Determinants of active convulsive epilepsy in rural Cameroon: A population based case-control study

Purpose: The aim of this study was to investigate the determinants of active convulsive epilepsy in rural Cameroon, in order to inform prevention and control strategies at the local and regional levels. Methods: This case-control study took place in the rural health district of Bafut, North-West Region of Cameroon. People with epilepsy receiving care in local health facilities or identified in the community were matched with non-epileptic controls for age and sex. The Limoges questionnaire was used for case definitions and screening for risk factors for epilepsy. Potential determinants were investigated through logistic regression models. Results: In all 170 participants (85 cases, with 85 controls) were included. Fewer cases than controls were married (27% vs. 58%; P<0.001) and more cases than control were living with parents (56% vs. 28%; P<0.001). In final multivariable regression analyses, a family history of epilepsy (odd ratio 3.11; 95% confidence interval: 1.61-6.01; P<0.001) and a poor obstetrical history (odd ratio: 4.34; 95% confidence interval: 1.29-14.58; P=0.018) were significant determinants of active convulsive epilepsy. Conclusion: In this rural area of Cameroon, the previously reported high prevalence of active convulsive epilepsy could be explained by a positive family history and a poor obstetrical history. The later being a potentially modifiable determinant, there is a need for additional efforts into maternal and child health, and for integrated disease control programs to mitigate the social impact of epilepsy.