The burden of headache disorders in Ethiopia: national estimates from a population-based door-to-door survey

Abstract

BackgroundHeadache disorders are the third-highest cause of disability worldwide, with migraine and medication-overuse headache (MOH) the major contributors. In Ethiopia we have shown these disorders to be highly prevalent: migraine 17.7%, TTH 20.6%, probable MOH (pMOH) 0.7%, any headache yesterday (HY) 6.4%. To inform local health policy, we now estimate disability and other burdens attributable to headache in this country.MethodsIn a cross-sectional survey using cluster-randomized sampling, we visited households unannounced in four diverse regions (urban and rural) of Ethiopia. We interviewed one member (18–65 years old) of each household using the HARDSHIP structured questionnaire. Screening and diagnostic questions based on ICHD-II were followed by burden enquiry in multiple domains. We estimated disability using disability weights (DWs) from the Global Burden of Disease 2013 study.ResultsWe interviewed 2385 participants (1064 [44.7%] male, 596 [25.0%] urban; participating proportion 99.8%). Reported mean intensity of migraine was 2.6 (scale 1–3). People with migraine spent 11.7% of their time in the ictal state (DW: 0.441); they were therefore 5.2% disabled overall. Pain and disability from TTH were much lower. Mean intensity of pMOH was 2.95. People with pMOH spent 60.2% of time with headache (DW: 0.223), and were 13.4% disabled. Average proportions of per-person lost productive time were, for migraine, 4.5% from paid work, 5.3% from household work; for pMOH they were 29.2% and 16.0%. There were highly-disabled minorities, and large gender differences, males losing more paid workdays, females more household workdays. All headache types were associated with impairments in quality of life. Across the population aged 18–65 years (effectively the working population), disability from headache was 1.4%, with 1.6% of workdays lost (half from migraine). Estimates from HY, eliminating recall error, were highly compatible.ConclusionsEthiopia is a low-income country, and cannot afford these losses – including, perhaps, 1.6% of GDP. Political action is necessary, aimed at mitigating both the economic burden and the associated ill health. WHO has recommended structured headache services with their basis in primary care as the most efficient, effective, affordable and equitable solution, potentially cost-saving. We believe they can be implemented within Ethiopia’s existing health-care infrastructure.

<p>Knowledge, Attitude, and Practice on Over-the-Counter Drugs Among Pharmacy and Medical Students: A Facility-Based Cross-Sectional Study</p>

“…24 This could be because these are the most prevalent illnesses that frequently affect many people and for which medications are usually available in pharmacies on as OTC. 25 Paracetamol 59.3% followed by NSAIDs 51.2%, were the most commonly used OTC drugs among the study participants. This finding was also consistent with findings from previous studies conducted in Addis Ababa, Gondar and Mekelle in which paracetamol and other anti-pain medications were the most frequently used OTC medications.…”

The Global Burden of Headache

“…Impact on productivity was very similar in the two countries for all headache types except pMOH: Ethiopians with pMOH reported much higher individual levels of missed paid work and household work 40 than their Zambian counterparts, 41 greatly countering the lower prevalence of pMOH in Ethiopia (►Table 2). Indirect costs of headache were estimated to translate into 1.6% lost GDP in Ethiopia 40 and a similar 1.9% loss in Zambia. 41…”

The Headache-Attributed Lost Time (HALT) Indices: measures of burden for clinical management and population-based research

“…The original HALT Indices were described in 2007 as a direct and close derivative of MIDAS [ 7 ]. Over 10 years, this was employed, usually as a module imported into the much larger Headache-Attributed Restriction, Disability, Social Handicap and Impaired Participation (HARDSHIP) questionnaire [ 1 ], in published population-based studies in China [ 8 ], India [ 9 ], Nepal [ 10 ], Pakistan [ 11 ], Ethiopia [ 12 ], Zambia [ 13 ], Russia [ 14 ], Lithuania [ 15 ], Italy [ 16 ] and eight other countries of the European Union [ 17 ], and in other studies not yet completed or published in Mongolia, Saudi Arabia, Morocco, Peru and Guatemala.…”