Epilepsy Prevalence and Determinants in Four Former Health Provinces of Burundi: A Mixed Methods Study

Background: Epilepsy remains one of the most prevalent neurological disorders globally, particularly in low-resource settings. Understanding the factors associated with epilepsy, especially convulsive forms, is essential for effective prevention and control strategies. This study aimed to determine the prevalence of epilepsy and identify associated risk factors in four provinces of Burundi (Bujumbura Municipality, Gitega, Ngozi, and Rumonge, under the former administrative organisation). Methods: A mixed-methods approach was employed, combining a cross-sectional survey and a concurrent qualitative component. The quantitative survey included 781 households within the catchment areas of selected health facilities. Data were analysed using simple and multiple block binary logistic regression, with the best-fitting model selected using the Bayesian Information Criterion. Results: The overall prevalence rate of epilepsy was 10.9 per 10,000 people. Significant risk factors included consumption of local traditional beer, pork consumption, foetal distress, non-caesarean delivery, sadness as a reported trigger, and discontinuation of antiepileptic medications. The qualitative findings, based on in-depth interviews with people with epilepsy and their care providers, highlighted limited awareness of epilepsy, delays in diagnosis, difficulty accessing treatment, and persistent stigma. Observational visits to health facilities and private pharmacies further revealed frequent shortages of antiepileptic drugs and inadequate treatment availability. Conclusion: Epilepsy continues to be a major public health challenge in Burundi. Reducing its burden will require increasing community awareness, enhancing early diagnosis and treatment through strengthened healthcare provider capacity, ensuring a reliable supply of antiepileptic medications, and improving access to care for vulnerable populations.