Effect of Onchocerciasis Elimination Measures on the Incidence of Epilepsy in Maridi, South Sudan

NCT ID: NCT05750043

Last Updated: 2023-11-30

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Total Enrollment

17000 participants

Study Classification

OBSERVATIONAL

Study Start Date

2018-03-01

Study Completion Date

2023-02-19

Brief Summary

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For the first time using a prospective design, a study confirms the results of previous retrospective studies, which found that strengthening onchocerciasis elimination efforts decreases the incidence of epilepsy, including nodding syndrome. Therefore, this study confirms the solid epidemiological link between onchocerciasis and epilepsy.

This study also shows that a community-based "Slash and Clear" vector control method can effectively decrease blackfly biting rates and potentially decrease onchocerciasis transmission.

Moreover, this study shows that epilepsy is a major cause of death in onchocerciasis endemic areas with high ongoing transmission.

Detailed Description

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Background High onchocerciasis transmission predisposes communities in endemic areas to a high epilepsy burden. The 4·4% (95%CI:4·1-4·7%) epilepsy prevalence documented in 2018 in Maridi, South Sudan, motivated the strengthening of onchocerciasis elimination measures. We evaluated the effect of these interventions on the incidence of epilepsy, including nodding syndrome (NS).

Methods Annual community-directed treatment with ivermectin (CDTi) was implemented in 2019, temporarily interrupted in 2020 and reimplemented biannually in 2021. Additionally, a community-based "Slash and Clear" vector control method was initiated in 2019 at the Maridi dam. A two-stage house-to-house survey was conducted before (2018) and after (2022) implementing the interventions, consisting of initial screening by community workers to detect suspected cases of epilepsy, followed by confirmation of the diagnosis by a trained clinician.

Finding Overall, 17,652 and 14,402 individuals participated in the pre- and post-intervention surveys, respectively. The epilepsy incidence decreased from 313·0 (95% confidence intervals (CI):273·7-357·7) to 34·7 (95%CI:17·6-66·1) per 100,000 person-years. Similarly, the incidence of NS decreased from 120·4 (95%CI:96·7-149·6) to 10·4 (95%CI:2·7-33·2) per 100,000 person-years. Despite biannual CDTi, only 56·6% of the population took ivermectin in 2021. Mortality of persons with epilepsy accounted for 17·1% (95%CI:14·0-20·7%) of the overall number of deaths in the population.

Interpretation In onchocerciasis-endemic areas with high prevalence of epilepsy, strengthening onchocerciasis elimination interventions can decrease the incidence of epilepsy, including NS. Additional efforts are needed in Maridi, where epilepsy is a major cause of mortality, to increase CDTi coverage and sustain blackfly control.

Conditions

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Onchocerciasis Epilepsy

Study Design

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Observational Model Type

OTHER

Study Time Perspective

PROSPECTIVE

Study Groups

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Population of selected villages in Maridi county

A total of 2,511 households containing 17,652 individuals were visited in 2018, and 2,254 households containing 14,402 individuals in 2022.

bi-annual CDTI

Intervention Type DRUG

bi-annual community directed treatment with ivermectin (CDTI) and community-based "slash and clear" vector control intervention

Interventions

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bi-annual CDTI

bi-annual community directed treatment with ivermectin (CDTI) and community-based "slash and clear" vector control intervention

Intervention Type DRUG

Other Intervention Names

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"slash and clear" vector control intervention

Eligibility Criteria

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Inclusion Criteria

* entire population of selected villages in Maridi County

Exclusion Criteria

* No
Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Amref Health Africa

OTHER

Sponsor Role collaborator

Universiteit Antwerpen

OTHER

Sponsor Role lead

Responsible Party

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Robert Colebunders

Professor

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Jane Carter, MD

Role: PRINCIPAL_INVESTIGATOR

Amref Health Africa

Locations

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Amref Health Africa

Juba, Central, South Sudan

Site Status

Countries

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South Sudan

Other Identifiers

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Project Code AID 011898

Identifier Type: -

Identifier Source: org_study_id