DESCRIPTION (provided by applicant): This proposal seeks support for a new initiative which extends the work of our pilot project, "Epidemiology and Burden of Neurocysticercosis in Bukina Faso" (R21 NS055353). Despite the fact that Burkina Faso is the second least developed country in the world, a strong research collaboration and dedication to improving the living conditions of the Burkinabi people made our pilot project, IFICAB ("Ivaluation du Fardeau Iconomique de la Cysticercose Au Burkina"), a success. The ultimate goal of the proposed project is to develop a sustainable, cost-beneficial and cost-effective intervention strategy to reduce the incidence and prevalence of neurocysticercosis (NCC) and associated neurological conditions across the lifespan. This proposal seeks to further strengthen research capacity through establishing reference centers for the immuno- diagnosis of cysticercosis in humans and pigs at the Institut de Recherche en Sciences de la Santi (IRSS) and for the radiological diagnosis of NCC at the Universiti de Ouagadougou. This will be done in conjunction with the creation of the Cysticercosis Working Group for Western and Central Africa, under the leadership of collaborators in Burkina Faso. Training two PhD students in neuroepidemiology and immunodiagnosis of cysticercosis and one masters student in public health is also proposed. Inclusion of epilepsy and NCC in the list of notifiable diseases for Burkina Faso will be pilot tested as a surveillance mechanism. Preliminary results indicate a high prevalence of epilepsy, NCC and cysticercosis in the three pilot villages studied. Based on these findings, we estimate that an educational intervention targeting pig farmers could reduce the incidence of infection in humans and pigs by one-half. We also estimate that this could result, in the long term, in reducing the incidence rate of recurrent seizures in Burkina Faso by 25% in villages where pigs are raised. We will use the PRECEDE PROCEED approach to develop educational materials to guide farmers in maximizing the monetary benefits of healthy pig raising. A pre-post randomized community trial will be conducted in 60 villages located in three provinces, using a 12-month baseline and 24 month post-intervention follow-up of 80 participants per village. The effectiveness of the educational materials in reducing the incidence rate of human and porcine cysticercosis, and of recurrent seizures and severe headaches as a secondary outcome, will be estimated. If effective, this sustainable intervention could be exported to other pig-raising countries in Sub- Saharan Africa to reduce the frequency of cysticercosis and epilepsy.

PUBLIC HEALTH RELEVANCE: Neurocysticercosis is a disease caused by a tapeworm transmitted between humans and pigs that is responsible for many cases of epilepsy in countries where pigs are raised in poor sanitary conditions. This study proposes an intervention in Burkina Faso to reduce the prevalence this infection. If successful, the frequency of epilepsy will decline, greatly improving the life and health of these communities.