{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,19]],"date-time":"2026-02-19T14:04:46Z","timestamp":1771509886792,"version":"3.50.1"},"update-to":[{"DOI":"10.1371\/journal.pntd.0011178","type":"new_version","label":"New version","source":"publisher","updated":{"date-parts":[[2023,7,11]],"date-time":"2023-07-11T00:00:00Z","timestamp":1689033600000}}],"reference-count":31,"publisher":"Public Library of Science (PLoS)","issue":"6","license":[{"start":{"date-parts":[[2023,6,28]],"date-time":"2023-06-28T00:00:00Z","timestamp":1687910400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100022083","name":"VLIR-UOS","doi-asserted-by":"crossref","award":["671055"],"award-info":[{"award-number":["671055"]}],"id":[{"id":"10.13039\/501100022083","id-type":"DOI","asserted-by":"crossref"}]},{"name":"FWO","award":["G0A0522N,"],"award-info":[{"award-number":["G0A0522N,"]}]},{"DOI":"10.13039\/100010434","name":"\u201cla Caixa\u201d Foundation","doi-asserted-by":"publisher","award":["B005782."],"award-info":[{"award-number":["B005782."]}],"id":[{"id":"10.13039\/100010434","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosntds.org"],"crossmark-restriction":false},"short-container-title":["PLoS Negl Trop Dis"],"abstract":"<jats:sec id=\"sec001\"><jats:title>Background<\/jats:title><jats:p>Community-directed treatment with ivermectin (CDTi) is used to eliminate onchocerciasis. However, despite 25 years of annual CDTi in Mahenge, Tanzania, the prevalence of onchocerciasis and onchocerciasis-associated epilepsy remained high in certain rural villages. Therefore, in 2019, bi-annual CDTi was introduced in the area. This study assessed the impact of the programme on the incidence of epilepsy in four villages.<\/jats:p><\/jats:sec><jats:sec id=\"sec002\"><jats:title>Methodology<\/jats:title><jats:p>Door-to-door epilepsy surveys were conducted prior to (2017\/18) and after (2021) implementing a bi-annual CDTi program. All household members were screened for epilepsy symptoms using a validated questionnaire, and suspected cases were examined by a medical doctor to confirm\/reject the diagnosis of epilepsy. The prevalence and annual incidence of epilepsy, including nodding syndrome, were calculated with 95% Wilson confidence intervals with continuity correction. The latter was also done for CDTi coverage in 2016 and 2021.<\/jats:p><\/jats:sec><jats:sec id=\"sec003\"><jats:title>Results<\/jats:title><jats:p>Precisely 5,444 and 6,598 persons were screened for epilepsy before and after implementing the intervention. The CDTi coverage of the overall population was 82.3% (95%CI: 81.3\u201383.2%) in 2021 and sustained in both distribution rounds (81.5% and 76.8%). The coverage was particularly high in children and teenagers aged 6 to 18 years (93.2%, 95%CI: 92.1\u201394.2%). The epilepsy prevalence remained similar: 3.3% (95%CI: 2.9\u20133.9%) in 2017\/18 versus 3.1% (95%CI: 2.7\u20133.5%) in 2021. However, the incidence of epilepsy declined from 177.6 (95%CI: 121.2\u2013258.5) in 2015\u20132017 and 2016\u20132018 to 45.5 (95%CI: 22.2\u201389.7) in 2019\u20132021 per 100,000 persons-years. The incidence of probable nodding syndrome varied from 18.4 (95%CI: 4.7\u201358.5) to 5.1 (95%CI: 0.3\u201332.8). None of the nine incidence cases of epilepsy for which information on ivermectin intake was available took ivermectin in the year they developed their first seizures.<\/jats:p><\/jats:sec><jats:sec id=\"sec004\"><jats:title>Conclusion<\/jats:title><jats:p>A bi-annual CDTi programme should be implemented in areas with high prevalence of onchocerciasis and epilepsy. High CDTi coverage among children is particularly important to prevent onchocerciasis-associated epilepsy.<\/jats:p><\/jats:sec>","DOI":"10.1371\/journal.pntd.0011178","type":"journal-article","created":{"date-parts":[[2023,6,28]],"date-time":"2023-06-28T17:37:23Z","timestamp":1687973843000},"page":"e0011178","update-policy":"https:\/\/doi.org\/10.1371\/journal.pntd.corrections_policy","source":"Crossref","is-referenced-by-count":23,"title":["Impact of a bi-annual community-directed treatment with ivermectin programme on the incidence of epilepsy in an onchocerciasis-endemic area of Mahenge, Tanzania: A population-based prospective study"],"prefix":"10.1371","volume":"17","author":[{"given":"Dan","family":"Bhwana","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lu\u00eds-Jorge","family":"Amaral","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Athanas","family":"Mhina","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Paul Martine","family":"Hayuma","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Filbert","family":"Francis","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Joseph N.","family":"Siewe Fodjo","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bruno P.","family":"Mmbando","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1919-1340","authenticated-orcid":true,"given":"Robert","family":"Colebunders","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2023,6,28]]},"reference":[{"issue":"1","key":"pntd.0011178.ref001","doi-asserted-by":"crossref","first-page":"e0008965","DOI":"10.1371\/journal.pntd.0008965","article-title":"Onchocerca volvulus and epilepsy: A comprehensive review using the Bradford Hill criteria for causation","volume":"15","author":"R Colebunders","year":"2021","journal-title":"PLoS Negl Trop Dis"},{"key":"pntd.0011178.ref002","unstructured":"World Health Organization. Guidelines for stopping mass drug administration and verifying elimination of human onchocerciasis: criteria and procedures Geneva: World Health Organization; 2016 [updated 2016. https:\/\/apps.who.int\/iris\/handle\/10665\/204180."},{"key":"pntd.0011178.ref003","article-title":"Onchocerciasis\u2014level 3 cause","volume":"396","author":"Global Health Metrics","year":"2020","journal-title":"Lancet"},{"issue":"10","key":"pntd.0011178.ref004","doi-asserted-by":"crossref","first-page":"284","DOI":"10.1016\/0169-4758(86)90138-9","article-title":"Periodic reproduction of Onchocerca volvulus","volume":"2","author":"H Schulz-Key","year":"1986","journal-title":"Parasitol Today"},{"key":"pntd.0011178.ref005","first-page":"11","article-title":"El s\u00edndrome epil\u00e9ptico y sus relaciones con la oncocercosis","volume":"1","author":"G. Casis-Sacre","year":"1938","journal-title":"Bol Salub Hig"},{"issue":"1","key":"pntd.0011178.ref006","doi-asserted-by":"crossref","first-page":"57","DOI":"10.1111\/j.1600-0447.1965.tb04970.x","article-title":"Epilepsy in the Wapogoro tribe in Tanganyika","volume":"41","author":"LM Aall-Jilek","year":"1965","journal-title":"Acta Psychiatrica Scandinavica"},{"key":"pntd.0011178.ref007","doi-asserted-by":"crossref","first-page":"93","DOI":"10.1016\/j.seizure.2018.11.004","article-title":"High prevalence of onchocerciasis-associated epilepsy in villages in Maridi County, Republic of South Sudan: A community-based survey","volume":"63","author":"R Colebunders","year":"2018","journal-title":"Seizure"},{"issue":"1","key":"pntd.0011178.ref008","doi-asserted-by":"crossref","first-page":"68","DOI":"10.1186\/s40249-018-0452-1","article-title":"High prevalence of epilepsy in onchocerciasis endemic health areas in Democratic Republic of the Congo","volume":"7","author":"E Lenaerts","year":"2018","journal-title":"Infect Dis Poverty"},{"issue":"1","key":"pntd.0011178.ref009","doi-asserted-by":"crossref","first-page":"12","DOI":"10.1186\/s40249-020-0628-3","article-title":"Prevalence and incidence of nodding syndrome and other forms of epilepsy in onchocerciasis-endemic areas in northern Uganda after the implementation of onchocerciasis control measures","volume":"9","author":"N Gumisiriza","year":"2020","journal-title":"Infect Dis Poverty"},{"issue":"11","key":"pntd.0011178.ref010","doi-asserted-by":"crossref","first-page":"1315","DOI":"10.1016\/S1473-3099(20)30122-5","article-title":"Changes in epilepsy burden after onchocerciasis elimination in a hyperendemic focus of western Uganda: a comparison of two population-based, cross-sectional studies","volume":"20","author":"N Gumisiriza","year":"2020","journal-title":"Lancet Infect Dis"},{"issue":"6","key":"pntd.0011178.ref011","doi-asserted-by":"crossref","first-page":"1051","DOI":"10.1111\/j.1528-1157.1992.tb01758.x","article-title":"Prevalence and incidence of epilepsy in Ulanga, a rural Tanzanian district: a community-based study","volume":"33","author":"HT Rwiza","year":"1992","journal-title":"Epilepsia"},{"issue":"2","key":"pntd.0011178.ref012","doi-asserted-by":"crossref","first-page":"123","DOI":"10.24248\/eahrj.v5i2.661","article-title":"Implementation Challenges of Community Directed Treatment with Ivermectin Program for Control of Onchocerciasis in Ulanga, Tanzania","volume":"5","author":"V. Mushi","year":"2021","journal-title":"East Afr Health Res J"},{"key":"pntd.0011178.ref013","unstructured":"World Health Organization, African Programme for Onchocerciasis Control. Conceptual and operational framework of onchocerciasis elimination with ivermectin treatment Ouagadougou: African Programme for Onchocerciasis Control; 2010 [updated 2010. https:\/\/apps.who.int\/iris\/handle\/10665\/275466."},{"issue":"1","key":"pntd.0011178.ref014","doi-asserted-by":"crossref","first-page":"64","DOI":"10.1186\/s40249-018-0450-3","article-title":"High prevalence of epilepsy in two rural onchocerciasis endemic villages in the Mahenge area, Tanzania, after 20 years of community directed treatment with ivermectin","volume":"7","author":"BP Mmbando","year":"2018","journal-title":"Infect Dis Poverty"},{"issue":"5","key":"pntd.0011178.ref015","doi-asserted-by":"crossref","first-page":"425","DOI":"10.1684\/epd.2019.1093","article-title":"Clinical presentation of epilepsy in six villages in an onchocerciasis endemic area in Mahenge, Tanzania","volume":"21","author":"D Bhwana","year":"2019","journal-title":"Epileptic Disord"},{"key":"pntd.0011178.ref016","doi-asserted-by":"crossref","first-page":"50","DOI":"10.1016\/j.actatropica.2018.01.009","article-title":"The blackfly vectors and transmission of Onchocerca volvulus in Mahenge, south eastern Tanzania","volume":"181","author":"A Hendy","year":"2018","journal-title":"Acta Trop"},{"issue":"1","key":"pntd.0011178.ref017","doi-asserted-by":"crossref","first-page":"21","DOI":"10.1186\/s40249-018-0406-7","article-title":"From river blindness control to elimination: bridge over troubled water","volume":"7","author":"R Colebunders","year":"2018","journal-title":"Infect Dis Poverty"},{"issue":"3","key":"pntd.0011178.ref018","doi-asserted-by":"crossref","first-page":"e017188","DOI":"10.1136\/bmjopen-2017-017188","article-title":"Evolution of epilepsy prevalence and incidence in a Tanzanian area endemic for onchocerciasis and the potential impact of community-directed treatment with ivermectin: a cross-sectional study and comparison over 28 years","volume":"8","author":"H Greter","year":"2018","journal-title":"BMJ Open"},{"issue":"2","key":"pntd.0011178.ref019","first-page":"103","article-title":"D\u00e9pistage de l\u2019\u00e9pilepsie en zones tropicales: validation d\u2019un questionnaire en Mauritanie","volume":"99","author":"M Diagana","year":"2006","journal-title":"Bull Soc Pathol Exot"},{"issue":"5","key":"pntd.0011178.ref020","doi-asserted-by":"crossref","first-page":"369","DOI":"10.1159\/000517065","article-title":"Epidemiology of Epilepsy in Low- and Middle-Income Countries: Experience of a Standardized Questionnaire over the Past Two Decades","volume":"55","author":"M Vergonjeanne","year":"2021","journal-title":"Neuroepidemiology"},{"issue":"4","key":"pntd.0011178.ref021","doi-asserted-by":"crossref","first-page":"475","DOI":"10.1111\/epi.12550","article-title":"ILAE official report: a practical clinical definition of epilepsy","volume":"55","author":"RS Fisher","year":"2014","journal-title":"Epilepsia"},{"issue":"28","key":"pntd.0011178.ref022","first-page":"603","article-title":"Prevalence of nodding syndrome\u2014Uganda, 2012\u20132013","volume":"63","author":"PJ Iyengar","year":"2014","journal-title":"MMWR Morb Mortal Wkly Rep"},{"issue":"8","key":"pntd.0011178.ref023","doi-asserted-by":"crossref","first-page":"857","DOI":"10.1002\/(SICI)1097-0258(19980430)17:8<857::AID-SIM777>3.0.CO;2-E","article-title":"Two-sided confidence intervals for the single proportion: comparison of seven methods","volume":"17","author":"RG Newcombe","year":"1998","journal-title":"Stat Med"},{"issue":"1","key":"pntd.0011178.ref024","doi-asserted-by":"crossref","first-page":"114","DOI":"10.1186\/s40249-018-0497-1","article-title":"Epidemiology of onchocerciasis-associated epilepsy in the Mbam and Sanaga river valleys of Cameroon: impact of more than 13 years of ivermectin","volume":"7","author":"JN Siewe Fodjo","year":"2018","journal-title":"Infect Dis Poverty"},{"issue":"6","key":"pntd.0011178.ref025","doi-asserted-by":"crossref","first-page":"ofaa206","DOI":"10.1093\/ofid\/ofaa206","article-title":"A Second Population-Based Cohort Study in Cameroon Confirms the Temporal Relationship Between Onchocerciasis and Epilepsy","volume":"7","author":"CB Chesnais","year":"2020","journal-title":"Open Forum Infect Dis"},{"issue":"3","key":"pntd.0011178.ref026","doi-asserted-by":"crossref","first-page":"e0009144","DOI":"10.1371\/journal.pntd.0009144","article-title":"A systematic review and an individual patient data meta-analysis of ivermectin use in children weighing less than fifteen kilograms: Is it time to reconsider the current contraindication?","volume":"15","author":"P Jittamala","year":"2021","journal-title":"PLoS Negl Trop Dis"},{"issue":"Suppl 11","key":"pntd.0011178.ref027","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1111\/j.0013-9580.2005.t01-1-53904.x-i1","article-title":"Epilepsy and mortality in Africa: a review of the literature","volume":"46","author":"AG Diop","year":"2005","journal-title":"Epilepsia"},{"issue":"2","key":"pntd.0011178.ref028","doi-asserted-by":"crossref","first-page":"225","DOI":"10.4269\/ajtmh.2011.10-0544","article-title":"Association between onchocerciasis and epilepsy in the Itwara hyperendemic focus, West Uganda: controlling for time and intensity of exposure","volume":"85","author":"C Kaiser","year":"2011","journal-title":"Am J Trop Med Hyg"},{"key":"pntd.0011178.ref029","doi-asserted-by":"crossref","first-page":"108568","DOI":"10.1016\/j.yebeh.2022.108568","article-title":"Community knowledge, attitudes, and practices regarding epilepsy in Mahenge, Tanzania: A socio-anthropological study in an onchocerciasis-endemic area with a high prevalence of epilepsy","volume":"128","author":"BP Mmbando","year":"2022","journal-title":"Epilepsy Behav"},{"issue":"4","key":"pntd.0011178.ref030","doi-asserted-by":"crossref","DOI":"10.3390\/brainsci8040059","article-title":"Quality of Life and Stigma in Epilepsy, Perspectives from Selected Regions of Asia and Sub-Saharan Africa","volume":"8","author":"W Boling","year":"2018","journal-title":"Brain Sci"},{"key":"pntd.0011178.ref031","doi-asserted-by":"crossref","first-page":"108372","DOI":"10.1016\/j.yebeh.2021.108372","article-title":"A peer support group intervention to decrease epilepsy-related stigma in an onchocerciasis-endemic area in Mahenge, Tanzania: A pilot study","volume":"124","author":"D Bhwana","year":"2021","journal-title":"Epilepsy Behav"}],"updated-by":[{"DOI":"10.1371\/journal.pntd.0011178","type":"new_version","label":"New version","source":"publisher","updated":{"date-parts":[[2023,7,11]],"date-time":"2023-07-11T00:00:00Z","timestamp":1689033600000}}],"container-title":["PLOS Neglected Tropical Diseases"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pntd.0011178","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,10,23]],"date-time":"2024-10-23T07:17:39Z","timestamp":1729667859000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pntd.0011178"}},"subtitle":[],"editor":[{"given":"Uwem Friday","family":"Ekpo","sequence":"first","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]}],"short-title":[],"issued":{"date-parts":[[2023,6,28]]},"references-count":31,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2023,6,28]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pntd.0011178","relation":{"new_version":[{"id-type":"doi","id":"10.1371\/journal.pntd.0011178","asserted-by":"object"}]},"ISSN":["1935-2735"],"issn-type":[{"value":"1935-2735","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,6,28]]}}}