Friday, December 7, 2012

Preventing Epilepsy in Burkina Faso

Epilepsy has been shown to be nearly 10 times more frequent and remains a highly stigmatized disease in developing countries. In areas where pigs are raised traditionally (i.e., free roaming) and where sanitation is poor, it has been shown that about 29% of people with epilepsy have lesions of neurocysticercosis (NCC) in their brain. NCC is a zoonotic parasitic infection of the brain caused by the tapeworm Taenia solium, which infects both humans and pigs. Humans carry the adult form of the worm which they acquire from eating undercooked contaminated pork meat. Pigs get infected by directly eating feces or food contaminated with human feces. Humans may get NCC when ingesting food (or possibly water) contaminated with human feces. Hélène Carabin, DVM, PhD, a researcher with the OU Health Sciences Center, is pioneering a unique community-based randomized controlled study (60 villages in 30 departments and 3 provinces of Burkina Faso) to assess if an educational package could cut the life cycle of the worm to prevent epilepsy.

Villagers in Burkina Faso raise pigs as part of their household livelihood.
Dr. Carabin's research team in Burkina Faso initially focused on pig management - limiting the movement of pigs to stop them from having access to human feces as a way of curtailing the cycle of transmission. Using focus groups and in-depth interviews, the team realized that improved pig management was not a feasible option, given the community's behaviors, preferences and the difficulty in finding food for the pigs. The participants, however, were knowledgeable about the risks of open defecation and were willing to improve sanitation. The research team then considered community-led total sanitation (CLTS), an innovative methodology for mobilizing communities to completely eliminate open defecation (OD). Communities are facilitated to conduct their own appraisal and analysis of open defecation and take their own action to become ODF (open defecation free). But CLTS is costly and requires extensive support.

And so the team has agreed upon a more successful and sustainable approach, and one that is ingeniously American - make a movie! The group hired a local filmmaker to film an educational comedy that advocates and teaches about the life cycle of the disease and how to prevent it through improved sanitation and pig management. To accompany the movie, they worked with Water and Sanitation for Africa (WSA) to adapt previously used PHAST (participatory hygiene and sanitation training) tools to emphasize the role of pigs in the disease. They also developed a comic book to accompany the movie. The field team has started the first follow-up visits in September and is offering the intervention to half of the villages. The team is now analyzing the baseline portion of the study.

Dr. Helene Carabin (left) with Dr. Linda Cowan on location in Pabre.
Dr. Carabin is a frequent collaborator with the OU WaTER Center. Her research includes study of infectious diseases, especially zoonotic infections that are transmitted between species of animals, including humans. Many of these diseases are transmitted due to poor sanitation and some are water-borne, water-based; they are significantly more problematic in regions of the world which lack sanitation and clean drinking water. Dr. Carabin wishes to acknowledge her colleagues in Burkina Faso (Rasmané Ganaba DVM PhD, Athanase Millogo MD, Jean-Bosco Ouédraogo PhD, and Zékiba Tarnagda DVM PhD) and in Belgium (Pierre Dorny DVM PhD and Nicolas Praet DVM PhD).
This study is funded by the National Institute of Neurological Disorders (NINDS) and the Fogarty International Center (FIC) under the BRAIN program.

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