Prevalence and factors associated with epilepsy among people aged 12 years and older in Beoumi, Botro and Sakassou districts of Gbeke region, Cote d’Ivoire: a community-based cross-sectional study

Epilepsy is a major neurological disorder affecting more than 50 million people worldwide, with nearly 80% of the disease burden occurring in low- and middle-income countries. Despite this substantial burden, population-based data on epilepsy prevalence in Cote d’Ivoire remain scarce, limiting evidence-based planning and implementation of effective control strategies. In response, Medecins Sans Frontieres (MSF) initiated an epilepsy and mental health programme in the Gbeke region in 2021. This study was conducted to estimate the prevalence of epilepsy in the general population and to identify sociodemographic factors associated with epilepsy in this setting. We conducted a cross-sectional, community-based household survey between 29 April and 31 May 2025 in three districts of the Gbeke region (Beoumi, Botro, and Sakassou), located in central Cote d’Ivoire. A two-stage cluster sampling design was used to recruit 2,586 participants aged 12 years and older, with villages selected by probability proportional to size as first-stage clusters and households selected within villages. This age restriction was applied because the screening questionnaire was validated for adolescents and adults; younger children would have required specialized pediatric neurological evaluation beyond the operational scope of the survey. Screen-positive participants were subsequently evaluated by neurologists for diagnostic confirmation using clinical assessment and supportive diagnostic investigations when indicated. Epilepsy prevalence and 95% confidence intervals (CI) were estimated using survey methods that account for the two-stage cluster design, and survey-adjusted analyses were used to identify factors associated with epilepsy. Among 2,586 participants (61.7% female; 70.3% rural), 424 screened positive, 288 were assessed by a neurologist and 59 were confirmed to have epilepsy, corresponding to a survey-adjusted prevalence among residents aged 12 years and over of 22.8 per 1,000 (95% CI: 17.4-29.3); adjustment for the published sensitivity of the screening instrument gave 24.0 per 1,000. Prevalence was 33.2 per 1,000 in Botro, 23.8 per 1,000 in Sakassou and 11.9 per 1,000 in Béoumi, and the district association was not statistically significant (design-adjusted p = 0.147). In the prespecified primary model, only age was associated with epilepsy (aOR 0.98 per additional year; 95% CI: 0.95-1.00; p = 0.038). In an exploratory model additionally including marital status, education and occupation, single status (aOR 2.72; 95% CI: 1.20-6.17) and home-based work (aOR 3.88; 95% CI: 1.20-12.53) were associated with epilepsy, but with 3.5 events per variable these estimates are unstable and are reported as exploratory. Of the 59 confirmed cases, 57 met the definition of active epilepsy, and 33 of them (57.9%; 95% CI: 38.4-75.2) were not receiving antiseizure medication; among all 59 confirmed cases the proportion was 35 (59.3%). Among residents aged 12 years and older in Béoumi, Botro and Sakassou districts, epilepsy prevalence was 22.8 per 1,000. Close to six in ten people with active epilepsy were not receiving antiseizure medication. Apart from age, the sociodemographic associations come from an exploratory model and should not be interpreted causally, given the small number of cases and the cross-sectional design. The findings support strengthening access to epilepsy diagnosis, antiseizure medication and continuity of care in the three study districts.