Neurocysticercosis in a rural population with extensive pig production in Angónia district, Tete Province, Mozambique
Introduction
Neurocysticercosis (NCC) is an important neurological disease in countries with high prevalence of Taenia solium infection and is reported to be a re-emerging problem in high income countries (Fabiani and Bruschi, 2013, Serpa and White, 2012). The condition develops when a person ingests parasite eggs present in stool of patients with taeniosis (Roman et al., 2000). Taeniosis is acquired by eating raw or undercooked infected pork. While patients with taeniosis generally exhibit little or no clinical signs and symptoms, a different scenario is observed in patients with NCC. Epilepsy is a common clinical presentation (Carabin et al., 2011, Del Brutto and Del Brutto, 2012, Del Brutto and Garcia, 2013, Winkler et al., 2009b) and leading cause of morbidity in patients with NCC (Dewhurst et al., 2013, Tegueu et al., 2013). Epilepsy is considered a major health problem in low and middle income countries, where the prevalence has shown to be much higher than in high income countries (Ngugi et al., 2010). Two systematic reviews have recently provided an updated estimate for the overall prevalence of epilepsy in sub-Saharan Africa but did not include data from Mozambique (Ngugi et al., 2010, Paul et al., 2012). Ndimubanzi et al. (2010) estimated in a systematic review that NCC occurred in 29% of people with epilepsy, while Quet et al. (2010) revealed a significant association between cysticercosis and epilepsy in a meta-analysis including only African studies (Ndimubanzi et al., 2010, Quet et al., 2010). Several studies on porcine cysticercosis have been carried out in Tete province, Mozambique and have provided an indication that the zoonotic parasite is wide spread in the area (Pondja et al., 2010, Pondja et al., 2015). The burden it poses on the human population has not been assessed so far. The aim of this study was to estimate the prevalence of NCC in Angónia district, a rural area of Mozambique based on: prevalence of human T. solium cysticercosis assessed by antigen Enzyme-Linked Immunosorbent Assay (ELISA) seropositivity, history of epilepsy, and brain computed tomography (CT) scan results.
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Ethical statement
The study protocol was reviewed and approved by the Ethical Committee of the Medical Faculty of Eduardo Mondlane University, the National Bioethics Committee of Mozambique, the Danish National Committee on Biomedical Research Ethics, Denmark and the Faculty of Health Sciences Ethics Committee at the University of Pretoria, South Africa.
Written informed consent was obtained from all study subjects before interview and sample collection. Study subjects who could not sign their name used
Serological results
Out of 1,723 interviewed study subjects, 27.5% were males and 72.5% were females. The average age was 30 ± 15.5 years. All 1,723 study subjects provided a blood sample for Ag-ELISA test. The test was positive in 249 (15.5% (95% CI, 12.8–16.2)) study subjects. Multiple logistic regression analysis indicated that males had a higher risk for a positive test in comparison to females (OR 2.1, 95% CI 1.6–2.8). Furthermore it was observed that absence of a latrine at household level (OR 0.6, 95% CI,
Discussion
Based on the results of the study a total of 77 (51.0% (95% CI, 42.7–59.2)) and 38 (25.2% (95% CI, 18.5–32.9)) study subjects were diagnosed with definitive and probable diagnosis of NCC, respectively. This is the first study on NCC in Angónia district and the results provide the evidence that people living in rural areas of Tete province, where T. solium is wide spread, are suffering. A high proportion of study subjects with NCC was expected, as most of them were Ag-ELISA positive, highly
Conclusions
This is the first study on NCC among study subjects with confirmed history of epilepsy in a remote, rural district of Mozambique. Findings of this study revealed a high proportion of NCC among people with epilepsy of Angónia district and support the idea that NCC is a cause of epilepsy in Africa. The parasite T. solium is present in the area and is causing morbidity among the affected population. Many cases of epilepsy could potentially be prevented if strategies to control T. solium
Acknowledgments
The authors are indebted to the Serviços Provinciais de Pecuária de Tete, Serviços Distritais de Agricultura de Angónia, Estação Zootécnica de Angónia, the community authorities and the study participants for their valuable co-operation.
The study was supported by the Danish International Development Agency (DANIDA) with its two projects: CESA-project (Cross-disciplinary risk assessment of Cysticercosis in Eastern and Southern Africa), funded by, file no. 104.Dan.8.L.721 and SLIPP-project
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