Prevalence of epilepsy and the epilepsy treatment gap in Bauchi, Northeast Nigeria: a cross-sectional study of two communities

Objective Epilepsy prevalence varies widely across Nigeria, with rates ranging from 3.1 to 37.0/1000 population. There have been no studies on epilepsy prevalence and treatment gap in the Northeast Region of Nigeria. This study aimed to study epilepsy prevalence and the epilepsy treatment gap (ETG) in an urban and a rural community in Northeast Nigeria. Design Cross-sectional, community-based survey. Setting Epilepsy screening of residents in two communities in Northeast Nigeria using a WHO screening tool and a validated study questionnaire from 1 March to 10 June 2022. Participants 8599 community residents aged ≥2 years. Outcome measures Prevalence of epilepsy, active epilepsy, ETG and associated factors. Results We screened 8599 residents, of whom 88 had epilepsy. Crude epilepsy prevalence was 10.2 per 1000 and was three times higher in the rural than in the urban community (18.5 vs 6.4; χ 2 =26.79, p<0.001). The age-adjusted prevalence was 11.3/1,000, whereas the prevalence of active epilepsy was 8.6/1000. ETG was noted in 78.4% participants with active epilepsy and was similar in urban and rural communities (76.7% vs 79.5%; χ 2 =0.087, p=0.768). Logistic regression analysis showed that the ETG was associated with a lack of counselling (OR 15.8, 95% CI 3.5 to 70.7, p<0.001) but not a prior diagnosis of epilepsy, sex, age, marital status, urban versus rural residence or distance to the health centre ≥2 versus <2 km. Among 20 participants with epilepsy, electroencephalography suggested focal epilepsy in four participants, generalised epilepsy in eight and normal findings in eight, while brain CT scans in six participants were all normal. Conclusion The prevalence of epilepsy in Bauchi State was within the range reported in Nigeria but three times higher in the rural than in the urban community. A high ETG was associated with poor counselling of people with epilepsy. Epilepsy counselling, health education and wider access to neurology services could reduce the burden of epilepsy in Northeast Nigeria.