Neurocysticercosis : a possible cause of epileptiform fits in people residing in villages served by the Bethanie clinic in the North West Province

Abstract

A study to detect human taeniasis and cysticercosis was conducted in four village communities served by the Bethanie clinic in the North West Province. It was selected because of reports of people being diagnosed with epileptiform episodes (fits/seizures). The total population of the four villages is estimated at 13 947 and many house holders rear pigs in small numbers for both meat and an immediate income. The primary aims of the work were to conduct in the study area a census of all small scale pig producers and a survey of rural village consumers – both by means of a structured questionnaire. In the former, to review pig husbandry practices, slaughter and marketing of pigs and in the latter, to provide information on pork consumption, sanitation as well as people’s knowledge of Taenia solium. From the questionnaires the total number of patients with recorded seizures in the study area, within the selected time frame were determined. Stool samples from consenting participants were screened for T. solium. A descriptive analysis of retrospective data was conducted to determine the proportional morbidity of neurocysticercosis from the medical records of patients diagnosed with seizures in an attempt to establish possible sources of infection and routes of transmission. Secondary objectives were to determine more accurately the total pig population in the study area and to determine the prevalence of cysticercosis in pigs through inspection of those slaughtered at an approved abattoir – surprisingly all found to be negative. The questionnaires revealed a poor understanding of the disease, poor sanitation and hygiene, poor methods of pig husbandry and poor meat inspection and control in rural smallholder communities. There was no significant statistical difference in the proportion of households reporting evidence of epilepsy, between those who owned pigs and those that did not. The incidence of high risk behavior is common, and there is a strong evidence of a tendency towards an association between epilepsy, consumption habits and various epidemiological factors which were considered as possible risk factors. The fact that no T. solium proglottids were found in the faecal samples collected is elaborated on. It is considered unlikely, but possible that the consumer/farmer information days played a significant role in the outcome of this study.