186-92.

Meyer AC, Dua T, Ma J, Saxena

S, Birbeck G. Global disparities in

epilepsy treatment gap: a system-

atic review. Bull WHO 2010;

5. Barker G. Adolescents, social

support and help-seeking behav-

iour: an international literaturere-

view and programme consultation

with recommendations for action.

WHO. Geneva, 2007.

http://www.who.int/

maternal_child_adolescent/

documents/9789241595711/en/

1

.

Katchanov J, Birbeck GL. Epi-

lepsy care guidelines for low- and

middle- income countries: From

WHO mental health GAP to na-

tional programs.BMC Med 2012;

-

(

4

.

1

0: 107.

2

.

Epilepsy in the World Health Or-

ganization African Region: Bridg-

ing the Gap. Available from:

http://www.who.int/mental_health/

management/epilepsy_in_African-

region.pdf [Last accessed

8

8:260-6.

[

Last accessed 20/07/13]

2

0/07/13].

2

7

6

.

Mikati M A. Seizures in child-

hood. In: Kliegman RM, Stanton

BF, St. Geme J W, Schor N F,

Behrman RE, editors. Nelson Text-

book of Pediatrics, 19 ed. Phila-

delphia: WB Saunders Company;

15. Scott RA, Lhatoo SD, Sander JW.

The treatment of epilepsy in devel-

oping countries: Wheredo we go

from here? Bull World Health

Organ 2001; 79:344-51.

16. National Population Commission.

Kaduna, Kaduna State, Nigeria.

2012

17. Fisher R S, BoasW v E, Blume W,

et al. Epileptic Seizures and Epi-

lepsy: Definitions Proposed by the

International League Against Epi-

lepsy (ILAE) and the International

Bureau for Epilepsy (IBE). Epilep-

sia 2005; 46: 470–2.

18. Commission on Epidemiology and

Prognosis of the International

League Against Epilepsy. Guide-

lines for epidemiological studies

on epilepsy. Epilepsia1993; 34:

24. Edwards T, Scott AG, Munyoki G,

et al. Active convulsive epilepsy in

a rural district of Kenya: a study of

prevalence and possible risk fac-

tors. Lancet Neurology 2008; 7: 50

-6.

25. Mushi D, Burton K, Mtuya C,

Gona JK, Walker R, Newton

CRJC. Perceptions, social life,

treatment and education gap of

Tanzanian children with epilepsy:

a community-based study. Epilepsy

Behav 2012;23(3): 224–29.

26. Sureka RK, Sureka R. Prevalence

of epilepsy in rural Rajasthan — a

door-to-door survey. J Assoc Phy-

sicians India2007; 55: 741-2.

27. Aigbe GO, Zannu AE. Differen-

tials in infant and child mortality

rates in Nigeria: Evidence from the

six geopolitical zones. Inter J

Human Soc Sci 2012; 2(16):206-

14.

28. Ogunlesi TA, Okeniyi JAO,

Oyedeji GA, Oyedeji OA. The

influence of maternal socio-

economic status on the manage-

ment of malaria in their children:

implications for the ‘Roll Back

Malaria Initiative. Niger J Paediatr

2005; 32 (2): 40-6.

th

2

011. p. 2013-17.

7

8

.

Baskind R, Birbeck GL. Epilepsy-

associated stigma in sub-Saharan

Africa: the social landscape of a

disease. Epilepsy Behav 2005; 7

(1):68–73.

Crepin S, Godet B, Chassain B,

Preux PM, Desport JC. Malnutri-

tion and epilepsy: A two-way rela-

tionship. Clinical Nutrition 2009;

2

8:219–25.

9

1

Ong LC. Anxiety and depression

in children with epilepsy. Neurol-

ogy Asia 2013; 18 (Supplement 1):

3

9 – 41.

5

92–6.

0. Adewuya AO, Ola BA. Prevalence

of and risk factors for anxiety and

depressive disorders in Nigerian

adolescents with epilepsy. Epilepsy

Behav2005;6 (3):342-7.

1. Lagunju IO, Akinyinka O, Ori-

madegun A,et al. Health-related

quality of life of Nigerian children

with epilepsy. Afr J Neurol Sci

1

9. Dent W, Helbok R, Matuja W B P,

Scheunemann S, Schmutzhard E.

Prevalence of Active Epilepsy in a

Rural Area in South Tanzania: A

Door-to-Door Survey. Epilepsia

1

2

005; 46: 1963-9.

2

0. Ogunlesi TA, Dedeke IOF, Ku-

poniyi OT. Socio-Economic Clas-

sification of Children attending

Specialist Paediatric Centres in

Ogun State, Nigeria. Niger Med

Pract 2008; 54(1):21-5.

2

009; 28(1).

2. Stevanovic D, Tadic I, Novakovic

T. Health-Related Quality of Life

in Children and Adolescents with

Epilepsy: A Systematic Review.

In: Gadze Z P (Ed.). Epilepsy in

Children - Clinical and Social

Aspects. Croatia; InTech,

29. Ahs J W, Tao W, Lofgren J, Fors-

berg BC. Diarrheal Diseases in

Low- and Middle-Income Coun-

tries: Incidence, Prevention and

Management. The Open Infect Dis

J 2010; 4: 113-24.

30. World Health Organization (2008).

Mental Health Gap Action Pro-

gramme (mhGAP): Scaling up care

for mental, neurological and sub-

stance use disorders.

2

1. Topbas M, Ozgun S, Sonmez MF,

et al. Epilepsy Prevalence in the 0-

1

7 Age Group in Trabzon, Turkey.

Iran J Pediatr 2012; 22(3):344-50.

2. Sampaio LP, Caboclo LO,

2

011:162-182. Available from:

Kuramoto K, Reche A, Yacubian

EM, Manreza ML. Prevalence of

epilepsy in children from a Brazil-

ian area of high deprivation. Pedi-

atr Neurol 2010; 42 (2):111-7.

3. Banerjee TK, Hazra A, Biswas A,

et al. Neurological disorders in

children and adolescents. Indian J

Pediatr 2009; 76(2):139-46.

http://www.intechopen.com/books/

epilepsy-in-children-clinical-and-

social-aspects/health-related-

quality-of-lifein-children-and-

adolescents-with-epilepsy-a-

whqlibdoc.who.int/publications/

2008/978924596206_eng.pdf

Last accessed 20/07/13

2

systematic-review [Last accessed

2

0/07/13]

1

3. Lhatoo S D, Sander, J W A S.

Cause-Specific Mortality in Epi-

lepsy. Epilepsia 2005; 46: 36–9.

4. Nuhu FT, Yusuf AJ, Akinbiyi A,

et al. The burden experienced by

family caregivers of patients with

epilepsy attending the government

psychiatric hospital, Kaduna Nige-

ria. Pan Afri Med J 2010; 5:16.

1