Open access peer-reviewed chapter

Taenia solium Cysticercosis in Pigs and Human: A Review of Epidemiological Data in West Africa (1990–2019)

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Rebecca Weka, Pam Luka, Ndudim Ogo and Paul Weka

Submitted: June 11th, 2019 Reviewed: September 5th, 2019 Published: April 22nd, 2020

DOI: 10.5772/intechopen.89559

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Taenia solium taeniasis/cysticercosis/neurocysticercosis is a neglected zoonotic disease endemic in sub-Saharan Africa, Latin-American and Asia and is an emerging public health and economic problem. The association between cysticercosis and epilepsy has been documented worldwide including West Africa. Poor sanitary conditions, traditional pig farming and poverty play an important role in perpetuation of Taenia solium. There has been limited research undertaken in T. solium in human and pigs in some West African countries, where prevalence of taeniasis was up 40%, human cysticercosis 10.3%, porcine cysticercosis 32.5–39.6% and epilepsy 28.0/1000–43.0/1000. The study identified porcine cysticercosis in 18 countries, human cysticercosis in 19 countries, taeniasis in 4 countries and epilepsy was reported in 25 countries. The aim of this study is to review scientific literature on the epidemiology of T. solium infections in pigs and humans in Western Africa and document data on the prevalence of epilepsy in the region. The objective is to document occurrence of disease in West Africa so as to offer options available for control. The study conducted literature search of online international databases of published resources for information on T. solium in Western Africa and Epilepsy from 1990 to 2018.


  • Taenia solium
  • epilepsy
  • human
  • pigs
  • West Africa
  • literature search
  • epidemiology

1. Introduction

Parasitic zoonoses are becoming increasingly important in the spectrum of emerging and re-emergent diseases for both developed and developing countries, and are typically associated with poor marginalized countries in low-income countries. They are regarded as disease of the poorest among the poor [1, 2, 3]. Taenia solium is found in sub-Saharan Africa, Central Asia and Latin America where domestic pig husbandry is practiced, poverty, illiteracy and deficient sanitary infrastructures are common [1, 4, 5]. Similarly, the disease has been reported in urban areas where most of the infected pigs are transported and consumed. The incidence of the disease in humans is increasing and now is a re-emerging disease in some developed countries and in areas of non-endemicity, due to international travel and immigration [6, 7]. Hence cysticercosis/neurocysticercosis/teaniosis complex caused by the larval stage of T. solium in both pigs and humans remains a significant cause of human morbidity and mortality in many parts of the world. It is seriously affecting pig production and also considered as a public health and economic problem in many developing countries affecting food security and negatively impacts the nutritional and economic well-being of the small holder farming community [8, 9].


2. Life cycle

2.1 Life cycle and pathogenesis

Taenia solium life cycle is sustained where free roaming pigs, have access to contaminated feces of tapeworm carriers. T. solium has a complex two host life cycle and is cyclically transmitted between pigs and man. Humans are the only definitive host and harbor the adult stages of these cestodes following ingestion of insufficiently cooked pork meat infested with cysticerci. Infection with the adult stage is relatively innocuous and carries mild clinical manifestations leading to taeniasis [1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11]. Pigs are the natural intermediate host, while human’s acts as the accidental dead-end intermediate host and are both infected with T. solium by ingestion of embryonated eggs from feces of tapeworm carriers from contaminated soil, water, vegetation/foods to form cysticerci. Infection with the cysticerci leads to more severe symptoms including headache and neurocysticercosis when the pathology occurs in the CNS [11].

2.2 Epidemiology

Neurocysticercosis has been considered to be the most common parasitic infestation of the central nervous system and the single most common cause of preventable acquired epilepsy and mortality in developing countries [12, 13, 14], and a strong correlation was reported between the prevalence of epilepsy and seropositivity against T. solium cysticercosis [15]. The association between cysticercosis and epilepsy has been documented as a leading neurological condition worldwide including West Africa. Epilepsy is a frequent chronic neurologic disorder that affects approximately 70 million people of all ages worldwide [15] Studies of [10] in 2010 reported that the median prevalence of active epilepsy was 4.9/1000 (2.3–10.3) for developed countries, 12.7/1000 (3.5–45.5) and 5.9/1000 (3.4–10.2) in rural and urban studies in developing countries. Neurocysticercosis has been associated with 30% of adult onset epilepsy in endemic regions where 10–20% of the general population can have brain lesions consistent with neurocysticercosis on CT scans [16]. Neurocysticercosis creates a tremendous economic burden in endemic areas incurring significant costs due to diagnosis, treatment and disability [17]. Poor sanitary conditions, traditional pig farming, lack of awareness of the disease and poverty play an important role in the perpetuation of the Taenia solium/cysticercosis, and are present in West Africa [18]. Research in the region on Taenia solium cysticercosis and taeniasis in both human and pigs has been limited. Prevalence information of the disease in some countries within the region has been scanty leading to underestimation of the prevalence, epidemiology and clinical impacts of the disease which has made it difficult to make definitive recommendations on control strategies. Data on porcine and human cysticercosis are available from several countries. However, there is no recent information on T. solium taeniasis-cysticercosis complex in some countries including Guinea Bissau, Liberia, Ivory coast and Sierra-Leone [19] as shown in Tables 1 and 2. The aim of this study is to review scientific and gray literature and to identify the empirical data on T. solium taeniasis/human/porcine cysticercosis/neurocysticercosis/epilepsy in West Africa and the risk factors responsible for the epidemiology of T. solium cysticercosis in order to understand the differences in exposure to the parasite in endemic areas around the world. This will give an update and compile the current knowledge on T. solium in Western Africa, including risk factors for infections in pigs and humans cysticercosis (HCC) from endemic communities. The objective of the study will be to review and document data on the prevalence of human cysticercosis/neurocysticercosis in the region with emphasis on epilepsy.

AuthorCountry/locationDiagnosisTotalPrevalenceType of study
[20]Benin, Southern BeninMeat inspection118.0730.06–0.69%Abattoir
[21]Burkina Faso, OuagadougouMeat inspection62,3110.22 (n = 139)Abattoir
[22]Burkina FasoB158/B60 Ag-ELISA33632.5–39.6%Cross sectional
[58]Burkina FasoMeat inspection117,0260.57% (n = 673)Abattoir
[59]Ghana, KumasiAnte mortem/post mortem41212.31% (n = 95)Cross sectional
[60]Ghana, Upper East RegionPost mortem6011.70%Cross sectional
[61]Nigeria, Bodija, Ibadan, Oyo StateMeat inspection5931.01% (n = 6)Abattoir
[62]Nigeria, Michika, Adamawa State,Post mortem2473.2% (n = 8)Cross sectional
[65]Nigeria, Nasarawa and Gonin Gora,Chikun, KadunaPost mortem439.3% (n = 4)Cross sectional
[63]Nigeria, Jalingo, Taraba StatePost mortem3234.95% (n = 16)Cross sectional
[23]Nigeria, Zuru, Kebbi StateLingual, post mortem42085.85% (n = 205)
14.4% (n = 118)
Cross sectional
Bodija, Ibadan,
Post mortem2504.4% (n = 11)Cross sectional
[24]Nigeria, Ibi Taraba StateAntemortem/post mortem43806.25% (n = 274)Cross sectional
[25]Nigeria, Nsukka Enugu StateLingual/post mortem235820% (n = 483)Cross sectional
[26]Nigeria, Enugu State
Udenu, Igbo-Eze South Nsukka Enugu State
Post mortem3792.4% (n = 9)Cross sectional
[66]Nigeria, JosAntibody ELISA11546% (n = 29)Cross sectional
[67]Gambia, Western regionLingual, Ag-ELISA17054.8%Cross sectional
[67]SenegalLingual, Ag-ELISA17056.4–13.2%Cross sectional

Table 1.

Selected studies of porcine cysticercosis in West Africa 1980–2019.

AuthorCountry/locationDiagnosisTotalEpilepsy (n)NeurocysticercosisCysticercosisTaeniasis
[27]BeninCapture recapture/Neurlogist313420.1/1000 (n = 66) GPNDNDND
[28]BeninCapture recapture/Neurlogist11,66812.7/1000 (148) GPNDNDND
[29]Benin, SavolouAb-ELISA, skull/muscle X-ray and pathol. of cysts14431.5 (22/1443), 17/186 GP4.0% (n = 57)1% (n = 14 skin nodules)ND
[29]Benin, VekkyAb-ELISA, skull/muscle X-ray and pathol. of cysts319GP3.5% (319)NDND
[29]BeninAb-ELISA, skull/muscle X-ray and pathol. of cysts2625GP1.6% (n = 41)NDND
[30]BeninAB,ELISA/(EITB)262541/1.3% (35) GPNDNDND
[31]BeninQuestionnaire,clinical/neurologist13,0468.05/1000 (n = 105), GPNDNDND
[32]Burkina FasoB158/B60 AG-ELISA3609GPND0–11.5% (n = 120)ND
[33]Burkina FasoAg B158/B60 ELISA1729/1719GPND3·8% (n = 65)CC 2.7% (n = 47) (2.7%)ND
[34]Burkina Faso´ aB158/B60 Ag-ELISA763GPND6.29% (n = 48)ND
[35]Burkina FasoB158/B60 Ag-ELISA questionnaire/neurologist36963.9% (n = 145), GP3.4% (n = 129)ND
[36]Burkina FasoAgELISA/CT scan/neurologist8884.4$(39) epi, VLVL29% (20/68)NDND
[37]Burkina FasoAg-ELISA, physician8884.5% (39) of 70 VL5/39 epileptics (12.8%), 3.4% (28/814)NDND
[34]Burkina FasoQuestionnaire neurologist4768669 (14.0%), VL0.6% (29)NDND
[38]Burkina-Faso16,62710.6 per 1000, CBNDNDND
[39]Ghana BunkpuruKato-Katz technique494NDND13.15% (n = 65)
[40]GhanaKintampoQuestionnairesclinicians/western blot586,60710.1/1000ND0.01ND
[41]SenegalDirect fecal examinationNDNDND2/43* 4.65
[42]Fecal egg countNDNDND4/43** 9.30
[42]Worm expulsion/amorphological identificationNDNDNDND1/43***2.33
[43]Nigeria ebonyi/benue stateQuestionnaire2500 and 6000(n = 52) 20.8/1000 and (28) 4.7/1000, PBNDNDND
[44]Nigeria Agu-Abor/EnuguQuestionnaire, medical82280.6%/1000 (n = 49)NDNDND
[48]Nigeria KadunaAb-ELISA30014.3% (n = 43)ND
[45]Nigeria AbujaAn 8000 B-Scan ScanmateOcular cysticercosis
[70]Nigeria Ukpo,Dunukofia Anambra state,Door to door Questionnaire, neurologist68004.3/1000 (n = 29)NDNDND
[46]Nigeria Odeda, Ogun State,Sodium acetate acetic acid formalin concentration method (SAF-Ether)428ND40% (n = 175)
[25]Nigeria Nsukka Enugu State,Stool microscopy1525NDND8·6% (n = 131)
[47]Nigeria JosAb-ELISA125ND9.6% (n = 12)ND
[48]Nigeria NasarawaCopro Ag ELISA, questionnaire1030 (n = 3)
[49]Nigeria Ile-IfeSurgeon/histopathological, biopsyCysticercosis of breastND
[50]Nigeria, Edo State,Surgeon, histopathologicalCysticercosis in the anterior chamberND
101, CB
[71]Nigeria OsunSurgery, Occular UltrasoundIntraocular cysticercosisND
[42]Senegal Soutou(Ag-ELISA) and (EITB),CT scan4037.69 (n = 31)/7.69 (n = 31)23.3 (10/43)ND
[52]Senegal Pikine, DakarQuestionnaire, physician, electroencephalography4500(n = 64) 14.2/1000NDNDND
[53]Senegal76828.3/per 1000NDNDND
[41]Liberia4436(123) 28.0per 1000
[54]Liberia273343.0 per 1000, CBNDNDND
[55]MauritaniaNeurologist23634.7% (n = 82), HB
[56]Togo, Tone9155 for epi and 1343 for cyst (n = 5264) 2.4%18.6%/1000, GBND38/1000ND
[57]Togo, the Kozah district of North Togo5264(n = 88) 16/1000ND23.3% (n = 123)ND

Table 2.

Selected prevalence of human cysticersosis and epilepsy in west African countries.

2/43* 4.65, foot note =direct microscopy.

4/43** 9.30, foot note = Ritchie formol ether method.

1/43*** 2.33,foot note= Worm expulsion.

2.3 Methods

A systematic literature search was done on studies carried out on cysticercosis in humans and pigs, seroprevalence of cysticercosis in humans and pigs, neurocysticercosis/taeniasis, risk factors for transmission of cysticercosis and epilepsy in West Africa published between 1980 and 2019. This search focused on the articles in which data was obtained using the following techniques and protocols: (1) enzyme-linked immunoelectrotransfer blot (EITB), (2) enzyme-linked immunosorbent assay (B158/B60 Ag-ELISA or HP10 Ag-ELISA), (3) copro-antigen ELISA and real-time polymerase chain reaction assay (copro-PCR). Language restriction was applied, the considered languages were English and French. The selected databases for this study were: PubMed (, Google scholar and others. The search was performed from May 22 to August 22, 2019.

2.4 Literature search

The following data were included in this study (1) peer-reviewed studies of T. solium taeniasis/cysticercosis/neurocysticercosis, porcine cysticercosis and epilepsy in West Africa. (2) “Gray literature” on T. solium taeniasis/cysticercosis, neurocysticercosis presence in West Africa which consisted of informally published written materials including reports. We performed a literature search using PubMed ( with date restriction from January 1, 1980 to January 5, 2019 using the following search term: (solium OR Tapeworm OR Taeniasis OR Taeni* OR Taeniosis OR Neurocysticercosis OR Cysticerc* OR epilepsy) AND West Africa (Benin OR Burkina Faso OR Ivory Coast OR Cape Verde OR Gambia OR Ghana OR Guinea OR Guinea Bissau OR Liberia OR Libya OR Malawi OR Mali OR Mauritania OR Niger OR Nigeria OR Senegal OR Sierra Leone OR Togo). We also searched other databases such as Google Scholar (, Cab Direct ( and African Journals Online ( using the following keywords: “Taenia solium,” “porcine cysticercosis,” “neurocysticercosis,” “human cysticercosis” and “taeniasis” Epilepsy, West Africa.

2.5 Data extraction and collection

Presence of T. solium in this study was defined as a documented case of disease related to the tapeworm, whether it was diagnosed and documented as human cysticercosis, neurocysticercosis, porcine cysticercosis, taeniasis or epilepsy. Initially, we reviewed all titles and abstracts, if accessible, and excluded studies outside West Africa, and studies with no specified diagnostic technique, studies written in languages other than English and French, and studies not having full paper, that is, abstracts only experimental studies were also excluded.

2.6 Study selection

Figure 1 describes the review process and the number of articles selected at each stage of the review. From an initial number of 550 articles, only 121 were eventually used. The search selected by removal of duplicate studies from the title selection and studies performed before 1980. Secondly, another set of articles were excluded due to: (1) parasites other than T. solium; (2) studies performed in non-west African countries; (3) articles written in languages other than French and English; (4) studies not presenting original data and/or the techniques and protocols performed on their studies and (5) studies not related to T. solium epidemiology and epilepsy in West African countries. Finally, when full texts were read, the following were selected. Community-based studies, case reports, HCC prevalence reports available, HCC diagnosis using the EITB and Ag ELISA, porcine cysticercosis using carcass inspection and Ab and Ag ELISA, Taeniasis studies based on Copro-Ag ELISA and stool microscopy, and epilepsy studies based on questionnaire, medical or non-medical sources.

Figure 1.

Flow diagram.


3. Results

The search identified 66 studies that reported the prevalence of T. solium taeniasis/cysticercosis/neurocysticercosis and epilepsy in West Africa from 1980 to 2019.The study identified porcine cysticercosis in 18 countries, human cysticercosis in 19 countries, taeniasis in 4 countries and epilepsy was reported in 25 countries(Tables 1 and 2). Figure 1 shows the flow chart of the selection of literature for the informed prevalence estimations of studies included in this review; 8 from Benin (1PC/7HCC/PWE), 11 from Burkina Faso (3PC/8HCC/PWE), 1 from Gambia (PC), 4 from Ghana (2PC/1EP/1TE), 2 from Liberia (PWE), 1 from Mali (PWE), 1 from Mauritania (PWE), 24 from Nigeria (PC10/HCC/PWE14), 3 from Senegal (1PC/2PWEI) and 4 from Togo (4 PWE).

3.1 Porcine cysticercosis in West Africa

One epidemiological studies from Benin [20] used carcass inspection to determine the prevalence of porcine inspection and obtained a prevalence of 0.06–0.69% among a total of 118,073, slaughtered pigs. Two studies from Burkina Faso used carcass inspection to determine the prevalence of porcine cysticercosis and obtained a prevalence of 0.22–0.57% in a total of 179,337 pigs [21, 58]. One study used B158/B60 Ag-ELISA to determine the prevalence of active cysticercosis in pigs and obtained a seroprevalence of 32.5–39.6% among 336 pigs [22]. Two studies from Ghana determined the prevalence of porcine cysticercosis by carcass inspection and obtained the prevalence of 2.31–11.70% [59, 60], among a total of 4181 pigs. A total of 10 studies in Nigeria determined the prevalence of porcine cysticercosis by carcass inspection and obtained a prevalence of 1–20% [23, 24, 25, 26, 61, 62, 63, 64, 65] among a total population of 12,781 pigs. While one study determined the seroprevalence of porcine cysticercosis and obtained a seroprevalence of 46% IgG antibodies among 115 pigs [66]. A study in Senegal determined the prevalence of porcine cysticercosis by lingual inspection and obtained a prevalence of 0.1–1.0%, while Ag-ELISA gave a seroprevalence of 4.8% [67]. All the data are presented in Table 1.

3.2 Human cysticercosis, taeniasis and epilepsy in West Africa

Sero-epidemiological studies from 16 countries were selected for the West African region, 3 studies [29] from Benin used Ab-ELISA, skull/muscle X-ray and pathology of cysts and a study used both Ab-ELISA and EITB [30]. The total number of individuals sampled for serological testing in this region was 4387. Prevalence of circulating antibodies ranged from 1 to 4%. Detailed description of each study is given in Table 2. The total number of individuals examined for epilepsy survey in the region was 27,848, excluding 1443 individuals that were involved in the serological study by [29]. Three studies used door-to-door method of survey in estimating the prevalence of epilepsy [27, 30, 31]. Two of the authors used capture/recapture method. They used questionnaires/neurologist to diagnose epileptics [27, 30, 31] and according to definition by the ILAE 1989, and PAANS [68, 69]. The prevalence of epilepsy in the country ranged from 8.08/1000 to 20.1/1000. A study [29] linked the 1.5% seroprevalence epilepsy to the prevalence of human cysticercosis. A 0–29% human cysticercosis seroprevalence in Burkina Faso was obtained from six studies using Ag-ELISA [32, 33, 34, 36, 37] and the prevalence of epilepsy in the region ranged from 4.5 to 14% per 1000. The total individuals sampled for seroprevalence studies were 13,413. Three of the studies associated the prevalence of epilepsy to cysticercosis [36, 37]. Two studies [34, 38] estimated the prevalence of epilepsy only, with a total individuals sample size of 29,315 excluding studies that associated the prevalence of epilepsy with cysticercosis.

Human taeniasis from Ghana was obtained from a study performing the Katao Khazt method and obtained a prevalence of 13.3% in a total sample size of 44 individuals [39]. Human cysticercosis in Ghana was obtained from a study by western blot and obtained a prevalence of 0.01% and the same study estimated the prevalence of epilepsy as 10.1/1000 in a total population size of 586,607 [40]. Human cysticercosis from Nigeria was obtained from two studies [47, 48] by using Ab ELISA with prevalence of cysticercosis ranging from 9.6 to 14.3% in a total of 425 individuals. There were five studies selected for epilepsy [43, 44, 51, 70] with prevalence ranging from 4.3/1000 to 20.8/1000 in a total of 64,979 individuals for the epilepsy study. Five studies in the region were case report of cysticercosis [45, 49, 50, 71] involving the ocular and breast cysticercosis. Human taeniasis was obtained from two studies by stool microscopy [25, 46] with a prevalence ranging from 8.6 to 40% among a total of 1953 individuals in the region. Human cysticercosis in Senegal was obtained from one study performing antigen and antibody ELISA [42]. The total number of individuals in the study were 403, and prevalence of both antigen and antibody was 7.6%.The prevalence of epilepsy in the country was obtained from two selected studies [52, 53] and the prevalence of epilepsy ranged from 8.3/1000 to 14.2/1000 in a total of 12,182 individuals. Prevalence of epilepsy from Liberia was obtained from two studies [41, 54] and the prevalence of epilepsy across the region ranged from 28.0/1000 to 43.0/1000 among a total of 7169. Prevalence of epilepsy from Mauritania was obtained in one study [55] with a prevalence of 34.7/1000 in a total of 236 individuals. Human cysticercosis was obtained from two sero-epidemiological studies from Togo by antibody ELISA and gave a prevalence of 23.3 [57] and cysticercosis 38/1000 [56] among a total of 14,419 individuals. The two studies also estimated the prevalence of epilepsy and obtained 16/1000 and 18.6/1000 [56, 57] among a total of 6607. A detailed description of each study is given in Table 2.

3.3 Risk factors for human cysticercosis in West Africa

Out of the selected articles reviewed, 16 identified risk factors associated with the prevalence of Taenia solium cysticercosis, taeniasis, epilepsy and porcine cysticercosis. Lack of proper meat inspection, clandestine slaughtering of pigs and illegal sales of meat leading to poor sanitary control were all risk factors that were associated with an increased prevalence of cysticercosis in Benin Republic [30] as it will promote sale of infected pork carcass to unsuspecting consumers (since condemnation cannot be carried out) and predispose them to infection by these parasites (taeniasis) which increases transmission of infection in the community while increase age, stigma and lack of medical facilities were associated with increase prevalence of epilepsy, people with epilepsy may hide their true identity due to fear of marginalization and may not get proper health care [31]. In Burkina Faso, being a male, pig farming including percentage of soil in sand, residing in poor homes, lack of latrine. Males may have poor hygiene compared with females as they are likely to eat improperly washed fruits or vegetables after purchase and may eat food from food vendors prepared outside the home who might be carriers of the adult tapeworm. The authors also thought the acidic nature of the gastrointestinal tract might have made the eggs tolerate slightly more acidic soil. The higher soil (sandy) percentage might have favored spread of taenid eggs unto vegetation and water by wind. Carabin et al. [32] and living in communities with higher percentage of traditional pig husbandry [32, 36] were risk factors associated with the seroprevalence of cysticercosis [32]. Other factors include pig ownership, preparation method of pork by mothers, access to latrine [33] and pork consumption, pork consumption is associated with cysticercosis either by self-infection or through ingestion of contaminated food and water [32, 37]. Interestingly, previous consumption of pork, being a paid worker or trader as against farmer and housewives was also associated with the seroprevalence of cysticercosis [22, 37]. It was also observed that free roaming pigs in the rainy season and knowledge of porcine cysticercosis was associated with an increase prevalence of porcine cysticercosis. Free roaming pigs get exposed to infected human feces deposited in the bush or open field thereby increasing the chance of infection and spread of porcine cysticercosis. Being a residence with more than one individual having epilepsy was associated with higher prevalence of active cysticercosis. Refs. [34, 36] observed that NCC and epilepsy were observed in older people compared with people with epilepsy without NCC. In addition, NCC was associated with epilepsy in communities where pig husbandry is practised and higher prevalence of NCC was observed in people with epilepsy. In Ghana, pork consumption and consumption of measly pork and pork soups lightly cooked were risk factors for taeniasis [39], while hypertension and exposure to Taenia solium infection were risk factors responsible for adult onset of epilepsy [40]. In Nigeria, pork preparation method and history of epilepsy was associated with seroprevalence of cysticercosis. Heat generated from boiling or frying is likely to kill the metacestode compared with heat from roasting or barbecuing [48]. Others include type and availability of toilets, open defecation, lack of personal hygiene after toilet use, pork consumption and traditional system of pig management [47]. One of the risk factors for epilepsy was history of febrile convulsions [70], purchasing home slaughtered pigs, lack of toilet facilities [64], sourcing pig from the northern part of the country and local breed of pigs [26]. It was observed in Senegal that the risk factor for seropositivity to cysticercosis was older age group and lack of latrine [42].


4. Discussion

Majority of studies on epilepsy use various combination of screening questionnaires, clinical confirmation by neurologists, general practitioners or medical students to identify cases of epilepsy with screening questionnaires developed by World Health Organization (WHO) [72] and Limoges Institute of Epidemiology and Tropical Neurology IENT questionnaire [69]. Epileptic seizures, which are the most common presentation of neurocysticercosis, have been documented in developing countries, which is three to six times higher than those in developed countries [68]. Causes of epilepsy are highly variable across different regions of sub-Saharan Africa and depend on geographical, climatic, political, social and hygienic conditions [73]. The main and most important causes of epilepsy seem to be very similar throughout sub-Saharan Africa showing that hypertension [40]. A genetic predisposition, a past history of febrile convulsions, perinatal neurological disorders, head injuries, cerebrovascular accidents and infections of the central nervous system account for most cases of epilepsy [73] Other presumed causes include witch craft/spiritual [43, 74], brain tumor [75], blood transmission and birth trauma due to self-delivery. Also included are protozoon and helminthic infections, including admission to hospital with malaria, exposure to T. canis, T. gondii, O. volvulus and T. solium [40] of which Taenia solium has received attention in sub-Saharan Africa over the past few years. Neurocysticercosis is a common cause of epilepsy in pig breeding area [76], however the wide variation in the frequency of epilepsy in the continent could be due to different definitions and type of epilepsy including the population studied and type of sample [44]. Some studies in the region showed the association between epilepsy and cysticercosis using different diagnostic criteria both for epilepsy and cysticercosis. These include three studies in Burkina Faso, of which some researchers [34] showed a seropositivity between cysticercal antigens and active epilepsy with a prevalence odds ratio (POR) of 2.40 (95%). A second study [36] showed 68 of the subjects confirmed with epilepsy by CT scan and 20 were diagnosed with definitive NCC (for a proportion of 45.5–46.9% in two of the study villages). The third study [37] showed that 39 of 70 positive were confirmed with epilepsy for a lifetime prevalence of 4.5% and epilepsy was associated with cysticercosis by Ag-ELISA (POR = 3.1, 95% BCI = 1.0; 8.3). All three studies confirmed epilepsy by ILAE definition/physician. In Senegal, a study [42] showed that one of 10 CT-scan positives individual by Ag-ELISA and EITB was reported to have epileptic seizures, and cerebral CT-scans showed that 23.3% of the seropositive were affected by neurocysticercosis. In Togo, a previous study [57] showed that cysticercosis (confirmed by ELISA, anatomopathological examination, cranial or muscle X-ray) caused 29.5% epilepsy in sufferers. A study by [40] in five Health and Demographic Surveillance System centeres in Kintampo Ghana and four other countries (Kenya, South Africa, Uganda and Tanzania) showed that epilepsy was significantly associated with exposure to T. solium (odds ratios 7·03, P = 0·002), in adults epilepsy confirmed by questionnaire/clinician and cysticercosis was confirmed by detection antibody by Western Blot, while active convulsive epilepsy in the study was defined as two or more unprovoked convulsive seizures (occurring at least 24 h apart, with at least one seizure in the preceding 12 months).

The stigmatization and marginalization of epilepsy is also enormous n many African countries, epileptic patients are cast out because it is considered a contagious or shameful disease [28, 43, 69, 77]. Those affected go through social seclusion and people will not marry PWE unless both parties have epilepsy. For example, consanguineous marriage is forbidden by culture in South East Nigeria [43], and may potentially force them to intermarry thereby promoting genetic transmission of epilepsy [43, 44]. Other beliefs include that inheriting properties from PWE will get one infected but if a medicine man performs burial rites for the dead person and takes away their properties and burn it then it stops. Burial of PWE far away from home prevents people from getting epilepsy. Eating, sleeping together or wearing same clothes with PWE is said to be a source of infection [43, 44]. Eating of pork by someone with epilepsy promotes cysticercosis and corroborates with a study that found a significant link between cysticercosis occurrence and epilepsy [78]. In West Africa, T. solium cysticercosis in pigs and man has been reported and reports have shown the prevalence’s of porcine cysticercosis across the west African countries varies from 0.05 to 46% for both carcass inspection and serological studies and prevalence of taeniid eggs were found to be between 8.6 and 40% based on stool microscopy while copro-antigen ELISA gave a prevalence of 30% [65] as shown in Tables 1 and 2. Difference in severity of infection caused by T. solium could also explain the differences in prevalence of epilepsy. In addition, the extent of the presence of other environmental factors such as use of bad hygiene practices, close contact of humans and pigs and consumption of inadequately cooked pork affects the differences in prevalence of epilepsy [31] including free roaming pigs [43]. Abattoirs and approved slabs are the only approved places for slaughter and inspection of pork meat for consumption, however most carcasses are sold uninspected hence, lack of inspection and large scale clandestine slaughter of pigs promote spread of cysticercosis [32, 34]. The poor knowledge of T. solium, poor hand washing practices, not treating drinking water and handling of raw pork with bare hands promote spread of cysticercosis [65]. Reports in the region indicate that home slaughter conditions were normally substandard because they are makeshift and not constructed to actually meet the requirements of ideal slaughter premises [48]. There was also strong association between knowledge of cysticercosis and occupation and could be attributed to the fact that people in certain occupations are considered to be more knowledgeable about the disease than others [48].


5. Conclusions

The high prevalence of porcine and human cysticercosis and epilepsy in the region indicates that there is a need to get more updated prevalence data of cysticercosis in rural areas where epilepsy is suspected to be more prevalent, compared to urban regions due to parasitic infection. Studies determining the association between epilepsy and cysticercosis should be carried out in countries where it has not been done. The conditions necessary for the parasite to thrive and be transmitted in the region is present in West Africa. Interventions studies including Health education has only been done recently in Burkina Faso, such intervention measures should be carried out in other parts of the region so as to enlighten the populace on the menace caused by the parasite and how it could be prevented.


6. Limitations

The present study has some limitations as the criteria for inclusion and exclusion of articles might have increased or reduced the number of studies used in the region and not all risk factor s and causes of epilepsy were discussed. The study did not determine the prevalence of epilepsy and both porcine and human cysticercosis, in the region as the aim of the study was to show data on studies done by other researchers in the region.



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Conflict of interest

The authors declare no conflict of interest.


Notes/thanks/other declarations

We wish to thank the management of National Veterinary Research Institute Vom for assistance rendered during the preparation of the manuscript.


Acronyms and abbreviations


people with epilepsy


human cysticercosis


antigen ELISA


antibody ELISA


not done


general population




cross sectional survey


computed tomography


hospital based

T. canis

Toxoca canis

T. gondii

Toxoplasma gondii

O. volvulus

Onchocerca volvulus


porcine cysticercosis




Bayesian hierarchical logistic regression credible intervals


  1. 1. WHO. A Rationale for Investment and Action World Health Organization 2016, WHO/HTM/NTD/NZD/2016; 2016
  2. 2. Gabriël S, Dorny P, Mwape KE, Trevisan C, Braae UC, Magnussen P, et al. Control of Taenia solium taeniasis/cysticercosis: The best way forward for sub-Saharan Africa? Acta Tropica. 2016;165:252-260
  3. 3. Torgerson PR, Macpherson CN. The socioeconomic burden of parasitic zoonoses: Global trends. Veterinary Parasitology. 2011;182:79-95
  4. 4. Fleury A, Sciutto E, de Aluja AS, Carpio A. Cysticercosis: A preventable, but embarrassing neglected disease still prevalent in non-developed countries. In: Zoonoses-Infections Affecting Humans and Animals. Dordrecht: Springer; 2015. pp. 335-354
  5. 5. Lightowlers MW, Assana E, Jayashi CM, Gauci CG, Donadeu M. Sensitivity of partial carcass dissection for assessment of porcine cysticercosis at necropsy. International Journal for Parasitology. 2015;45:815-818
  6. 6. Del Brutto OH, García HH. Neurocysticercosis in non endemic countries: Time for a reappraisal. Neuroepidemiology. 2012;39:145-146
  7. 7. Lightowlers MW, Garcia HH, Gauci CG, Donadeu M, Abela-Ridder B. Monitoring the outcomes of interventions against Taenia solium: Options and suggestions. Parasite Immunology. 2016;38:158-169
  8. 8. Trevisan C, Devleesschauwer B, Schmidt V, Winkler AS, Harrison W, Johansen MV. The societal cost of Taenia solium cysticercosis in Tanzania. Acta Tropica. 2017a;165:141-154
  9. 9. Johansen MV, Trevisan C, Gabriël S, Magnussen P, Braae UC. Are we ready for Taenia solium cysticercosis elimination in sub-Saharan Africa? Parasitology. 2016;144:59-64
  10. 10. Praet N, Kanobana KC, Maketa V, Lukanu P, Pascal L, Katja P, et al. Taenia solium cysticercosis in the Democratic Republic of Congo: How does pork trade affect the transmission of the parasite? PLoS Neglected Tropical Diseases. 2010;4(9):e817. DOI: 10.1371/journal.pntd.0000817
  11. 11. Carabin H, Ndimubanzi PC, Budke CM, Nguyen H, Qian Y, Cowan LD, et al. Clinical manifesta-tions associated with neurocysticercosis: A systematic review. PLoS Neglected Tropical Diseases. 2011;5:e1152
  12. 12. Carpio A, Hauser WA. Epilepsy in the developing world. Current Neurology and Neuroscience Reports. 2009;9:319-326
  13. 13. Prasad KN, Prasad A, Gupta RK, Nath K, Pradhan S, Tripathi M, et al. Neurocysticercosis in patients with active epilepsy from a pig farming community of Lucknov district, North India. Transactions of the Royal Society of Tropical Medicine and Hygiene. 2009;103(2):144-150
  14. 14. Preux PM, Druet-Cabanac M. Epidemiology and aetiology of epilepsy in sub-Saharan Africa. Lancet Neurology. 2005;4:21-31
  15. 15. Ngugi AK, Bottomley C, Kleinschmidt I, Sander JW, Newton CR. Estimation of the burden of active and life-time epilepsy: A meta-analytic approach. Epilepsia. 2010;51:883-890
  16. 16. Ndimubanzi PC, Carabin H, Budke CM, Nguyen H, Qian YJ, Rainwater E, et al. A systematic review of the frequency of neurocyticercosis with a focus on people with epilepsy. PLoS Neglected Tropical Diseases. 2010;4:e870
  17. 17. Carabin H, Krecek RC, Cowan LD, Michael L, Foyaca-Sibat H, Nash T, et al. Estimation of the cost of Taenia solium cysticercosis in eastern Cape Province, South Africa. Tropical Medicine and International Health. 2006;11:906-916
  18. 18. Weka RP, Kamani J, Cogan T, Eisler M, Morgan ER. Overview of Taenia solium cysticercosis in West Africa. Acta Tropica. 2018;190:329-338
  19. 19. Geerts S, Nguekam J, Brandt J, Dorny P, Antwerpen N, Science A. The taeniasis-cysticercosis complex in west and Central Africa. Southeast Asian Journal of Tropical Medicine and Public Health. 2004;35:262-265
  20. 20. Goussanou SE, Kpodekon TM, Saegerman C, Azagoun E, Youssao AI, Farougou S, et al. Spatial distribution and risks factors of porcine cysticercosis in southern Benin based meat inspection records. International Research Journal of Microbiology. 2013;4(8):188-196
  21. 21. Dahourou LD, Ndayikeza C, Savadogo M, Gbati OB. Prevalence and economic losses resulting from parasitic zoonosis on swine and ruminants in Ouagadougou abattoir (Burkina Faso). International Journal of Biological and Chemical Sciences. 2018;12(5):2226-2235
  22. 22. Ganaba R, Praet N, Carabin H, Millogo A, Tarnagda Z, Dorny P, et al. Factors associated with the prevalence of circulating antigens to porcine cysticercosis in three villages of Burkina Faso. PLoS Neglected Tropical Diseases. 2011;5(1):e927
  23. 23. Gweba M, Faleke OO, Junaidu AU, Fabiyi JP, Fajinmi AO. Some risk factors for Taenia solium cysticercosis in semi-intensively raised pigs in Zuru, Nigeria. Veterinaria Italiana. 2010;46(1):57-67
  24. 24. Karshima N, Bobbo A, Udokainyang A, Salihu A. Taenia solium cysticercosis in pigs slaughtered in IBI local government area of Taraba state, Nigeria. Journal of Animal Science Advances. 2013;3(3):103-109
  25. 25. Onah DN, Chiejina SN. Taenia solium cysticercosis and human taeniasis in the Nsukka area of Enugu state, Nigeria. Annals of Tropical Medicine and Parasitology. 1995;89(4):399-407
  26. 26. Idika I, Njoga A, Eze I, Iheagwam C, Ezenduka E, Njoga E, et al. Re-evaluation of porcine cysticercosis in Nsukka area of Enugu state, Nigeria. Asian Pacific Journal of Tropical Disease. 2017;7(9):519-522
  27. 27. Debrock C, Preux P-M, Houinato D, Druet-Cabanac M, Kassa F, Adjien C, et al. Estimation of the prevalence of epilepsy in the Benin region of Zinvié using the capture-recapture method. International Journal of Epidemiology. 2000;29(2):330-335
  28. 28. Houinato D, Yemadje LP, Glitho G, Adjien C, Avode G, Druet-Cabanac M, et al. Epidemiology of epilepsy in rural B enin: Prevalence, incidence, mortality, and follow-up. Epilepsia. 2013;54(4):757-763
  29. 29. Avode DG, Bouteille B, Houngbe F, Adjien C. Epilepsy, cysticercosis and and neurocysticercosis in Benin. European Neurology. 1998;39(1):60
  30. 30. Houinato D, Ramanankandrasana B, Adjidé C, Melakul Z, Josse R, Avodé G, et al. Seroprevalence of cysticercosis in Benin. Transactions of the Royal Society of Tropical Medicine and Hygiene. 1998;92:621-624
  31. 31. Yemadje LP, Houinato D, Quet F, Druet-Cabanac M, Preux PM. Understanding the differences in prevalence of epilepsy in tropical regions. Epilepsia. 2011;52(8):1376-1381
  32. 32. Carabin H, Millogo A, Cissé A, Gabriël S, Sahlu I, Dorny P, et al. Prevalence of and factors associated with human cysticercosis in 60 villages in three provinces of Burkina Faso. PLoS Neglected Tropical Diseases. 2015;9(11):e0004248
  33. 33. Carabin H, Millogo A, Ngowi HA, Bauer C, Dermauw V, Koné AC, et al. Effectiveness of a community-based educational programme in reducing the cumulative incidence and prevalence of human Taenia solium cysticercosis in Burkina Faso in 2011-14 (EFECAB): A cluster-randomised controlled trial. The Lancet Global Health. 2018;6(4):e411-e425
  34. 34. Sahlu I, Bauer C, Ganaba R, Preux PM, Cowan LD, Dorny P, et al. The impact of imperfect screening tools on measuring the prevalence of epilepsy and headaches in Burkina Faso. PLoS Neglected Tropical Diseases. 2019;13(1):e0007109
  35. 35. Sahlu I, Carabin H, Ganaba R, Preux PM, Cissé AK, Tarnagda Z, et al. Estimating the association between being seropositive for cysticercosis and the prevalence of epilepsy and severe chronic headaches in 60 villages of rural Burkina Faso. PLoS Neglected Tropical Diseases. 2018;13(1):e0007101
  36. 36. Millogo A, Nitiéma P, Carabin H, Boncoeur-Martel MP, Rajshekhar V, Tarnagda Z, et al. Prevalence of neurocysticercosis among people with epilepsy in rural areas of Burkina Faso. Epilepsia. 2012;53(12):2194-2202
  37. 37. Nitiéma P, Carabin H, Hounton S, Praet N, Cowan LD, Ganaba R, et al. Prevalence case-control study of epilepsy in three Burkina Faso villages. Acta Neurologica Scandinavica. 2012;126(4):270-278
  38. 38. Debouverie M. Epidemiologie des Syndromes Cpileptiques: A Pro-pos d’une Ctude africaine. Nancy, France: Thkse MCdecine; 1991
  39. 39. Bimi L, Laar AK, Anto F. Prevalence and risk factors of taeniasis in the Bunkpurugu-Yunyoo District of northern Ghana. Journal of Bacteriology and Parasitology. 2012;3:129
  40. 40. Ngugi AK, Bottomley C, Kleinschmidt I, Wagner RG, Kakooza-Mwesige A, Ae-Ngibise K, et al. Prevalence of active convulsive epilepsy in sub-Saharan Africa and associated risk factors: Cross-sectional and case-control studies. The Lancet Neurology. 2013;12(3):253-263
  41. 41. Goudsmit J, van der Waals FW, Gajdusek C. Epilepsy in the Gbawein and Wroughbarh clan of Grand Bassa county, Liberia: The endemic occurrence of'See-ee'in the native population. Neuroepidemiology. 1983;2(1-2):24-34
  42. 42. Secka A, Grimm F, Marcotty T, Geysen D, Niang AM, Ngale V, et al. Old focus of cysticercosis in a senegalese village revisited after half a century. Acta Tropica. 2011;119(2-3):199-202
  43. 43. Osakwe C, Otte WM, Alo C. Epilepsy prevalence, potential causes and social beliefs in Ebonyi state and Benue state, Nigeria. Epilepsy Research. 2014;108(2):316-326
  44. 44. Ezeala-Adikaibe BA, Orjioke C, Ekenze O, Ijoma U, Onodugo O, Molokwu O, et al. Prevalence of active convulsive epilepsy in an urban slum in Enugu south East Nigeria. Seizure. 2016;35:100-105
  45. 45. Babalola O, Adu A, Akano AO. Ocular cysticercosis in a 32-year-old man in Abuja: Ultrasonic features as an aid in diagnosis. Clinical Ophthalmology. 2275;2013:7
  46. 46. Mogaji HO, Adeniran AA, Fagbenro MT, Olabinke DB, Abe EM, Ekpo UF. Prevalence of human taeniasis in Odeda area of Ogun state, Nigeria. International Journal of Tropical Disease and Health. 2016;17:1-8
  47. 47. Weka RP, Ikeh EI, Kamani J. Seroprevalence of antibodies (IgG) to Taenia solium among pig rearers and associated risk factors in Jos metropolis, Nigeria. Journal of Infection in Developing Countries. 2013;7(02):067-072
  48. 48. Edia-Asuke AU, Inabo HI, Mukaratirwa S, Umoh VJ, Whong CM, Asuke S, et al. Seroprevalence of human cysticercosis and its associated risk factors among humans in areas of Kaduna metropolis, Nigeria. Journal of Infection in Developing Countries. 2015;9(08):799-805
  49. 49. Omonisi AE, Odujoko OO, Aluko JA, Akinyemi HA, Alatishe OI, Omoniyi-Esan GO. Human cysticercosis of the breast mimicking breast cancer: A report of a case from Ile-Ife, Nigeria. Nigerian Journal of Medicine: Journal of the National Association of Resident Doctors of Nigeria. 2014;23(4):351-354
  50. 50. Uhumwangho OM, Ugiagbe EE. Cysticercosis in the anterior chamber: A case report. West African Journal of Medicine. 2012;31(4):270-272
  51. 51. Osuntokun BO, Adeuja AO, Nottidge VA, Bademosi O, Olumide A, Ige O, et al. Prevalence of the epilepsies in Nigerian Africans: A community-based study. Epilepsia. 1987;28(3):272-279
  52. 52. Ndoye NF, Sow AD, Diop AG, Sessouma B, Sene-Diouf F, Boissy L, et al. Prevalence of epilepsy its treatment gap and knowledge, attitude and practice of its population in sub-urban Senegal an ILAE/IBE/WHO study. Seizure. 2005;14(2):106-111
  53. 53. N’Diaye Epid Cmiologie des Cpilep-sies au SCnCgal. 7th Meeting of the Pan-African Assoc. of Neural. Abidjan: Science; 1986
  54. 54. Gerrits C. A west African epilepsy focus. Lancet. 1983;1:358
  55. 55. Diagana M, Preux PM, Tuillas M, Ould Hamady A, Druet-Cabanac M. Dépistage de l’épilepsie en zones tropicales: validation d’un questionnaire en Mauritanie. Bulletin de la Société de Pathologie Exotique. 2006;99(2):103-107
  56. 56. Balogou AA, Grunitzky KE, Beketi KA, Bouteille B, Dumas M. Cysticercosis and epilepsy in the city of tone, north of Togo. Revue Neurologique. 2000;156(3):270-273
  57. 57. Dumas M. Cysticercose et neurocysticercose: enquête épidémiologique dans le nord du Togo. Bulletin de la Société de Pathologie Exotique. 1990;83:263-274
  58. 58. Coulibaly ND, Yameogo KR. Prevalence and control of zoonotic diseases: Collaboration between public health workers and veterinarians in Burkina Faso. Acta Tropica. 2000;76(1):53-57
  59. 59. Atawalna J, Ewura S, Mensah M. Prevalence and financial losses associated with porcine cysticercosis in the Kumasi metropolis of Ghana. International Journal of Livestock Research. 2015;5(9):21-26
  60. 60. Permin A, Yelifari L, Bloch P, Steenhard N, Hansen NP, Nansen P. Parasites in cross-bred pigs in the upper east region of Ghana. Veterinary Parasitology. 1999;87(1):63-71
  61. 61. Cadmus SI, Adesokan HK, Awosanya AE. Public health issues and observations made during meat inspection at Bodija municipal abattoir, Ibadan, Oyo state, Nigeria. Nigerian Veterinary Journal. 2008;29(2):43-47
  62. 62. Biu AA, Ijudai J. Prevalence and morphometric studies on porcine cysticercosis in Adamawa state, Nigeria. Sokoto Journal of Veterinary Sciences. 2012;10(1):28-31
  63. 63. Agere H, Bemgba E, Iorgema U. Prevalence of Cysticercosis in Pigs Slaughtered in Jalingo, Nigeria. 2016;1(2):578-581
  64. 64. Adesokan HK, Adeoye FA. Porcine cysticercosis in slaughtered pigs and factors related to Taenia solium transmission amongst abattoir workers in Ibadan, Nigeria. The Pan African Medical Journal. 2019;32:145
  65. 65. Edia-Asuke AU, Inabo HI, Umoh VJ, Whong CM, Asuke S, Edeh RE. Assessment of sanitary conditions of unregistered pig slaughter slabs and post mortem examination of pigs for Taenia solium metacestodes in Kaduna metropolis, Nigeria. Infectious Diseases of Poverty. 2014;3(1):45
  66. 66. Weka RP, Ikeh EI. Seroprevalence of cysticercosis and intestinal parasitism in pigs in Jos Metropolis. Journal of Animal and Veterinary Advances. 2009;8:883-887
  67. 67. Secka A, Marcotty T, De Deken R, Van Marck E, Geerts S. Porcine cysticercosis and risk factors in the Gambia and Senegal. Journal of Parasitology Research. 2010
  68. 68. Commissionon Epidemiology and Prognosis, International League Against Epilepsy. Guidelines for epidemiologic studies on epilepsy. Epilepsia. 1993;34:592-596
  69. 69. Preux PM, Druet-Cabanac M, Debrock C, Tapie PH, Dumas M, et al. Comitde Recherchesurl’ Epilepsiedel’ Institutd’ Epidmiologie Neurologiqueetde Neurologie Tropicalede Limoges. Bulletin de la Société de Pathologie Exotique. 2000;93:276-278
  70. 70. Nwani PO, Nwosu MC, Asomugha LA, Enwereji KO, Arinzechi EO, Ogunniyi AO. Epidemiology of active epilepsy in a suburban community in Southeast Nigeria: A door-to-door survey. Nigerian Journal of Clinical Practice. 2015;18(4):527-533
  71. 71. Adegbehingbe BO, Soetan EO, Adeoye AO. Case report: intraocular cysticercosis. West African Journal of Medicine. 2003;22(4):354-355
  72. 72. Placencia M, Sander JW, Shorvon SD, Ellison RH, Cascante SM. Validation of a screening questionnaire for the detection of epileptic seizuresinepidemiologicalstudies. Brain. 1992;115:783-794
  73. 73. Winkler AS. Epilepsy and neurocysticercosis in sub-Saharan Africa. In: Foyaca Sibat H, editor. Novel Aspects on Cysticercosis and Neurocysticercosis. Vol. 30. Rijeka, Croatia: IntechOpen; 2013. pp. 307-340
  74. 74. Eseigbe EE, Sheikh TL, Nuhu FT. Childhood epilepsy in a tropical child psychiatric unit: Challenges of providing care in a resource-constrained environment. Annals of African Medicine. 2013;12(4):236
  75. 75. Ogunrin OA, Adeyekun A, Adudu P. Etiologies of epilepsy and health-seeking itinerary of patients with epilepsy in a resource poor setting: Analysis of 342 Nigerian Africans. Seizure. 2013;22(7):572-576
  76. 76. Phiri IK, Ngowi H, Afonso S, Matenga E, Boa M, Mukaratirwa S, et al. The emergence of Taenia solium cysticercosis in eastern and southern Africa as a serious agricultural problem and public health risk. Acta Tropica. 2003;87(1):13-23
  77. 77. Adewuya AO. Parental psychopathology and self-rated quality of life in adolescents with epilepsy in Nigeria. Developmental Medicine and Child Neurology. 2006;48:600-603
  78. 78. Quet F, Rafael F, Ngoungou EB, Diagana M, Druet-Cabanac M, Preux PM. Investigating epilepsy in Africa: 10 years of data collection using a standardized questionnaire in 2,269 peoples with epilepsy. Epilepsia. 2011;52(10):1868-1876

Written By

Rebecca Weka, Pam Luka, Ndudim Ogo and Paul Weka

Submitted: June 11th, 2019 Reviewed: September 5th, 2019 Published: April 22nd, 2020