Abstract
<title>Abstract</title> <p>Background 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 West and Central Africa (MSF-WaCA) 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. Methods 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. Community health workers administered a validated epilepsy screening questionnaire to all eligible individuals. 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. Results Among 2,586 participants (61.7% female; 70.3% rural), 59 individuals were confirmed to have epilepsy, corresponding to a survey-adjusted prevalence of 22.8 per 1,000 population (95% CI: 15.3–30.3; design effect 1.71). Prevalence varied across districts, with the highest rate observed in Botro (33.2 per 1,000), followed by Sakassou (23.8 per 1,000) and Beoumi (11.9 per 1,000). In survey-adjusted multivariable analysis, epilepsy was associated with residence in Botro district (adjusted odds ratio [aOR] 2.84; 95% CI: 1.12–7.22), single marital status (aOR 5.01; 95% CI: 2.54–9.85), economic inactivity (aOR 3.36; 95% CI: 1.23–9.17), and home-based work (aOR 2.35; 95% CI: 1.13–4.87). Overall, 59.3% of people living with epilepsy were not receiving antiepileptic treatment, indicating a substantial treatment gap. Conclusion Epilepsy prevalence in the Gbeke region is substantially higher than global estimates and shows marked geographic variation across districts. The large treatment gap highlights persistent barriers to diagnosis, access to antiepileptic therapy, and continuity of care. These findings underscore the need to strengthen epilepsy services through integration into primary healthcare, targeted interventions in high-prevalence districts, and community-based strategies to improve early detection and sustained treatment in Cote d'Ivoire.</p>