Epilepsy is one of the most common chronic neurological diseases, affecting approximately 50 million people worldwide (WHO, 2023), with an average prevalence of 0.5–1.0% in the general population. Despite its significant medical, social, and economic burden, systematic epidemiological studies have never been conducted in the Adjara region of Georgia. As a result, health authorities lack the representative data necessary for evidence-based planning, resource allocation, and intervention design.
The aim of our study is to determine the prevalence, incidence, mortality, and treatment adequacy of epilepsy in Adjara through a population-based, protocol-based study. We will conduct door-to-door screening of approximately 12,000 residents using the WHO Epilepsy Questionnaire adapted for Georgia, followed by multidisciplinary diagnostic confirmation (neurology, neuropsychology, electroencephalography, magnetic resonance imaging). Robust statistical approaches will take into account cluster design and non-response (non-sensitivity).
Expected outcomes include:
• Reliable estimates of epilepsy prevalence and incidence in Adjara
• Quantification of treatment gaps, misdiagnoses, and mismatches in healthcare needs
• Evidence-based recommendations for regional and public health authorities.
By addressing this critical knowledge gap, the project will directly contribute to the development of cost-effective healthcare strategies, reducing epilepsy-related disability, and aligning Georgian data with global epidemiological standards.
At the same time, the unique scale of this study (covering 12,000 residents) provides a rare opportunity to explore  other important but neglected health issues In the Adjara region.  Two additional modules will be implemented:
• Goiter and thyroid diseases: Adjara has historically been one of the iodine-deficient and goiter-endemic regions of Georgia. Although universal salt iodization was mandatory at the national level in 2005, recent clinical evidence indicates an increase in diffuse non-toxic goiter in young patients. The project will collect thyroid-specific questionnaire and laboratory data (TSH, FT4) to provide updated epidemiological data, assess trends since 2000–2005, and study comorbidities with epilepsy.
• Child development and cytomegalovirus (CMV): Stunting in children under 5 years of age remains a pressing problem in Adjara, previously associated with iodine deficiency and widespread lead exposure (UNICEF, 2018). However, no study in Georgia has examined CMV - the most common congenital infection in the world - as a risk factor for developmental disorders. This project will implement a confirmatory developmental screening (ASQ-3, which has already been translated and adapted) with CMV testing (antibody serology) to generate the first regional data on CMV prevalence and its association with child development.
 

Project Objective

To strengthen neurological and public health in Ajara by providing reliable, population-based epidemiological evidence on epilepsy, thyroid disorders and developmental delays in young children.

Tasks:

• Epilepsy (primary):
o Screening of ≥12,000 population.
o Assessment of prevalence, incidence, mortality and treatment gaps.
• Goiter/Thyroid (secondary):
o Assessment of prevalence of diffuse and nodular goiter.
o Assessment of thyroid hormone deficiency in the risk population (out of 12,000) identified during screening and in pregnant women (State Program of the Ministry of Health of Ajara).
• Child Development/CMV (Secondary):
o Screening ≥1,0000 - <5 years of age with ASQ-3 (12,000 population screening) 
o Assessment of CMV prevalence and its association with developmental outcomes (based on antibody testing).
 

Tangible Results
• Epilepsy: First epidemiological database in Adjara; 1–2 publications.
• Peer-reviewed epidemiological report (first developed in Adjara)
• Open access database (identified)
• Healthcare recommendations for the Adjara healthcare system
• Academic publications in high-impact journals (e.g., Epilepsy, Seizures)
• Goiter: Updated data on the prevalence of thyroid disorders, >15 years after ultrasonography; publication in an endocrinology journal.
• Cytomegalovirus: First data on cytomegalovirus and developmental delay in Georgia; Publication in a pediatric/virology journal.
Broader impact
• More accurate diagnosis and treatment planning;
• Evidence-based budget allocation for AEDs and services (proper pension fund activities);
• Social stigma reduced through awareness-raising campaigns;
• Strengthened health system capacity;
• Epilepsy treatment improved through evidence-based allocation of AEDs and services;
• Re-evaluation of public health iodized salt use using new data specific to Adjara;
• Early childhood programs informed about cytomegalovirus and developmental risks
 

Healthcare System
More accurate diagnosis, evidence-based budget allocation, and reduced stigma.