The prevalence, risk factors and behavioural and emotional consequences of acute seizures in a rural Kenyan setting

The incidence of acute seizures (e.g. both febrile seizures and acute symptomatic seizures) is higher in Africa than elsewhere, but most studies are based on hospital admissions. Acute seizures in children are associated with behavioural/emotional problems which may be related to the seizures, underlying aetiology, neurological impairments and/or genetic predisposition. Behavioural/emotional problems occur in up to 26% of older Kenyan children in the community, but there are no large community-based studies in preschool children in Africa to plan interventions. I screened 7,047 children aged 1-6 years living in Kilifi, Kenya for acute seizures with a proportion of these (N=3,273) examined for behavioural/emotional problems using the Child Behaviour Checklist (CBCL). Factorial structure of the CBCL was examined using structural equation modelling, while associations were determined using several regression analysis techniques. Prevalence of behavioural/emotional problems and acute seizures was computed as a probability of occurrence, by exponentiation of the constant term of a logit model. The CBCL had between good and excellent psychometric properties and the seven-syndrome structure fitted well with the Kenyan preschool children. The prevalence of total behavioural/emotional problems was high (13% (95%CI, 12%-14%)) and so was that for acute seizures (6.1% (95%CI, 5.5%-6.8%). Behavioural/emotional problems were particularly associated with seizure disorders, which explained the greatest variation in a structural equation model. Risk factors for acute seizures included family history of seizures, previous hospitalisation and snoring at night. The overall crude prevalence of behavioural/emotional problems in those with acute seizures was 27% (95%CI, 21%-34%), being significantly greater than for those without seizures (11% (95%CI, 11%-12%); X2 p≤0.001). Acute seizures remained associated with behavioural/emotional problems (RR=2.40 (95%CI, 1.61-3.58)), externalising problems (RR=2.09 (95%CI, 1.40-3.13)) and internalising problems (RR=1.99 (95%CI, 1.36-2.91)), after accounting for potential confounders. The prevalence of behavioural/emotional problems and acute seizures is high in preschool children in this rural area, and are associated with preventable risk factors. Behavioural/emotional problems are associated with acute seizures and should be assessed and addressed in preschool children with seizures.