Abstract
Onchocerciasis-associated epilepsy (OAE) is severe yet preventable and treatable, but it is absent from global burden metrics (GBD), limiting prioritisation and funding for the millions at risk. This fellowship will deliver the first GBD-compatible estimates of the OAE burden and test how integrated enhanced onchocerciasis control plus decentralised epilepsy care prevent new cases, reduce disability and excess mortality, and at what cost. I will measure burden as disability-adjusted life years (DALYs), combining morbidity and premature death. Two innovations make this possible: 1) new disability weights derived from WHODAS-2.0 and mRS, aligned to standard GBD categories; 2) the first age-/sex-specific epilepsy mortality rates in highly endemic areas. A mixed design of repeated population surveys and clinic–community cohorts in Tanzania and South Sudan, with intervention and control sites, will track epilepsy incidence, seizures, disability and survival and onchocerciasis transmission. Comparator-based analyses, individual-level mixed regression and a calibrated, stochastic onchocerciasis EPIONCHO-IBM model will separate prevention from care benefits. Payer and societal costing will yield cost per DALY averted and a simple transferability toolkit. The resulting global burden estimates, effect sizes and cost-effectiveness will let Ministries target prevention, align medicine supply with endemicity and fund affordable scale-up, moving OAE from neglected to rare and well-managed.
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