Skip to main content

Prevalence, incidence, and trends of epilepsy among children and adolescents in Africa: a systematic review and meta-analysis

Abstract

Background

Epilepsy contributes to a significant disease burden in children and adolescents worldwide. The incidence of childhood epilepsy is threefold higher in low and middle income countries compared in high-income countries. Epilepsy is a serious neurological condition associated with stigma and discrimination, an impaired quality of life, and other mental health related problems.

Objective

This study is aimed to synthesize existing evidence and estimate the pooled prevalence and incidence of epilepsy in children and adolescents in Africa.

Methods

A comprehensive and systematic search of relevant databases was conducted. The quality of each study was assessed using the Newcastle-Ottawa Quality Assessment Scale adapted for meta-analysis. Two reviewers screened retrieved articles, conducted critical appraisals, and extracted the data. Heterogeneity between studies was assessed by visual inspection of forest plots and statistically using Cochran’s Q statistics and the I2 test. Publication bias was checked by visual inspection of funnel plots as well as statistically using Egger’s correlation and Begg’s regression tests. Finally, the pooled prevalence and incidence of childhood epilepsy were computed with 95% confidence intervals.

Result

In this review and meta-analysis 42 studies with 56 findings were included to compute the pooled prevalence of childhood epilepsy. On the other hand, 6 studies were included to estimate the combined incidence. The pooled prevalence of cumulative epilepsy was 17.3 per 1000 children. Whereas the pooled prevalence of active and lifetime epilepsy was 6.8 and 18.6 per 1000 children respectively. The pooled incidence of childhood epilepsy was 2.5 per 1000 children.

Conclusion

Nearly 1 in 50 children are suffering from epilepsy in Africa. However, little attention has been paid to the prevention and treatment of childhood epilepsy. Mass epilepsy screening, scaling up treatment coverage, and designing strict treatment follow up and monitoring mechanisms are recommended.

Peer Review reports

Introduction

Epilepsy is a chronic neurological condition that affects over 50 million people of all ages and sexes worldwide [1,2,3]. The prevalence of epilepsy is disproportionately concentrated in low and middle-income countries (LMICs). The incidence of epilepsy is almost threefold higher in LMICs (139 per 100, 000) compared in high-income countries (HICs) (48.9 per 100, 000) [4,5,6]. Moreover, premature mortality associated with epilepsy is significantly higher in LMIC compared in HICs. The high burden of epilepsy in LMICs is largely attributed to inadequate medical services, poor socioeconomic conditions, and traditional beliefs regarding the treatment of epilepsy [7].

Epilepsy contributes to a significant disease burden in children and adolescents worldwide. Globally, more than 11 million children aged less than 15 years have active epilepsy [8,9,10]. In 2017, more than 291 million children aged less than 20 had epilepsy and intellectual disabilities, of which 95% lived in low and middle income countries [11]. In addition, more than 90% of epileptic cases in Sub-Saharan countries have been reported in children and adolescents aged < 20 years [12, 13]. Similarly, majority of epileptic cases in Ethiopia are reported in children and young adolescents [14, 15].

The highest incidence of epilepsy is reported during the early age of children and decline as age increases to adulthood [5, 16, 17]. A study in Norway suggests that incidence of epilepsy was reported144 per 100, 000 person-years in the first year of life. It then dropped to 61 per 100, 000 person-years in children aged 1 to 4 years and 54 per 100, 000 person-years in children aged 5 to 10 years. The perinatal and neonatal complications as well as early childhood infection contributes to the high burden of epilepsy in the early age of children [16].

Epilepsy is caused by both modifiable and non-modifiable risk factors. However, the causes are varied significantly between developing and developed countries. The main etiologies of epilepsy in developing countries are birth asphyxia, febrile seizures, perinatal and neonatal problems, and head related traumas. Whereas the common etiologies reported in developed countries are brain tumors, traumatic head injury, and cerebrovascular diseases [7, 12, 18]. In addition, epilepsy is found to be higher in children with family history of seizure. More than 20% of childhood epilepsy is associated with genetic inheritance [19]. Furthermore, parasitic infections like onchocerca volvulus, neurocysticercosis, and infection with plasmodium species are associated with increased rate of childhood epilepsy [20].

Epilepsy has a deadly impact on the lives of children and their family members. It is the leading cause of neurological impairment in children worldwide [21]. Children with epilepsy experiences poor school performance and school dropout, traumas including head traumas and burns, stigma and discriminations, mental health problems, impaired cognitive development, and premature mortality [22, 23]. In addition, epilepsy causes serious psychosocial consequences among families members due to the belief that the condition is resulted from sorcery practiced by the society, a breach of traditional cultural taboos, bad luck, or punishment from God for wrong feat [3, 24, 25].

Although epilepsy has such enormous negative consequences on the lives of children and their families; little or no attention has been paid to the treatment and prevention of disease in Africa. Consequently, millions of children and their families are still suffering from epilepsy. Additionally, no conclusive studies have been conducted to show the burden of epilepsy among children in Africa. Therefore, the findings of this study provide more general and conclusive evidence that provides essential insights to the prevention and treatment of childhood epilepsy in the continent.

Method

Design and protocol registration

A systematic review and meta-analysis of observational studies on childhood epilepsy were conducted in the African countries. The protocol for this review and meta-analysis was prepared in accordance with the Preferred Reporting Items for Systematic Review and Meta-analysis Protocols (PRISMA-P-2015) statement [26]. The protocol is registered at PROSPERO with the registration number CRD42022329754/www.crd.york.ac.uk/prospero.

Eligibility criteria

The inclusion criteria for this study were studies on epilepsy among children aged less than 18 years; studies conducted in the African countries; observational studies (case-control, cross-sectional, and cohort studies); studies reported the prevalence or incidence of epilepsy; and English language articles that have been published in peer-reviewed journals without restriction of publication date. Articles that were not fully accessed were excluded because of incomplete data. Additionally, case reports, conference reports, expert opinions and qualitative studies were excluded.

Search strategies

Systematic search of electronic databases MEDLINE/PubMed, HINARI, Web of Science, SCOPUS, and African Journals online (AJOL), as well as other gray literature and online open-access institutional repositories were retrieved using different search strategies. In addition, manual searches were conducted to identify additional studies. Manual searches are supplemental approaches to database searches conducted by inputting specific search terms or conditions into a search system or interface [27]. The searching terms were developed based on the research questions and study objectives. The following keywords were used in combination or in separation to find relevant articles in the African countries:

Epilepsy/Seizure/Convulsion, and Magnitude/Epidemiology/Prevalence/Incidence, and Children/Adolescents/Pediatrics/Infants/ Neonates.

Study screening and selection

The Preferred Reporting Items for Systematic review and Meta-analyses (PRISMA-2015) diagram was used to screen retrieved studies and report the findings [28]. A total of 2547 studies were retrieved through electronic databases, gray literature, and manual searches. All retrieved articles were imported to EndNote X8 reference managers and 960 articles were removed because of duplications. After excluding duplicate articles, the titles and abstract of 1587 articles were reviewed and 1234 were removed because of unrelated titles or outcomes not reported. The full text of 353 articles were reviewed which resulted in further exclusion of 311 articles. Finally, 42 articles with 56 epilepsy reports (unclassified, active, or lifetime epilepsy) were included (Fig. 1).

Fig. 1
figure 1

The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flow chart to screen studies included in the review and meta-analysis

Quality assessment

The quality of each study was assessed using the Newcastle-Ottawa Quality Assessment Scale (NOS) adapted for meta-analysis. Stars were assigned to evaluate study quality with 9–10 stars indicating “very good” quality, 7–8 stars “good” quality, 5–6 stars “satisfactory” quality, and 0–4 stars indicating “unsatisfactory” quality. Two authors (NA and GB) have conducted the quality appraisals and the average assessment scale of the two authors were used for the final decision.

Data extraction and management

Data was extracted using Microsoft Excel 2016 spreadsheet and the Joanna Briggs Institute (JBI) data extraction form for observational studies. Two authors (GB and KD) reviewed the included studies and extracted data from eligible articles. The third reviewer (NE) handled disagreements between the two authors and consensus was reached through discussion.

Heterogeneity

Heterogeneity was assessed using Cochran’s Q statistics and the I2 tests. A p-value < 0.10 of the Cochran’s Q statistic and the I2 test statistic of greater than 75% were declared to have significant statistical heterogeneity [29]. Significant heterogeneity was observed between studies; consequently, subgroup analysis was conducted based on the types of epilepsy reported, study settings, and by the region of the country. However, non of these were the source of heterogeneity.

Publication bias

The possible risk of publication bias was examined by visual inspection of funnel plot and by the statistically by Begg’s correlation and Egger’s regression tests. The visual inspection of funnel plot showed significant publication bias with substantial asymmetry. Consequently, Begg’s correlation and Egger’s regression tests were performed. Egger’s and Begg’s statistical tests revealed significant publication bias with p-value of < 0.001 and p = 0.0034 respectively. Sensitivity analysis showed that individual studies have excessive influence on the overall estimate since the point estimate of omitted studies lies outside the confidence interval of the combined analysis. Due to the presence of a substantial publication bias, trim and fill analysis was performed which yields an unbiased estimate of effect size (Fig. 2).

Fig. 2
figure 2

A Funnel plot that includes both the observed studies and the imputed studies

Result

Study characteristics

A total of 42 studies with 56 findings (active, lifetime, or unclassified epilepsy) were included to estimate the pooled prevalence of epilepsy in children and adolescents aged less than 18 years. Of these included epilepsy findings, 26 were active epilepsy [17, 30,31,32,33,34,35,36,37,38,39,40,41,42,43,44,45,46,47,48,49] and 8 were lifetime epilepsy [35, 38, 39, 42, 44, 46, 50, 51]. However, the remaining 22 were not mentioned whether active or lifetime epilepsy and we reported it unclassified epilepsy [21, 34, 48, 52,53,54,55,56,57,58,59,60,61,62,63,64,65,66,67,68,69]. Thirty studies were population-based studies [17, 30, 32, 33, 35,36,37,38,39,40,41,42,43,44, 46,47,48,49,50,51,52, 56,57,58, 62, 66,67,68,69,70]; 5 hospital-based studies with 3 in neurological units [21, 53, 54, 59, 60]; and 7 studies were from high parasitic endemic areas [34, 45, 55, 61, 63,64,65] (Table 1).

Table 1 Characteristics of included studies the prevalence of epilepsy in African countries August 2023

The highest prevalence of childhood epilepsy was observed in neurological units of hospital-based studies in South Africa and Nigeria. In these studies more than half children who visited the neurological units had epilepsy [53, 59]. In addition, a higher prevalence of epilepsy was reported in parasitic endemic areas of Cameroon, the Republic of Sudan, South Sudan, and the Republic of Congo [45, 55, 61, 64, 65]. Additionally, exposure to multiple parasites is associated with a higher rate of active convulsive epilepsy [71].

Prevalence of epilepsy

The pooled prevalence of cumulative epilepsy was 17.3 per 1000 children (95% CI: 15.60–19.00, I2: 99.52%, p < 0.001) (Fig. 3). Significant heterogeneity was observed between studies, consequently, subgroup analysis was performed between types of epilepsy (active, lifetime or unclassified), study settings (institutional, population based, or high parasite endemic areas), and the region or country location (northern, central, eastern, or southern Africa). The pooled prevalence of lifetime and active epilepsy were 18.6 (95% CI: 12.6–24.5, I2: 98.27%, p < 0.001) and 6.8 (95%CI: 5.7-8 per; I2: 98.47%, p < 0.001) per 1000 children respectively. On the other hand, the pooled prevalence of unclassified epilepsy was 45.5 (95% CI: 39.4–61.6, I2: 99.77%, p < 0.001) per 1000 children (Fig. 4).

Fig. 3
figure 3

Forest plot of the pooled childhood epilepsy in Africa

Fig. 4
figure 4

Sub group analysis of childhood epilepsy by the types of epilepsy

The pooled prevalence of epilepsy in the health institutions was 189 (95% CI: 155.7, 221.3) per 1000 children. Whereas, the pooled prevalence of epilepsy in high parasite endemic areas was 44 (95%CI: 35.6–53.2) per 1000 children. However, the pooled prevalence of epilepsy in the general population was 8 (95% CI: 7.3 to 9.2) per 1000 children (Fig. 5). Subgroup analysis was performed by region or location of the country. The highest prevalence of epilepsy was reported in Southern African countries (129.3/1000) followed by Central African countries (32.3/1000) and Northern African countries (24.1/1000 (Fig. 6).

Fig. 5
figure 5

Sub-group analysis of childhood epilepsy by the study setting

Fig. 6
figure 6

Sub group analysis by the region

Incidence of epilepsy

Six studies were included to estimate the pooled incidence of epilepsy in children and adolescents in Africa. The incidence of epilepsy varies significantly in the African countries. The highest incidence was reported in Tanzania (850 per 100,000) [72] and the lowest reported in Kenya (60/100,000) [41] and Nigeria (94/100,000) [73]. The pooled incidence of epilepsy in children and adolescents was 250 per 100, 000 children (95%CI:180–320, I2: 97.94%, p < 0.001)(Fig. 7).

Fig. 7
figure 7

Forest plot for the pooled incidence of childhood epilepsy in Africa

Discussion

In this review and meta-analysis, the authors explored and integrate evidence available on childhood epilepsy in Africa. Through gathering and summarizing all available evidence on childhood epilepsy the authors have provided a more representative and reliable data regarding childhood epilepsy in the continent. The knowledge derived from this review and meta-analysis can be used as baseline data by policymakers, national and international organizations, researchers, and other stakeholders to design and implement strategies to control childhood epilepsy in Africa.

The prevalence of epilepsy varies significantly between and within countries in Africa. The prevalence rate ranges from 0.2/1000 in Senegal [30] to 510/1000 in South Africa [53] and 594/1000 in Nigeria [59]. This variation could be attributed to the heterogeneity of methodology or differences in the definition of epilepsy between studies. The variation could also be due to the nature of reported epilepsies; lifetime, active, or cumulative epilepsies. In addition, the variation could be related to the settings in which the samples selected. In some studies, samples were selected from the general population which could better represent the population. However, in other studies, samples were selected from hospitals particularly in neurological units which increases the prevalence. Additionally, the inconsistencies might be related to the use of different epilepsy screening tools.

This study reveals that epilepsy remains a significant public health concern in Africa. One in fifty children in Africa are suffering from this preventable and treatable medical condition. This finding is supported by the global studies [11, 74] and studies in developing countries [10, 13, 18]. The reason could be children are vulnerable to perinatal and neonatal complications and early childhood infections which are risk factors of epilepsy [10, 43]. Moreover, the high endemicity of neuro-parasites in some African countries might contribute to the high burden of epilepsy in children and adolescents in Africa [71].

The prevalence of cumulative epilepsy was 17.3 per 1000 children (95% CI: 15.60–19.00). This finding is higher than the global prevalence of epilepsy (9·39/1000, 95% CI: 8·55–10·23) [12]. The reason could be explained in terms of population differences where the current study involved children and adolescents, which increases the prevalence of epilepsy due to the neonatal and perinatal complications as well as early childhood infections. The prevalence of active epilepsy was 6.8 (95%CI: 5.7–8.00) per 1000 children. The finding is congruent with the systematic review and meta-analysis of international studies (6.38, 95% CI: 5.57–7.30) per 1000 persons [6]. The high prevalence of active epilepsy in children and adolescents could be related to the poor treatment adherence or frequent exposure to epilepsy risk factors.

The prevalence of lifetime epilepsy was 18.6 (95% CI: 12.6–24.5 ) per 1000 children. The finding was higher than the systematic review and meta-analysis of international studies (7.60, 95% CI 6.17–9.38) per 1000 children [6] and with similar estimate of the global burden of epilepsy [7]. The reason could be partly explained in terms of the higher reported risk factors of epilepsy in Africa such as perinatal and neonatal infection, traumatic brain injury, and other central nervous system infections. In addition, the large treatment gap and poor treatment outcome contribute to the high burden of epilepsy in the African countries [17, 58].

The incidence rate of epilepsy is highly varied across studies [41, 72, 73]. The observed heterogeneity could be attributed to the incidence rate estimation where some studies estimated the incidence rate per year and others estimated in every two or three years. The pooled incidence of epilepsy was 250 (95%CI:180–320, I2: 97.94%, p < 0.001) per 100,000 children. The incidence was higher than global incidence of epilepsy (89.06, 95%CI; 31.68– 98.01) [21], the meta-analysis of international studies (61.44, 95% CI 50.75–74.38) per 100,000 person-years [6], and a study in Norway (70, 95%CI: 64–75) [16]. The reason could be explained by the different in the source populations at risk where the current study involves children and adolescents whereas the later study was on the general population.

The prevalence of epilepsy was 24 folds higher in institutional based studies compared to population based studies. The reason could be children in neurological units are complaints of neurological problems which increases the prevalence of epilepsy due to the higher epilepsy case load in these institutions. The higher prevalence of epilepsy in the health institutions reveals that emphasis should be given to mass epilepsy screening at the community level.

The pooled estimate of childhood epilepsy was higher in parasite endemic areas. This finding is supported by other studies in the continent [71, 75]. The reason could be neuro-parasites causes infection to the brain which then alter the electrical activity of the brain and causes epilepsy [71]. Therefore, prevention and early treatment of parasitic infections such as malaria, neurocysticercosis, and onchocerca has an advantage to the control of childhood epilepsy.

This study reveals that the prevalence of epilepsy has been increasing over the last 30 years in children and adolescents. This could be due to the fact that the number of studies on epilepsy increases over time which could better investigate more epilepsy cases in the community. In addition, the increased prevalence may actually reflect better awareness and education around epilepsy due to increased efforts in the past decade. Thus, there may be both better recognition by providers as well as better health-seeking behaviors. The highest prevalence of epilepsy was reported between 2017 and 2022. The average rate of epilepsy in these years was 19.82 per 1000 children. The reason could be explained in terms of increased population crisis and its associated negative mental health consequences which might contribute to an increased burden of epilepsy. This suggests that more population-based epilepsy screening as well as escalating the prevention and treatment of epilepsy should be strengthened (Fig. 8).

Fig. 8
figure 8

Trends of childhood epilepsy prevalence in Africa from 1992 to 2022 (n = number of study in the specified years)

Conclusion

Epilepsy has still contributed to a significant disease burden in children and adolescents in African. However, little or no attention has been paid to the prevention and control of the diseases. Mass epilepsy screening, escalating preventive and treatment measures, as well as regular treatment follow up and monitoring are recommended towards the control of childhood epilepsy.

Data availability

Data will be available from the corresponding author upon reasonable request.

Abbreviations

HICs:

High-Income Countries

LMICs:

Low and Middle-Income Countries

NOS:

Newcastle-Ottawa Quality Assessment Scale

PRISMA:

Preferred Reporting Item for Systematic Review and Meta analysis

SSC:

Sub Saharan Countries

References

  1. World Health Organization (WHO). Department of Mental Health, Substance Abuse, World Health Organization. Mental Health Evidence, Research Team. Mental health atlas 2005. World Health Organization; 2020.

  2. Beaumanoir A. American Academy of Pediatrics. Commission on Epidemiology and Prognosis, International League against Epilepsy. Guidelines for epidemiologic studies on epilepsy. Epilepsia. 1993;34:592–6.

    Article  Google Scholar 

  3. Beghi E. The epidemiology of epilepsy. Neuroepidemiology. 2020;54(2):185–91.

    Article  MathSciNet  PubMed  Google Scholar 

  4. Ngugi AK, Bottomley C, Kleinschmidt I, Sander JW, Newton CR. Estimation of the burden of active and life-time epilepsy: a meta‐analytic approach. Epilepsia. 2010;51(5):883–90.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Camfield P, Camfield C. Incidence, prevalence and aetiology of seizures and epilepsy in children. Epileptic Disord. 2015;17(2):117–23.

    Article  PubMed  Google Scholar 

  6. Fiest KM, Sauro KM, Wiebe S, Patten SB, Kwon C-S, Dykeman J, Pringsheim T, Lorenzetti DL, Jetté N. Prevalence and incidence of epilepsy: a systematic review and meta-analysis of international studies. Neurology. 2017;88(3):296–303.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Organization WH. Epilepsy: a public health imperative: summary. In. World Health Organization; 2019.

  8. Forsgren L. Incidence and prevalence. Epilepsy in children. 2nd ed. London: Arnold; 2004. pp. 21–5.

    Google Scholar 

  9. Rabie FM, Al Asmari AH, Al-Barak SA, Al-Rashed FM, Mare N. Prevalence and determinants of Epilepsy among School Children in Aseer Region-KSA. J Educ Pract. 2016;7(21):149–53.

    Google Scholar 

  10. Guerrini R. Epilepsy in children. Lancet. 2006;367(9509):499–524.

    Article  PubMed  Google Scholar 

  11. Olusanya BO, Wright SM, Nair M, Boo N-Y, Halpern R, Kuper H, Abubakar AA, Almasri NA, Arabloo J, Arora NK. Global burden of childhood epilepsy, intellectual disability, and sensory impairments. Pediatrics 2020, 146(1).

  12. Ba-Diop A, Marin B, Druet-Cabanac M, Ngoungou EB, Newton CR, Preux P-M. Epidemiology, causes, and treatment of epilepsy in sub-saharan Africa. Lancet Neurol. 2014;13(10):1029–44.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Paul A, Davies Adeloye RG-C, Kolčić I, Grant L, Chan KY. An estimate of the prevalence of epilepsy in sub–Saharan Africa: a systematic analysis. J Global Health 2012, 2(2).

  14. Tekle-Haimanot R, Forsgren L, Ekstedt J. Incidence of epilepsy in rural central Ethiopia. Epilepsia. 1997;38(5):541–6.

    Article  CAS  PubMed  Google Scholar 

  15. Niriayo YL, Mamo A, Kassa TD, Asgedom SW, Atey TM, Gidey K, Demoz GT, Ibrahim S. Treatment outcome and associated factors among patients with epilepsy. Sci Rep. 2018;8(1):1–9.

    Article  CAS  Google Scholar 

  16. Aaberg KM, Gunnes N, Bakken IJ, Lund Søraas C, Berntsen A, Magnus P, Lossius MI, Stoltenberg C, Chin R, Surén P. Incidence and prevalence of childhood epilepsy: a nationwide cohort study. Pediatrics 2017, 139(5).

  17. Kakooza-Mwesige A, Ndyomugyenyi D, Pariyo G, Peterson SS, Waiswa PM, Galiwango E, Chengo E, Odhiambo R, Ssewanyana D, Bottomley C, et al. Adverse perinatal events, treatment gap, and positive family history linked to the high burden of active convulsive epilepsy in Uganda: a population-based study. Epilepsia Open. 2017;2(2):188–98.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Farghaly WM, Abd Elhamed MA, Hassan EM, Soliman WT, Yhia MA, Hamdy NA. Prevalence of childhood and adolescence epilepsy in Upper Egypt (desert areas). Egypt J Neurol Psychiatry Neurosurg. 2018;54(1):1–7.

    Article  Google Scholar 

  19. Cansu A, Serdaroğlu A, Yüksel D, Doğan V, Özkan S, Hırfanoğlu T, Şenbil N, Gücüyener K, Soysal Ş, Çamurdan A. Prevalence of some risk factors in children with epilepsy compared to their controls. Seizure. 2007;16(4):338–44.

    Article  PubMed  Google Scholar 

  20. Kanu I, Anyanwu EC, Nwachukwu NC, Ehiri JE, Merrick J. Clinical microbiological aspects of epileptic seizures in the tropical countries with specific focus on Nigeria. ScientificWorldJournal. 2005;5:401–9.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Abuga JA, Kariuki SM, Abubakar A, Kinyanjui SM, van Hensbroek MB, Newton CR. The burden of neurological impairments and disability in older children measured in disability-adjusted life-years in rural Kenya. PLOS Global Public Health. 2022;2(2):e0000151.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Kariuki SM, Matuja W, Akpalu A, Kakooza-Mwesige A, Chabi M, Wagner RG, Connor M, Chengo E, Ngugi AK, Odhiambo R, et al. Clinical features, proximate causes, and consequences of active convulsive epilepsy in Africa. Epilepsia. 2014;55(1):76–85.

    Article  CAS  PubMed  Google Scholar 

  23. Organization WH. Epilepsy: a public health imperative. 2019.

  24. Fisher RS, Boas WVE, Blume W, Elger C, Genton P, Lee P, Engel J Jr. Epileptic seizures and epilepsy: definitions proposed by the International League against Epilepsy (ILAE) and the International Bureau for Epilepsy (IBE). Epilepsia. 2005;46(4):470–2.

    Article  PubMed  Google Scholar 

  25. Duggan M. Epilepsy and its effects on children and families in rural Uganda. Afr Health Sci. 2013;13(3):613–23.

    CAS  PubMed  PubMed Central  Google Scholar 

  26. Moher D, Shamseer L, Clarke M, Ghersi D, Liberati A, Petticrew M, Shekelle P, Stewart LA. Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement. Syst Reviews. 2015;4(1):1.

    Article  Google Scholar 

  27. Vassar M, Atakpo P, Kash MJ. Manual search approaches used by systematic reviewers in dermatology. J Med Libr Association: JMLA. 2016;104(4):302.

    Article  Google Scholar 

  28. Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. BMJ. 2009;339:b2535.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Higgins JP, Thompson SG. Quantifying heterogeneity in a meta-analysis. Stat Med. 2002;21(11):1539–58.

    Article  PubMed  Google Scholar 

  30. Agbohoui O, Sene-Diouf F, Ba M, Ndiaye M, Diagne M, Diop AG, Ndiaye IP. [Neuroepidemiology of epilepsy in Senegalese school milieu]. Dakar Med. 1999;44(1):99–104.

    CAS  PubMed  Google Scholar 

  31. Angwafor SA, Bell GS, Ngarka L, Otte W, Tabah EN, Nfor LN, Njamnshi TN, Njamnshi AK, Sander JW. Incidence and prevalence of epilepsy and associated factors in a health district in North-West Cameroon: a population survey. Epilepsy Behav 2021, 121(Pt A):108048.

  32. Balogou AA, Grunitzky EK, Belo M, Sankaredja M, Djagba DD, Tatagan-Agbi K, Mandlhate C, Barakamfitiye DG. Management of epilepsy patients in Batamariba district, Togo. Acta Neurol Scand. 2007;116(4):211–6.

    Article  CAS  PubMed  Google Scholar 

  33. Burton KJ, Rogathe J, Whittaker R, Mankad K, Hunter E, Burton MJ, Todd J, Neville BG, Walker R, Newton CR. Epilepsy in Tanzanian children: association with perinatal events and other risk factors. Epilepsia. 2012;53(4):752–60.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Carter JA, Neville BG, White S, Ross AJ, Otieno G, Mturi N, Musumba C, Newton CR. Increased prevalence of epilepsy associated with severe falciparum malaria in children. Epilepsia. 2004;45(8):978–81.

    Article  PubMed  Google Scholar 

  35. Christianson AL, Zwane ME, Manga P, Rosen E, Venter A, Kromberg JG. Epilepsy in rural South African children–prevalence, associated disability and management. South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde 2000, 90(3):262–266.

  36. Dent W, Helbok R, Matuja WB, Scheunemann S, Schmutzhard E. Prevalence of active epilepsy in a rural area in South Tanzania: a door-to-door survey. Epilepsia. 2005;46(12):1963–9.

    Article  PubMed  Google Scholar 

  37. Edwards T, Scott AG, Munyoki G, Odera VM, Chengo E, Bauni E, Kwasa T, Sander LW, Neville BG, Newton CR. Active convulsive epilepsy in a rural district of Kenya: a study of prevalence and possible risk factors. Lancet Neurol. 2008;7(1):50–6.

    Article  PubMed  PubMed Central  Google Scholar 

  38. Ezeala-Adikaibe BA, Orjioke C, Ekenze O, Ijoma U, Onodugo O, Molokwu O, Chime P, Mbadiwe N, Aneke E, Onyekonwu C. Prevalence of active convulsive epilepsy in an urban slum in Enugu South East Nigeria. Seizure. 2016;35:100–5.

    Article  PubMed  PubMed Central  Google Scholar 

  39. Houinato D, Yemadje LP, Glitho G, Adjien C, Avode G, Druet-Cabanac M, Preux PM. Epidemiology of epilepsy in rural Benin: prevalence, incidence, mortality, and follow-up. Epilepsia. 2013;54(4):757–63.

    Article  PubMed  Google Scholar 

  40. Hunter E, Rogathi J, Chigudu S, Jusabani A, Jackson M, McNally R, Gray W, Whittaker RG, Iqbal A, Birchall D, et al. Prevalence of active epilepsy in rural Tanzania: a large community-based survey in an adult population. Seizure. 2012;21(9):691–8.

    Article  PubMed  Google Scholar 

  41. Ibinda F, Wagner RG, Bertram MY, Ngugi AK, Bauni E, Vos T, Sander JW, Newton CR. Burden of epilepsy in rural Kenya measured in disability-adjusted life years. Epilepsia. 2014;55(10):1626–33.

    Article  PubMed  PubMed Central  Google Scholar 

  42. Kariuki SM, Ngugi AK, Kombe MZ, Kazungu M, Chengo E, Odhiambo R, Nyaguara A, Neville BG, Newton CR. Prevalence and mortality of epilepsies with convulsive and non-convulsive seizures in Kilifi, Kenya. Seizure. 2021;89:51–5.

    Article  PubMed  PubMed Central  Google Scholar 

  43. Kariuki SM, Chengo E, Ibinda F, Odhiambo R, Etyang A, Ngugi AK, Newton CR. Burden, causes, and outcomes of people with epilepsy admitted to a rural hospital in Kenya. Epilepsia. 2015;56(4):577–84.

    Article  PubMed  PubMed Central  Google Scholar 

  44. Kind CJ, Newton C, Kariuki SM. Prevalence, risk factors, and neurobehavioral comorbidities of epilepsy in Kenyan children. Epilepsia Open. 2017;2(4):388–99.

    Article  PubMed  PubMed Central  Google Scholar 

  45. Lenaerts E, Mandro M, Mukendi D, Suykerbuyk P, Dolo H, Wonya’Rossi D, Ngave F, Ensoy-Musoro C, Laudisoit A, Hotterbeekx A, et al. High prevalence of epilepsy in onchocerciasis endemic health areas in Democratic Republic of the Congo. Infect Dis Poverty. 2018;7(1):68.

    Article  PubMed  PubMed Central  Google Scholar 

  46. Mung’ala-Odera V, White S, Meehan R, Otieno GO, Njuguna P, Mturi N, Edwards T, Neville BG, Newton CR. Prevalence, incidence and risk factors of epilepsy in older children in rural Kenya. Seizure. 2008;17(5):396–404.

    Article  PubMed  PubMed Central  Google Scholar 

  47. Ngugi AK, Bottomley C, Scott JA, Mung’ala-Odera V, Bauni E, Sander JW, Kleinschmidt I, Newton CR. Incidence of convulsive epilepsy in a rural area in Kenya. Epilepsia. 2013;54(8):1352–9.

    Article  PubMed  PubMed Central  Google Scholar 

  48. Nwani P, Nwosu M, Asomugha L, Enwereji K, Arinzechi E, Ogunniyi A. Epidemiology of active epilepsy in a suburban community in Southeast Nigeria: a door–to–door survey. Niger J Clin Pract. 2015;18(4):527–33.

    Article  CAS  PubMed  Google Scholar 

  49. Rwiza HT, Kilonzo GP, Haule J, Matuja WB, Mteza I, Mbena P, Kilima PM, Mwaluko G, Mwang’ombola R, Mwaijande F, et al. Prevalence and incidence of epilepsy in Ulanga, a rural Tanzanian district: a community-based study. Epilepsia. 1992;33(6):1051–6.

    Article  CAS  PubMed  Google Scholar 

  50. Farghaly WM, Abd Elhamed MA, Hassan EM, Soliman WT, Yhia MA, Hamdy NA. Prevalence of childhood and adolescence epilepsy in Upper Egypt (desert areas). Egypt J Neurol Psychiatry Neurosurg. 2018;54:1–7.

    Article  Google Scholar 

  51. Mahmoud NAH. Prevalence of epilepsy in primary school children in El-Minia City, Egypt. Egypt J Neurol Psychiat Neurosurg. 2009;46(1):33–9.

    Google Scholar 

  52. Abuga JA, Kariuki SM, Abubakar A, Nyundo C, Kinyanjui SM, Van Hensbroek MB, Newton CR. Neurological impairment and disability in children in rural Kenya. Dev Med Child Neurol. 2022;64(3):347–56.

    Article  PubMed  Google Scholar 

  53. Ackermann S, Le Roux S, Wilmshurst JM. Epidemiology of children with epilepsy at a tertiary referral centre in South Africa. Seizure. 2019;70:82–9.

    Article  PubMed  Google Scholar 

  54. Bistervels IM, Kariuki SM, Newton C. Risk of convulsive epilepsy following acute seizures in Kenyan children. Epilepsia Open. 2016;1(3–4):112–20.

    Article  PubMed  PubMed Central  Google Scholar 

  55. Colebunders R, Olore JYC, Puok PC, Bhattacharyya K, Menon S, Abd-Elfarag S, Ojok G, Ensoy-Musoro M, Lako C. High prevalence of onchocerciasis-associated epilepsy in villages in Maridi County, Republic of South Sudan: a community-based survey. Seizure. 2018;63:93–101.

    Article  PubMed  PubMed Central  Google Scholar 

  56. Dossou GA, Houinato D, Tevoedjre M, Adjien C, Adoukonou T, Guedou F. Epilepsy in Schools in Cotonou (Benin) Epilepsie en Milieu Scolaire a Cotonou (Benin). Afr J Neurol Sci 2003, 22(2).

  57. Duggan MB. Epilepsy in rural Ugandan children: seizure pattern, age of onset and associated findings. Afr Health Sci. 2010;10(3):218–25.

    CAS  PubMed  PubMed Central  Google Scholar 

  58. Eseigbe E, Nuhu E, Sheikh T, Adama S, Eseigbe P, Aderinoye A, Adebayo O, Gazali K. Factors associated with treatment gap in children and adolescents with epilepsy in a rural Nigerian community. Nigerian J Paediatrics. 2014;41(1):22–7.

    Article  Google Scholar 

  59. Eyong KI, Ekanem EE, Asindi AA, Chimaeze T. Clinical profile of childhood epilepsy in Nigerian children seen in a tertiary hospital. Int J Contemp Pediatr. 2017;4(4):1138–41.

    Article  Google Scholar 

  60. Frank-Briggs AI, EA DA. Pattern of paediatric neurological disorders in port harcourt. Nigeria Int J Biomedical Science: IJBS. 2011;7(2):145–9.

    Article  CAS  Google Scholar 

  61. Levick B, Laudisoit A, Tepage F, Ensoy-Musoro C, Mandro M, Bonareri Osoro C, Suykerbuyk P, Kashama JM, Komba M, Tagoto A, et al. High prevalence of epilepsy in onchocerciasis endemic regions in the Democratic Republic of the Congo. PLoS Negl Trop Dis. 2017;11(7):e0005732.

    Article  PubMed  PubMed Central  Google Scholar 

  62. Mohamed IN, Elseed MA, Hamed AA, Abdel-Rahman ME, El-Sadig SM, Omer IM, Osman AH, Ahmed AE, Karrar ZA, Salih MA. Prevalence of epilepsy in 74,949 school children in Khartoum State, Sudan. Paediatr Int Child Health. 2017;37(3):188–92.

    Article  PubMed  Google Scholar 

  63. Ngoungou EB, Dulac O, Poudiougou B, Druet-Cabanac M, Dicko A, Mamadou Traore A, Coulibaly D, Farnarier G, Tuillas M, Keita MM, et al. Epilepsy as a consequence of cerebral malaria in area in which malaria is endemic in Mali, West Africa. Epilepsia. 2006;47(5):873–9.

    Article  PubMed  Google Scholar 

  64. Prischich F, De Rinaldis M, Bruno F, Egeo G, Santori C, Zappaterreno A, Fattouch J, Di Bonaventura C, Bada J, Russo G, et al. High prevalence of epilepsy in a village in the Littoral Province of Cameroon. Epilepsy Res. 2008;82(2–3):200–10.

    Article  PubMed  Google Scholar 

  65. Raimon S, Dusabimana A, Abd-Elfarag G, Okaro S, Carter JY, Newton CR, Logora MY, Colebunders R. High prevalence of Epilepsy in an onchocerciasis-endemic area in Mvolo County, South Sudan: a Door-To-Door survey. Pathogens 2021, 10(5).

  66. Sebera F, Munyandamutsa N, Teuwen DE, Ndiaye IP, Diop AG, Tofighy A, Boon P, Dedeken P. Addressing the treatment gap and societal impact of epilepsy in Rwanda–results of a survey conducted in 2005 and subsequent actions. Epilepsy Behav. 2015;46:126–32.

    Article  PubMed  PubMed Central  Google Scholar 

  67. Simms V, Atijosan O, Kuper H, Nuhu A, Rischewski D, Lavy C. Prevalence of epilepsy in Rwanda: a national cross-sectional survey. Trop Med Int Health. 2008;13(8):1047–53.

    Article  PubMed  Google Scholar 

  68. Winkler AS, Kerschbaumsteiner K, Stelzhammer B, Meindl M, Kaaya J, Schmutzhard E. Prevalence, incidence, and clinical characteristics of epilepsy–a community-based door-to-door study in northern Tanzania. Epilepsia. 2009;50(10):2310–3.

    Article  PubMed  Google Scholar 

  69. Yemadje LP, Houinato D, Boumédiène F, Ngoungou EB, Preux PM, Druet-Cabanac M. Prevalence of epilepsy in the 15 years and older in Benin: a door-to-door nationwide survey. Epilepsy Res. 2012;99(3):318–26.

    Article  PubMed  Google Scholar 

  70. Angwafor SA, Bell GS, Ngarka L, Otte WM, Tabah EN, Nfor LN, Njamnshi TN, Sander JW, Njamnshi AK. Epilepsy in a health district in North-West Cameroon: clinical characteristics and treatment gap. Epilepsy Behav 2021, 121(Pt A):107997.

  71. Kamuyu G, Bottomley C, Mageto J, Lowe B, Wilkins PP, Noh JC, Nutman TB, Ngugi AK, Odhiambo R, Wagner RG, et al. Exposure to multiple parasites is associated with the prevalence of active convulsive epilepsy in sub-saharan Africa. PLoS Negl Trop Dis. 2014;8(5):e2908.

    Article  PubMed  PubMed Central  Google Scholar 

  72. Rwiza H, Kilonzo G, Haule J, Matuja W, Mteza I, Mbena P, Kilima P, Mwaluko G, Mwang’Ombola R, Mwaijande F. Prevalence and incidence of epilepsy in Ulanga, a rural Tanzanian district: a community-based study. Epilepsia. 1992;33(6):1051–6.

    Article  CAS  PubMed  Google Scholar 

  73. Ngugi AK, Bottomley C, Scott JAG, Mung’ala–Odera V, Bauni E, Sander JW, Kleinschmidt I, Newton CR. Incidence of convulsive epilepsy in a rural area in K Enya. Epilepsia. 2013;54(8):1352–9.

    Article  PubMed  PubMed Central  Google Scholar 

  74. Deuschl G, Beghi E, Fazekas F, Varga T, Christoforidi KA, Sipido E, Bassetti CL, Vos T, Feigin VL. The burden of neurological diseases in Europe: an analysis for the global burden of Disease Study 2017. Lancet Public Health. 2020;5(10):e551–67.

    Article  PubMed  Google Scholar 

  75. Christensen SS, Eslick GD. Cerebral malaria as a risk factor for the development of epilepsy and other long-term neurological conditions: a meta-analysis. Trans R Soc Trop Med Hyg. 2015;109(4):233–8.

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

We would like to acknowledge Wollo university for providing technical support for conducting this systematic review and meta-analysis. We would also like to thank all colleagues for their unreserved help during the write-up of this review and meta-analysis.

Funding

No funding was used.

Author information

Authors and Affiliations

Authors

Contributions

Gebeyaw Biset and Kirubel Dagnaw conceived and designed the protocol. Nigussie Abebaw and Gebeyaw Biset wrote the first draft of the protocol. Gebeyaw Biset and Natnael Atnafu designed a search strategy. GB, KD, and Endalk Birrie conducted study screening, quality appraisals, and data extraction. GB and Natan Estifanos has conducted the analysis and result write up. All authors have read and approved the final draft of the manuscript.

Corresponding author

Correspondence to Gebeyaw Biset.

Ethics declarations

Ethics approval and consent to participate

Not applicable.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Biset, G., Abebaw, N., Gebeyehu, N.A. et al. Prevalence, incidence, and trends of epilepsy among children and adolescents in Africa: a systematic review and meta-analysis. BMC Public Health 24, 771 (2024). https://doi.org/10.1186/s12889-024-18236-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1186/s12889-024-18236-z

Keywords