The prevalence and determinants of epilepsy in Ghana: A population‐based study in two districts using a three‐stage approach

OBJECTIVE: Epilepsy imposes a disproportionate burden in Africa, yet there are no reliable epidemiological data from Ghana. This community-based cross-sectional survey addressed this gap in southeastern Ghana, incorporating an analytical comparison of confirmed cases and age- and sex-matched controls. METHODS: We conducted a population-based cross-sectional study using a validated tool and a three-stage screening approach to estimate the prevalence of active epilepsy in the two Ghanaian districts of Shai-Osudoku and Ningo-Prampram. The three-stage approach consisted of population screening, detailed individual assessment, and clinical confirmation by specialists. To identify factors associated with epilepsy, we conducted a cross-sectional analysis comparing confirmed cases with age- and sex-matched controls randomly selected from the same population. Trained fieldworkers administered standardized questionnaires to capture sociodemographic data and historical risk exposures. RESULTS: The attrition-adjusted prevalence of active epilepsy was 8.84 per 1000 people (95% confidence interval [CI]: 8.00-9.68), higher in Shai-Osudoku (12.30 per 1000) than in Ningo-Prampram, and greatest in remote rural areas. Prevalence was higher among males (10.53 per 1000) and peaked at ages 20-29 years (11.44 per 1000). The poorest quintile had a prevalence three times that of the wealthiest. In children (≤16 years), fever-related convulsions (adjusted odds ratio [aOR] = 94.75; 95% CI: 17.40-515.96; p < .001) and history of cerebral/severe malaria (1.03; 95% CI: 1.01-1.06; p = .003) were strongly associated with epilepsy; younger males had higher odds (2.78; 95% CI: 1.12-6.88). In adults, household members with epilepsy (6.21; 95% CI: 2.56-15.11), family history (3.55; 95% CI: 1.13-11.19), head injury (24.45; 95% CI: 3.07-194.60), and household ownership of cats (1.76; 95% CI: 1.10-2.81) or pigs (2.26; 95% CI: 1.10-4.66) were significant risk factors. SIGNIFICANCE: Our findings highlight a high burden of epilepsy in southeastern Ghana, with variations observed across geographic, demographic, and socioeconomic groups. Modifiable risks such as head injury and cerebral or severe malaria highlight urgent needs for targeted prevention, improved health care access, and poverty alleviation strategies.