Validation of a Hausa Childhood Epilepsy Screening and Seizure Classification Tool

Background: A validated epilepsy screening and seizure classification instrument, used by community health workers (CHWs), can enhance epilepsy diagnosis and classification to bring care to the 60-90% of children with epilepsy who remain untreated in low- and middle-income countries (LMICs). Methods: An epilepsy screening and seizure type classification tool was translated to the local language (Hausa) and administered by CHWs in clinics in Kano, Nigeria. Children were then evaluated by Kano epileptologists (gold standard). An epileptologist in the U.S., blinded to the clinical evaluations in Kano also interpreted the questionnaire results. Sensitivity, specificity, predictive values, and receiver operating characteristics (ROCs) of the questionnaire were determined. Findings: Of 765 consecutive children screened, the 82 who screened positive and 63 randomly selected from those who screened negative were evaluated by epileptologists. The screening tool demonstrated a sensitivity of 0.95 (95% CI= 0.90, 0.99), specificity of 0.88 (0.80, 0.96), and positive and negative predictive values of 0.90 (0.84, 0.97) and 0.94 (0.88, 0.99), respectively, for epilepsy diagnosis. The ROC for predicting a physician diagnosis of epilepsy was 0.92 (0.87, 0.96) and for predicting classification of focal onset and generalized seizures were 0.89 (0.84, 0.95) and 0.88 (0.81,0.94), respectively. Among children who screened positive for epilepsy, positive and negative predictive values were 1.00 (0.90, 1.00) and 0.73 (0.59, 0.86), respectively, for generalized seizures, and 0.67 (0.51, 0.83) and 1.00 (0.90, 1.00), respectively, for focal onset seizures. Interpretation: This childhood epilepsy screening and classification tool performed well when used by CHWs in northern Nigeria. Funding Statement: Fogarty International Center/NIH (1R21TW010899). Declaration of Interests: This study (ATA, ET, US, HA, ASS, HX, UW, ZI, DJI, HMY, MHA) was supported by Fogarty International Center/National Institutes of Health (FIC/NIH, 1R21TW010899). US was also supported by the VECD Fogarty Global Health Fellows Program (FIC/NIH, D43 TW009337). MHA also reports funding from the US Centers for Disease Control (CDC). DJI also reports funding from the US Agency for International Development (USAID). AAP reports funding from the American Academy of Neurology (Practice Research training scholarship). Ethics Approval Statement: This validation study protocol was approved by the Ethics Committees at AKTH and at the Kano State Ministry of Health, and by the Vanderbilt University Medical Center Internal Review Board.