The validation of a three-stage screening methodology for detecting active convulsive epilepsy in population-based studies in health and demographic surveillance systems

We validated a three-stage cross-sectional screening methodology on a randomly selected sample of participants of a three-stage prevalence survey of epilepsy. Diagnosis of ACE by an experienced clinician was used as ‘gold standard’. We further compared the expenditure of this method with the standard two-stage methodology.We screened 4442 subjects in the validation and identified 35 cases of ACE. Of these, 18 were identified as false negatives, most of whom (15/18) were missed in the first stage and a few (3/18) in the second stage of the three-stage screening. Overall, this methodology had a sensitivity of 48.6% and a specificity of 100%. It was 37% cheaper than a two-stage survey.This was the first study to evaluate the performance of a multi-stage screening methodology used to detect epilepsy in demographic surveillance sites. This method had poor sensitivity attributed mainly to stigma-related non-response in the first stage. This method needs to take into consideration the poor sensitivity and the savings in expenditure and time as well as validation in target populations. Our findings suggest the need for continued efforts to develop and improve case-ascertainment methods in population-based epidemiological studies of epilepsy in LMIC.Epilepsy is a common non-communicable neurological condition and a significant cause of disability and mortality [1]. It is estimated to affect nearly 70 million people worldwide, 90% of who live in low and middle income countries (LMIC) [2]. There is a wide range of prevalence estimates from studies estimates in LMIC [2]. It is unclear if this heterogeneity is caused by different methods and/or tools used, many of which have not been validated in the target populations [3-5].In high income countries (HIC), researchers utilize medical and service records to provide epidemiological data on epilepsy. In LMIC this methodology is unreliable since there is low usage and/or lack of access to health care facilities by majority of the po