THE CLINICAL AND SOCIAL CHARACTERISTICS OF EPILEPTIC PATIENTS IN ULANGA DISTRICT, TANZANIA

During a community-based epilepsy study in Ulanga, a rural district in Tanzania, 203 of 207 individuals with epilepsy were studied in detail to identify their clinical and psychosocial characteristics. They had a mean age of 27.9 + 16.9 (SD) and male-to-female ratio of 0.8. Their mean age of onset of seizures was 15.4 years (range, 1 month to 85 ye ars), and the mean duration of seizures was 12 years (range, 0 months to 57 years). Partial seizures accounted for 66 (32.5%), generalized s eizures 120 (59.1%), and 17 (8.4%) were unclassifiable. Most 46 (69.7 %)! partial seizures were secondary generalized, whereas, of the gener alized seizures, generalized tonic-clonic accounted for 112 (93.3%). T he patients were on no regular treatment, and most had active epilepsy , with 161 (81.3%) experiencing one or more seizures during the preced ing year. Burns with contractures or disfiguring scars were the most f requent physical complications and occurred in 49 (24.1%) of the cases . Twenty-three (21.7%) of the cases were assessed to have subnormal in telligence that adversely affected their chance of attending or comple ting school. Of the 181 patients who were at or above school age, 56 ( 30.9%) had never attended school, whereas of 124 who attended school a nd whose school outcome was evaluated, only 37 (29.8%) completed the p rimary school level; 78 (62.9%) stopped prematurely. School outcome wa s adversely affected by onset of seizures before school age and subnor mal intelligence. Of the 116 individuals above marriageable age (above 19 by rural standards), 39 (33.6%) were married, 49 (42.2%) were sing le, i.e., never got married, whereas 23 (19.8%) were divorced. More wo men than men tended to get married, only to end in a higher divorce ra te (29.2% in women compared to 4.5% in men). Early onset of seizures ( before the marital age of 19 years) was associated with a lower rate o f getting married, whereas the rate of marriage for those getting seiz ures after age 19 was higher but with an increased rate of divorce. Th e study indicates poor social functions with respect to schooling and marriage among persons with seizures. Detailed studies are required to find out the attitudes and beliefs behind those handicaps before psyc hosocial intervention programs are initiated.