Epilepsy & Global Health - A New Priority

An article from BBC discusses how epilepsy is turning into a global health issue.

Epilepsy is twice as common in low and middle-income countries as it is in the developed world, according to an international team of researchers.

They say the higher incidence is linked to increased risk factors, including head injuries and infections such as pork tapeworm and river blindness.

And more than 60% of sufferers in those countries receive no appropriate treatment, they say in the Lancet.

A Lancet editorial said epilepsy had to be a global health priority.

Epilepsy is a condition in which disturbances to the brain's normal electrical activity cause recurring seizures or brief episodes of altered consciousness.

There are about 40 different types. Epilepsy is not a mental illness, but can develop after injury or damage to the brain.

About 85% of the global burden of epilepsy occurs in low and middle-income countries.

'Bewitched'

Writing in the Lancet, researchers led by Prof Charles Newton, of the University of Oxford, say the death rate in developing countries is much higher than in developed ones - and that the reason for this is likely to be a failure to treat people with the condition.

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Prof Newton said: "The burden of epilepsy in these regions is at least double that found in high-income countries, and sadly, adequate facilities for diagnosis, treatment and ongoing management of epilepsy are virtually non-existent in many of the world's poorest regions."

He added: "Many people with epilepsy or their families do not even know that they have a disorder that can be controlled with biomedical treatment, so it is vitally important that awareness is raised and medical care improved in these regions."

Medications are available - but there can be problems distributing them, especially to remote areas.

The researchers say there are low-cost ways of improving the situation and of reducing the stigma often faced by people with epilepsy and their families - such as working with traditional healers and awareness campaigns to increase understanding of the condition.

In some countries, traditional beliefs about the causes of the condition, including bewitchment, spiritual causes and curses, lead to stigma and increase the chance that a person with epilepsy will not get the treatment they need.

A Lancet editorial adds: "Given the prevalence of epilepsy globally, it should be included as a priority on the public health agenda, and access to treatment should be greatly improved in developing countries.

"It is time for all governments to take epilepsy more seriously."

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Sleeplessness epidemic reaches 150 million in the developing world

Interesting study on the prevalence of sleep issues in the developing world.

Levels of sleep problems in the developing world are approaching those seen in developed nations, linked to an increase in problems like depression and anxiety.

According to the first ever pan-African and Asian analysis of sleep problems, led by Warwick Medical School at the University of Warwick, an estimated 150 million adults are suffering from sleep-related problems across the developing world.

The results are published in a study in the journal Sleep.

Warwick Medical School researchers have found a rate of 16.6 per cent of the population reporting insomnia and other severe sleep disturbances in the countries surveyed – close to the 20 per cent found in the general adult population in the West, according to nationwide surveys in Canada and the US.

The researchers, which also included academics from the INDEPTH Network in Ghana and the University of the Witwatersrand in South Africa, looked at the sleep quality of 24,434 women and 19,501 men aged 50 years and over in eight locations in rural populations in Ghana, Tanzania, South Africa, India, Bangladesh, Vietnam and Indonesia, and an urban area in Kenya.

They examined potential links between sleep problems and social demographics, quality of life, physical health and psychiatric conditions.

The strongest link was found between psychiatric conditions like depression and anxiety and sleep problems, mirroring trends seen in the developed world.

There was striking variation across the countries surveyed – Bangladesh, South Africa and Vietnam had extremely high levels of sleep problems, in some cases surpassing Western sleeplessness rates.

However India and Indonesia reported relatively low levels of severe sleep problems.

The research also found a higher prevalence of sleep problems in women and older age groups, consistent with patterns found in higher income countries.

Dr Saverio Stranges was the leading author of the manuscript at Warwick Medical School and colleague Ngianga-Bakwin Kandala performed the analyses.

Dr Stranges said: “Our research shows the levels of sleep problems in the developing world are far higher than previously thought.

“This is particularly concerning as many low-income countries are facing a double burden of disease with pressure on scarce financial resources coming from infectious diseases like HIV, but also from a growing rate of chronic diseases like cardiovascular diseases and cancer.

“This new study suggests sleep disturbances might also represent a significant and unrecognised public health issue among older people, especially women, in low-income settings.

“Also it seems that sleep problems are not linked to urbanisation as the people surveyed were mostly living in rural settings.

“We might expect even higher figures for people living in urban areas.”

One of the most striking elements of the analysis was the differences between countries analysed.

Bangladesh had the highest prevalence of sleep problems among the countries analysed

– with a 43.9 per cent rate for women – more than twice the rate of developed countries and far higher than the 23.6 per cent seen in men.

Bangladesh also saw very high patterns of anxiety and depression.

Vietnam too had very high rates of sleep problems – 37.6 per cent for women and 28.5 per cent for men.

Meanwhile in African countries, Tanzania, Kenya and Ghana saw rates of between 8.3 per cent and 12.7 per cent.

However South Africa had double the rate of the other African countries – 31.3 per cent for women and 27.2 per cent for men.

India and Indonesia both had very low prevalence of sleep issues – 6.5 per cent for Indian women and 4.3 per cent for Indian men.

Indonesian men reported rates of sleep problems of 3.9 per cent and women had rates of 4.6 per cent.

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