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Influence of Community-Based Epilepsy Screening on Epilepsy Detection among Adults in Nigeria

Abstract

Epilepsy remains an important neurological and public health concern among adults in Nigeria and may affect individuals' physical health, psychological well-being, social participation, employment, independence, and overall quality of life. Epilepsy is characterized by a predisposition to recurrent unprovoked seizures, but many affected individuals may remain undiagnosed because seizures may be infrequent, misunderstood, or attributed to supernatural or cultural explanations. Stigma, fear, misinformation, financial constraints, geographical barriers, limited access to neurological services, and shortages of trained healthcare professionals may further contribute to delayed detection and treatment. Undetected epilepsy may expose affected individuals to recurrent seizures, injuries, social discrimination, reduced economic productivity, and other avoidable complications. Community-based epilepsy screening provides an opportunity to identify adults with seizure-related symptoms or histories suggestive of epilepsy through accessible community outreach programmes, primary healthcare centres, mobile health services, community health campaigns, and other community platforms. Early identification may facilitate neurological assessment, appropriate diagnostic evaluation, treatment initiation, seizure management education, and referral to specialist services where necessary. Against this background, this study investigates the influence of community-based epilepsy screening on epilepsy detection among adults in Nigeria. The study will be anchored on the Health Belief Model, Social Ecological Model, and the Health Systems Framework. The Health Belief Model explains how adults' perceptions of susceptibility to epilepsy, perceived severity, perceived benefits of screening, perceived barriers, and cues to action may influence participation in community-based epilepsy screening. The Social Ecological Model emphasizes the influence of individual, family, community, cultural, socioeconomic, and environmental factors on seizure recognition, healthcare-seeking behaviour, stigma, and access to neurological services. The Health Systems Framework emphasizes service delivery, health workforce, health information, medical products and technologies, financing, and accessibility as essential components of effective community-based neurological screening and treatment programmes. Collectively, these theoretical perspectives provide a suitable framework for explaining how community-based epilepsy screening may influence epilepsy detection among adults in Nigeria. The study will adopt a quantitative cross-sectional analytical or quasi-experimental research design. The study population will comprise adults aged 18 years and above residing in selected communities across Nigeria. A multistage sampling technique will be used to select states, local government areas, communities, households, and eligible adults. Community-based epilepsy screening will be measured using indicators such as availability of screening services, screening coverage, frequency of community screening activities, assessment of seizure history and neurological symptoms, seizure-related questionnaires, availability of trained healthcare personnel, neurological assessment resources, epilepsy health education, stigma-reduction education, and referral arrangements. Epilepsy detection will be assessed using indicators such as history of recurrent unprovoked seizures, suspected epilepsy cases identified through screening, newly identified individuals requiring neurological assessment, seizure frequency and characteristics, referrals for specialist evaluation, clinical confirmation of epilepsy where appropriate, and linkage to appropriate treatment and follow-up services. Data will be collected using structured questionnaires, community screening registers, seizure assessment forms, healthcare facility records, referral registers, and relevant community health programme documents. Descriptive statistics will be used to summarize participants' characteristics, seizure-related findings, screening coverage, and patterns of epilepsy detection. Inferential statistical techniques, including chi-square tests, correlation analysis, and logistic or multiple regression analysis, will be used to determine the influence of community-based epilepsy screening on epilepsy detection. Where appropriate, epilepsy detection rates before and after implementation of community-based screening activities may be compared to determine changes associated with the intervention. Diagnostic tests will also be conducted to assess the reliability, validity, and robustness of the findings. The study is expected to find that community-based epilepsy screening has a significant positive influence on epilepsy detection among adults in Nigeria. Adults who participate in community-based epilepsy screening are expected to have a higher likelihood of having previously unrecognized seizure disorders identified than adults without access to such services. Community-based screening may facilitate recognition of recurrent seizure patterns and provide opportunities for appropriate clinical and neurological assessment. Early detection may support timely treatment, seizure management, safety education, and referral for specialist evaluation where necessary. Bringing epilepsy screening closer to communities may reduce geographical, financial, and time-related barriers and encourage individuals who may otherwise avoid healthcare because of stigma or misconceptions to seek appropriate assessment. Community-based epilepsy education may also improve understanding of seizure symptoms, first-aid responses, treatment adherence, and the importance of seeking professional healthcare rather than relying solely on traditional or unverified explanations. Conversely, inadequate screening coverage, shortage of trained healthcare personnel, limited access to neurological services, low awareness, stigma, cultural misconceptions, financial barriers, and weak referral and follow-up systems may reduce the effectiveness of community-based epilepsy screening. The study therefore expects accessible and well-organized community-based epilepsy screening to contribute significantly to improved detection and early management of epilepsy among adults in Nigeria. The study is expected to contribute to the literature on community-based epilepsy screening, epilepsy detection, neurological health, seizure disorders, adult health, community health services, neurological disease prevention, preventive healthcare, health education, and public health in Nigeria. The findings will provide useful information to the Federal Ministry of Health and Social Welfare, National Primary Health Care Development Agency, state ministries of health, primary healthcare centres, hospitals, neurologists, community health workers, mental and neurological health programmes, development partners, and policymakers regarding strategies for improving epilepsy detection and care. The study will also provide evidence-based recommendations for expanding community-based epilepsy screening programmes, strengthening community awareness of seizure disorders, reducing epilepsy-related stigma and misconceptions, improving training of community health workers in seizure recognition, increasing access to neurological assessment and treatment, strengthening referral and follow-up systems, improving availability of appropriate medicines and healthcare services, and integrating epilepsy screening into community-based neurological and non-communicable disease programmes across Nigeria.

Keywords: Community-based epilepsy screening, epilepsy detection, adults, seizure disorders, neurological health, epilepsy screening, community health services, neurological disease prevention, stigma reduction, preventive healthcare, Nigeria, public health.