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Okiah L, Olowo S, Iramiot SJ, Nekaka R, Ssenyonga LVN. Lived experiences of caregivers of persons with epilepsy attending an epilepsy clinic at a tertiary hospital, eastern Uganda: A phenomenological approach. PLoS One 2023; 18:e0274373. [PMID: 37463142 DOI: 10.1371/journal.pone.0274373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Accepted: 06/21/2023] [Indexed: 07/20/2023] Open
Abstract
INTRODUCTION Epilepsy has been found to affect caregivers' quality of life, lifestyle, psychological health, social well-being, and working time. Caregivers in Uganda as in the rest of the world are important in assisting a person with epilepsy in complying with medical directions and are actively involved in communicating with healthcare professionals. Little is known about the lived experiences of caregivers of persons afflicted with epilepsy in Uganda. The purpose of this study was to determine the lived experiences of caregivers of persons with epilepsy attending the epilepsy clinic at Mbale regional referral hospital, eastern Uganda. METHODS AND MATERIALS The caregivers' lived experiences were elicited directly from them and their health workers who work with them in the care of the patients. Forty participants which consisted of 30 caregivers and 10 key informant health workers were selected for the study through purposive sampling. Face-to-face in-depth interviews with an unstructured interview guide were conducted to gather participants' information. The principal investigator conceptualized the interview guide, the guide was then reviewed by co-investigators, and revised and approved as the final data collection instrument after an extensive and comprehensive literature review. The interview guide comprised two sections; the first section comprised the questions that elicited the participants' social-demographic information. The second section comprised questions that explored caregivers' experiences of persons afflicted with epilepsy. Notations were taken and a digital recorder was used purposely for audio recordings. All interviews lasted for an hour and were audio-recorded with the participant's consent. An inductive thematic analysis was employed and adopted to identify the patterns emerging from the texts. RESULTS The caregivers majorly perceived epilepsy as a burden. Four main themes were revealed from the analysis and these are: psychological burdens which included, worries about the future of the patient, being looked down upon; social burdens which entailed, affected public relations, feelings of stigma; an economic burden which included interference with the source of income, affected productivity at work; and physical burdens which included, Feelings of uneasiness and disrupted sleep among others. CONCLUSION The caregivers majorly perceived epilepsy as a serious burden. This burden can be psychological, social, economic, and physical. Therefore, services and plans targeting patients with epilepsy need to consider the burden that caregivers encounter to comprehensively manage epilepsy.
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Affiliation(s)
- Lindah Okiah
- Department of Nursing, Busitema University Faculty of Health Sciences, Mbale, Uganda
| | - Samuel Olowo
- Department of Nursing, Busitema University Faculty of Health Sciences, Mbale, Uganda
| | - Stanely J Iramiot
- Department of Microbiology and Immunology, Busitema University Faculty of Health Sciences, Mbale, Uganda
| | - Rebecca Nekaka
- Department of Community and Public Health, Busitema University Faculty of Health Sciences, Mbale, Uganda
| | - Lydia V N Ssenyonga
- Department of Nursing, Busitema University Faculty of Health Sciences, Mbale, Uganda
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2
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Potential of Capric Acid in Neurological Disorders: An Overview. Neurochem Res 2023; 48:697-712. [PMID: 36342577 DOI: 10.1007/s11064-022-03809-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 10/07/2022] [Accepted: 10/26/2022] [Indexed: 11/09/2022]
Abstract
To solve the restrictions of a classical ketogenic diet, a modified medium-chain triglyceride diet was introduced which required only around 60% of dietary energy. Capric acid (CA), a small molecule, is one of the main components because its metabolic profile offers itself as an alternate source of energy to the brain in the form of ketone bodies. This is possible with the combined capability of CA to cross the blood-brain barrier and achieve a concentration of 50% concentration in the brain more than any other fatty acid in plasma. Natural sources of CA include vegetable oils such as palm oil and coconut oil, mammalian milk and some seeds. Several studies have shown that CA has varied action on targets that include AMPA receptors, PPAR-γ, inflammatory/oxidative stress pathways and gut dysbiosis. Based on these lines of evidence, CA has proved to be effective in the amelioration of neurological diseases such as epilepsy, affective disorders and Alzheimer's disease. But these studies still warrant more pre-clinical and clinical studies that would further prove its efficacy. Hence, to understand the potential of CA in brain disease and associated comorbid conditions, an advance and rigorous molecular mechanistic study, apart from the reported in-vitro/in-vivo studies, is urgently required for the development of this compound through clinical setups.
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Liu J, Zhang P, Zou Q, Liang J, Chen Y, Cai Y, Li S, Li J, Su J, Li Q. Status of epilepsy in the tropics: An overlooked perspective. Epilepsia Open 2023; 8:32-45. [PMID: 36588194 PMCID: PMC9977758 DOI: 10.1002/epi4.12686] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 12/13/2022] [Indexed: 01/03/2023] Open
Abstract
Epilepsy is one of the most common serious chronic neurological diseases affecting people of all ages globally. It is characterized by recurrent seizures. About 50 million people worldwide have epilepsy. Indubitably, people with epilepsy (PWE) may be without access to appropriate treatment. Many studies have examined the molecular mechanisms and clinical aspects of epilepsy; nonetheless, the treatment gap exists in some special areas. In the tropics, the specific geographical and ecological conditions and a lack of medical resources result in neglect or delay of diagnosis for PWE. Herein, we summarized the epidemiology of epilepsy in the tropics and discussed the disease burden and existing problems, aiming to offer a medical environment for patients in need and highlight the importance of reducing the epileptic disease burden in tropical countries.
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Affiliation(s)
- Jiaqi Liu
- Department of Neurology, the First Affiliated Hospital, International School of Public Health and One Health, Hainan Medical University, Haikou, China.,Hainan Provincial Key Laboratory of Tropical Brain Research and Transformation, Hainan Medical University, Haikou, China
| | - Peng Zhang
- Department of Neurology, the First Affiliated Hospital, International School of Public Health and One Health, Hainan Medical University, Haikou, China.,Hainan Provincial Key Laboratory of Tropical Brain Research and Transformation, Hainan Medical University, Haikou, China.,Department of Forensic Medicine, Hainan Medical University, Haikou, China
| | - Qin Zou
- Department of Medical Psychology, The First Affiliated Hospital of Hainan Medical University, Haikou, China
| | - Jiantang Liang
- Department of Neurology, the First Affiliated Hospital, International School of Public Health and One Health, Hainan Medical University, Haikou, China.,Hainan Provincial Key Laboratory of Tropical Brain Research and Transformation, Hainan Medical University, Haikou, China
| | - Yongmin Chen
- Department of Functional Diagnosis, The Second Affiliated Hospital of Hainan Medical University, Haikou, China
| | - Yi Cai
- Department of Neurology, the First Affiliated Hospital, International School of Public Health and One Health, Hainan Medical University, Haikou, China
| | - Shichuo Li
- China Association Against Epilepsy, Beijing, China
| | - Jinmei Li
- Department of Neurology, West China Hospital of Sichuan University, Chengdu, China
| | - Jing Su
- Department of Neurology, the First Affiliated Hospital, International School of Public Health and One Health, Hainan Medical University, Haikou, China
| | - Qifu Li
- Department of Neurology, the First Affiliated Hospital, International School of Public Health and One Health, Hainan Medical University, Haikou, China.,Hainan Provincial Key Laboratory of Tropical Brain Research and Transformation, Hainan Medical University, Haikou, China
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Thorbecke R, Pfäfflin M, Bien CG, Hamer HM, Holtkamp M, Rating D, Schulze-Bonhage A, Straub HB, Strzelczyk A, May TW. Have attitudes toward epilepsy improved in Germany over the last 50 years? Epilepsy Behav 2023; 138:108982. [PMID: 36459812 DOI: 10.1016/j.yebeh.2022.108982] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 10/24/2022] [Accepted: 10/29/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVE In Germany, six previous representative surveys on attitudes toward epilepsy (AE) have been conducted between 1967 and 2008 using the four original Caveness questions (CQs) from 1949 to 1980. The aims of this study were (1) to investigate changes in AE over the time span of 50 years, including the current survey in 2018 (2) to investigate the first-time emotional reactions measured with the Scales of Attitudes toward People with Epilepsy (SAPE) (3) to identify predictors of AE. METHODS A representative face-to-face survey with CQ, in addition with the SAPE scales of Social Distance, Stereotypes, Personal Concerns, and Emotional Reactions was carried out in Germany in 2018. One thousand and twenty-six persons who ever had heard of epilepsy participated. Respondents who answered "don't know" in the CQs were subsequently asked to answer only yes/no. The analysis of trends from 1967 to 2018 was based on the pooled data of the surveys. The four CQs in the 2018 survey were included in the SAPE item pool and an exploratory principal axis factor analysis was performed. General linear models were performed to identify predictors. RESULTS For all four CQs, the trend of improved AE was significant over the past 50 years. In the 2018 survey, excluding the "don't know" answer option increased the proportion of negative responses for contact of one's own children with a person with epilepsy (PWE) from 6.9% to 11.4% and for the marriage of one's own children with a PWE from 13.9% to 23.8%. When encountering a PWE, 30.1% would feel insecure or uncomfortable and nearly 60% were concerned that the PWE might be injured in case of a seizure. Knowing what to do in case of a seizure, knowing that seizures can be treated successfully, personal contact with a PWE along with younger age, and higher education were found to be the strongest predictors for positive AE identified by multivariate analyses. Exploratory principal axis factor analysis revealed that three of the four CQs items loaded > 0.30 at the factors of Social Distance and Stereotypes of SAPE but none on the factors measuring emotional reactions. SIGNIFICANCE AE measured by CQs have markedly improved in Germany over the last 50 years. Germany is to our knowledge the only country with such a long-term trend investigation in AE. Negative AE may be underestimated by survey questions with "don't know" answer option. Emotional aspects of attitudes are underexposed resp. neglected in the CQs, which are used worldwide for measuring AE. Additional tools like SAPE can close this gap. The identified predictors may help to derive interventions against negative AE.
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Affiliation(s)
| | - Margarete Pfäfflin
- Protestant Hospital of Bethel Foundation, University Medical School OWL, Bielefeld University, Campus Bielefeld-Bethel, Germany
| | - Christian G Bien
- Society of Epilepsy Research, Epilepsy Center Bethel, Bielefeld, Germany; Dept. of Epileptology (Krankenhaus Mara), Bielefeld University, Campus Bielefeld-Bethel, Germany
| | - Hajo M Hamer
- Epilepsy Center, Dept. of Neurology, University Hospital Erlangen, Germany
| | - Martin Holtkamp
- Epilepsy-Center Berlin-Brandenburg, Institute for Diagnostics of Epilepsy, Berlin, Germany
| | | | - Andreas Schulze-Bonhage
- Epilepsy Center, University Medical Center - University of Freiburg, European Reference Network Epicare, Germany
| | - Hans-Beatus Straub
- Epilepsy Center Berlin-Brandenburg, Epilepsieklinik Tabor, Bernau, Germany
| | - Adam Strzelczyk
- Epilepsy Center Frankfurt Rhine-Main, Center of Neurology and Neurosurgery, Goethe-University Frankfurt, Frankfurt am Main, Germany
| | - Theodor W May
- Protestant Hospital of Bethel Foundation, University Medical School OWL, Bielefeld University, Campus Bielefeld-Bethel, Germany; University of Bielefeld, Bielefeld, Faculty of Psychology and Sports Science, Germany
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Legesse E, Nigussie T, Kebede Y, Aman M, Chaka M, Tilahun D. What is the community's knowledge and understanding regarding epilepsy? Epilepsy knowledge and its determinants among residents of Debub Bench District, Bench Sheko Zone, Southwest Ethiopia, 2019: a cross-sectional study. BMJ Open 2022; 12:e052480. [PMID: 35105625 PMCID: PMC8804647 DOI: 10.1136/bmjopen-2021-052480] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE Epilepsy is a neurological condition marked by recurring seizures. People with epilepsy, particularly in low-income and middle-income countries, are stigmatised due to a lack of understanding and a negative attitude towards the disease. Increased public awareness of epilepsy will aid in the search for therapy and the quality of life of the patients. The study aimed to assess knowledge about epilepsy and the associated factors among residents of Debub Bench District, Bench Sheko Zone, Southwest Ethiopia in 2020. SETTING This community-based, cross-sectional study triangulated with qualitative method was conducted from 25 April 2020 to 20 May 2020. Multistage sampling technique was used to select 601 participants. A structured and interviewer-administered questionnaire was used to collect data. Data were entered in EpiData Manager V.4.0.2.101 and exported to SPSS V.23 for analyses. Multivariable logistic regression was carried out to identify the factors associated with knowledge of epilepsy. A p value of <0.05 was taken to indicate statistical significance. RESULTS A total of 601 respondents participated, of whom 340 (56.6%) were male. The mean age of the respondents was 34.84±11.42 years. The proportion with good knowledge of epilepsy was 55.1%. Factors associated with good knowledge of epilepsy were attending primary education (adjusted OR (AOR)=2.06, 95% CI 1.27 to 3.34), secondary education (AOR=5.01, 95% CI 2.62 to 9.58), above secondary education (AOR=5.67, 95% CI 2.35 to 13.69), being in high wealth index (AOR=1.74, 95% CI 1.09 to 2.78), being a government employee (AOR=3.69, 95% CI 1.39 to 9.83), being a merchant (AOR=3.16, 95% CI 1.80 to 5.54) and being an urban resident (AOR=2.15, 95% CI 1.36 to 3.42). CONCLUSION Only 55% of the residents have sufficient knowledge about epilepsy. Factors associated with knowledge of epilepsy were educational status, wealth index, occupation and residence.
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Affiliation(s)
| | | | - Yohannes Kebede
- Health, Behavior and Society, Jimma University, Jimma, Ethiopia
| | - Mamusha Aman
- Health, Behavior and Society, Jimma University, Jimma, Ethiopia
| | - Mulugeta Chaka
- Health, Behavior and Society, Jimma University, Jimma, Ethiopia
| | - Dejene Tilahun
- Health, Behavior and Society, Jimma University, Jimma, Ethiopia
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Aksoy M, Büyükbayram Z. Evaluating the knowledge of and attitudes toward epilepsy among Turkish undergraduate nursing students: A cross-sectional study. Epilepsy Behav 2022; 126:108477. [PMID: 34922329 DOI: 10.1016/j.yebeh.2021.108477] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 11/26/2021] [Accepted: 11/27/2021] [Indexed: 11/03/2022]
Abstract
AIM This study was conducted to examine the knowledge of and attitudes toward epilepsy among nursing students. METHOD This descriptive and cross-sectional study was conducted with 369 nursing students. Data were collected through an anonymous online questionnaire prepared using the Introductory Information Form, Epilepsy Knowledge Scale (EKS), and Epilepsy Attitude Scale (EAS). Descriptive statistics, the Mann-Whitney U test, Student's t test, one-way ANOVA, and Pearson correlation test were used in the data analysis. A p value of 0.05 was considered the threshold for statistical significance. FINDINGS The sample of the study consisted of nursing students, and more than half of the students (63.4%) were females. 32.2% of the students were third-year students, and the mean age was 21.36 ± 2.12 years. The mean scores obtained on the EKS and the EAS were 10.03 ± 33.21 and 56.39 ± 5.40, respectively. A significant positive correlation was found between the knowledge and attitude scores of the students regarding epilepsy (p < 0.05), and students' attitude scores toward epilepsy increased with increased knowledge of the subject matter. Overall, female students had better knowledge levels and a more positive attitude toward epilepsy than male students (p < 0.05). Further, the students who had witnessed an epileptic seizure, knew someone with epilepsy, or provided care for patients with epilepsy, had higher scores on the EKS, and displayed better knowledge toward epilepsy (p < 0.05). CONCLUSION Nursing students were found to have moderate knowledge of and a positive attitude toward epilepsy. The positive attitude toward epilepsy increased with the increasing knowledge of epilepsy.
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Affiliation(s)
- Meyreme Aksoy
- Siirt University, Faculty of Health Sciences, Department of Nursing Fundamentals, Siirt, Turkey. https://orcid.org/0000-0001-7468-9822/
| | - Zeliha Büyükbayram
- Siirt University, Faculty of Health Sciences, Department of Internal Medicine Nursing, Siirt, Turkey. https://orcid.org/0000-0001-9152-6662/
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Turan GB, Aksoy M, Özer Z. Attitudes of individuals in Eastern Turkey toward epilepsy and the factors associated with these attitudes. Epilepsy Behav 2021; 121:108097. [PMID: 34111764 DOI: 10.1016/j.yebeh.2021.108097] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 05/24/2021] [Accepted: 05/24/2021] [Indexed: 10/21/2022]
Abstract
AIM This study was performed to analyze the attitudes of individuals in eastern Turkey toward epilepsy and the factors associated with these attitudes. METHODS Designed as a cross-sectional descriptive study, this study was performed from January 28 to February 8, 2021. A snowball sampling technique was used to select the study sample, and a survey was sent online to individuals aged 18 or above. A total of 617 individuals who filled in this online survey form were included in this research. Data were collected via a personal information form and the Public Attitudes Toward Epilepsy (PATE) scale. RESULTS The results showed that the mean scores of the participants on the PATE scale, on its general domain, and on its personal domain were 1.79±0.63, 1.70±0.63, and 1.96±0.77, respectively. Comparing the participants' mean PATE scale scores on the basis of their descriptive characteristics revealed statistically significant differences in the mean scores on the scale and its two domains in terms of age, place of residence, educational level, knowing anyone who had epilepsy or experienced epileptic seizures, and witnessing a person having an epileptic seizure (p < 0.05). CONCLUSION Individuals living in eastern Turkey have positive attitudes toward epilepsy. Moreover, it was found that, among all the participants, those who were relatively young, those who lived in a provincial center, those who had a relatively high educational level, those who knew an individual with epilepsy, and those who had witnessed an epileptic seizure have more positive attitudes toward epilepsy than their counterparts. IMPLICATIONS It is recommended to design educational programs focusing on raising the level of public awareness and knowledge regarding epilepsy.
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Affiliation(s)
| | - Meyreme Aksoy
- Department of Nursing, Faculty of Health Sciences, Siirt University, Siirt, Turkey
| | - Zülfünaz Özer
- Department of Nursing, Faculty of Health Sciences, Istanbul Sabahattin Zaim University, Istanbul, Turkey
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Sarkar NDP, Bardaji A, Baingana FK, Rivera JM, Criel B, Bunders-Aelen J, Grietens KP. Intra-household Variation in Pathways to Care for Epilepsy and Mental Disorders in Eastern Uganda. Front Public Health 2021; 9:583667. [PMID: 34381746 PMCID: PMC8350049 DOI: 10.3389/fpubh.2021.583667] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 06/14/2021] [Indexed: 11/22/2022] Open
Abstract
Integrating mental, neurological, and substance use (MNS) health care into the public health system has become a global priority, with mental health, and well-being now being part of the Sustainable Development Goals. In the aim to provide good quality care for MNS disorders, understanding patients' pathways to care is key. This qualitative study explores the pathways to care of patients attending an outpatient mental health clinic of a district hospital in eastern rural Uganda, from the perspectives of their caregivers. Twenty seven in-depth interviews were conducted with caregivers of MNS patients visiting the clinic, with a focus on four case-presentations. Data analysis consisted of thematic and emergent content analyses using NVivo 11. Results across all interviews highlight that chosen help-seeking itineraries were largely pluralistic, combining and alternating between traditional healing practices, and biomedical care, regardless of the specific MNS disorder. Intra-household differences in care seeking pathways—e.g., where one patient received traditional help or no care at all, while the other received biomedical care—depended on caregivers' perceived contextual illness narrative for each patient, in combination with a variety of other factors. If interpreted as a form of bewitchment, traditional medicine and healing was often the first form of care sought, while the mental health clinic was seen as a recourse to “free” care. Patients, especially younger children, who showed visible improvements once stabilized on psychotropic medication was a source of motivation for caregivers to continue with biomedical care at the mental health clinic. However, stock-outs of the free psychotropic medication at the clinic led to dissatisfaction with services due to out-of-pocket expenses and precipitated returning to alternative therapy choices. This article showcases the importance of understanding the complex and varied combinations of individual, cultural, socioeconomic and structural factors that may affect caregivers' choices of pathways to care for patients with MNS disorders in eastern rural Uganda. These cumulative complex processes and context-specific help-seeking behaviors, which ultimately impact patient treatment and MNS health outcomes, need to be first acknowledged, understood and taken into account if we are to promote more inclusive, effective and integrated public mental health systems globally.
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Affiliation(s)
- Nandini D P Sarkar
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium.,Athena Institute for Research on Innovation and Communication in Health and Life Sciences, Faculty of Sciences, Vrije Universiteit Amsterdam, Amsterdam, Netherlands.,ISGlobal, Hospital Clinic - University of Barcelona, Barcelona, Spain
| | - Azucena Bardaji
- ISGlobal, Hospital Clinic - University of Barcelona, Barcelona, Spain
| | - Florence K Baingana
- School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Joan Muela Rivera
- PASS Suisse, Neuchatel, Switzerland.,Medical Anthropology Research Centre (MARC) at Departament d'Antropologia, Filosofia i Treball Social, Universidad Rovira i Virgili, Tarragona, Spain
| | - Bart Criel
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Joske Bunders-Aelen
- Athena Institute for Research on Innovation and Communication in Health and Life Sciences, Faculty of Sciences, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
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Fuller AT, Almojuela A, Kaddumukasa MN, Chakraborty P, Smith PJ, Kolls BJ, Van Belleghem F, Muhumuza C, Nshemerirwe S, Kaddumukasa M, Nakasujja N, Nakku J, Kakooza-Mwesige A, Haglund MM, Koltai DC. Hospital-based epilepsy care in Uganda: A prospective study of three major public referral hospitals. Epilepsy Behav 2021; 114:107301. [PMID: 32861671 DOI: 10.1016/j.yebeh.2020.107301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 06/23/2020] [Accepted: 06/28/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVE This study sets out to describe the current demographics of people with epilepsy (PWE) attending hospital-based care in Uganda and the epilepsy treatment practices within three of the largest Ugandan public referral hospitals. METHODS In a six-month prospective cohort study, 626 children and adults attending epilepsy clinics at Mulago National Referral Hospital, Butabika National Referral Mental Hospital and Mbarara Regional Referral Hospital were enrolled. Using a study questionnaire, data were collected at baseline and at 3 weeks, 3 months, and 6 months following enrollment. Specific data surrounding individual patient demographics, clinical characteristics and severity of epilepsy, and treatment of epilepsy with antiepileptic drugs (AEDs) were collected. RESULTS Female patients totaled to 50.8%, with a nearly equal gender distribution at each hospital. There was no statistical difference in gender or age between sites. The majority of PWE had completed primary school, with less than 15% of patients completing more than a secondary education. Seizure severity was high, with most patients having multiple seizures per week at the initial onset of epilepsy, and greater than 90% of patients reporting a loss of consciousness with seizures. The majority of patients (54.95%) also reported a developmental or learning delay. Most patients were on 1 AED (46.01%) or 2 AEDs (36.90%), with carbamazepine being the most frequently prescribed AED. There was a trend towards improved seizure severity over the follow-up period, as assessed by the corresponding Personal Impact of Epilepsy Scale (PIES) subscale. CONCLUSIONS People with epilepsy attending hospital-based care in Uganda tend to have severe forms of epilepsy requiring management with AEDs. Current hospital-based practices show a positive trend for seizure burden and quality of life of PWE in Uganda. Further interventions to improve overall access to biomedical care are required to continue to advance the management of PWE across all communities. This article is part of the Special Issue "The Intersection of Culture, Resources, and Disease: Epilepsy Care in Uganda".
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Affiliation(s)
- Anthony T Fuller
- Duke Division of Global Neurosurgery and Neurology, Department of Neurosurgery, Box 3807 Duke University Medical Center, Durham, NC 27705, USA; Duke Global Health Institute, 310 Trent Dr, Durham, NC 27710, USA; Duke University, School of Medicine, Durham, NC, USA
| | - Alysa Almojuela
- Section of Neurosurgery, Rady Faculty of Health Sciences, University of Manitoba, GB1-820 Sherbrook Street, Health Sciences Centre, Winnipeg, MB R3A 1R9, Canada
| | - Martin N Kaddumukasa
- Department of Medicine, Mulago National Referral Hospital, Neurology Unit, Kampala, Uganda; School of Medicine, College of Health Sciences, Makerere University, P.O. Box 7072, Kampala, Uganda
| | - Payal Chakraborty
- Duke Division of Global Neurosurgery and Neurology, Department of Neurosurgery, Box 3807 Duke University Medical Center, Durham, NC 27705, USA; Duke Global Health Institute, 310 Trent Dr, Durham, NC 27710, USA
| | - Patrick J Smith
- Duke University School of Medicine, Department of Psychiatry and Behavioral Sciences, DUMC Box 3119, Trent Drive, Durham, NC, USA
| | - Brad J Kolls
- Duke Division of Global Neurosurgery and Neurology, Department of Neurosurgery, Box 3807 Duke University Medical Center, Durham, NC 27705, USA; Duke University School of Medicine, Department of Neurology, Durham, NC, USA; Duke Clinical Research Institute, Neuroscience Medicine, 300 W Morgan St, Durham, NC 27701, USA
| | - Florence Van Belleghem
- Duke Division of Global Neurosurgery and Neurology, Department of Neurosurgery, Box 3807 Duke University Medical Center, Durham, NC 27705, USA; Department of Medicine, Group Biomedical Sciences, KU Leuven, Belgium
| | - Christine Muhumuza
- Duke Division of Global Neurosurgery and Neurology, Department of Neurosurgery, Box 3807 Duke University Medical Center, Durham, NC 27705, USA; Makerere University School of Public Health, Department of Epidemiology and Biostatistics, Mulago Complex, P.O. Box 7072, Kampala, Uganda
| | - Sylvia Nshemerirwe
- Butabika National Referral Mental Hospital, P.O. Box 7017, Kampala, Uganda
| | - Mark Kaddumukasa
- School of Medicine, College of Health Sciences, Makerere University, P.O. Box 7072, Kampala, Uganda
| | - Noeline Nakasujja
- Department of Psychiatry, School of Medicine, Makerere University College of Health Sciences, P.O. Box 7072, Kampala, Uganda
| | - Juliet Nakku
- Butabika National Referral Mental Hospital, P.O. Box 7017, Kampala, Uganda
| | - Angelina Kakooza-Mwesige
- Department of Paediatrics and Child Health, Makerere University College of Health Sciences, Mulago Hill Road, P.O. Box 7072, Kampala, Uganda; Department of Paediatrics and Child Health, Mulago National Referral Hospital, Pediatric Neurology Unit, Kampala, Uganda
| | - Michael M Haglund
- Duke Division of Global Neurosurgery and Neurology, Department of Neurosurgery, Box 3807 Duke University Medical Center, Durham, NC 27705, USA; Duke Global Health Institute, 310 Trent Dr, Durham, NC 27710, USA; Duke University, School of Medicine, Durham, NC, USA
| | - Deborah C Koltai
- Duke Division of Global Neurosurgery and Neurology, Department of Neurosurgery, Box 3807 Duke University Medical Center, Durham, NC 27705, USA; Duke University School of Medicine, Department of Psychiatry and Behavioral Sciences, DUMC Box 3119, Trent Drive, Durham, NC, USA; Duke University School of Medicine, Department of Neurology, Durham, NC, USA.
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Anguzu R, Akun P, Katairo T, Abbo C, Ningwa A, Ogwang R, Mwaka AD, Marsh K, Newton CR, Idro R. Household poverty, schooling, stigma and quality of life in adolescents with epilepsy in rural Uganda. Epilepsy Behav 2021; 114:107584. [PMID: 33248944 PMCID: PMC7613327 DOI: 10.1016/j.yebeh.2020.107584] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 10/20/2020] [Accepted: 10/21/2020] [Indexed: 12/25/2022]
Abstract
BACKGROUND Epilepsy remains a leading chronic neurological disorder in Low- and Middle-Income Countries. In Uganda, the highest burden is among young rural people. We aimed to; (i) describe socio-economic status (including schooling), and household poverty in adolescents living with epilepsy (ALE) compared to unaffected counterparts in the same communities and (ii) determine the factors associated with the overall quality of life (QoL). METHODS This was a cross-sectional survey nested within a larger study of ALE compared to age-matched healthy community children in Uganda. Between Sept 2016 to Sept 2017, 154 ALE and 154 healthy community controls were consecutively recruited. Adolescents recruited were frequency and age-matched based on age categories 10-14 and 15-19 years. Clinical history and standardized assessments were conducted. One control participant had incomplete assessment and was excluded. The primary outcome was overall QoL and key variables assessed were schooling status and household poverty. Descriptive and multivariable linear regression analysis were conducted for independent associations with overall QoL. RESULTS Mean (SD) age at seizure onset was 8.8 (3.9) years and median (IQR) monthly seizure burden was 2 (1-4). Epilepsy was associated with living in homes with high household poverty; 95/154 (61.7%) ALE lived in the poorest homes compared to 68/153 (44.5%) of the healthy adolescents, p = 0.001. Nearly two-thirds of ALE had dropped out of school and only 48/154 (31.2%) were currently attending school compared to 136/153 (88.9%) of healthy controls, p < 0.001. QoL was lowest among ALE who never attended school (p < 0.001), with primary education (p = 0.006) compared to those with at least secondary education. Stigma scores [mean(SD)] were highest among ALE in the poorest [69.1(34.6)], and wealthy [70.2(32.2)] quintiles compared to their counterparts in poorer [61.8(31.7)], medium [68.0(32.7)] and wealthiest [61.5(33.3)] quintiles, though not statistically significant (p = 0.75). After adjusting for covariates, ALE currently attending school had higher overall QoL compared to their counterparts who never attended school (β = 4.20, 95%CI: 0.90,7.49, p = 0.013). QoL scores were higher among ALE with ≥secondary education than those with no or primary education (β = 10.69, 95%CI: 1.65, 19.72). CONCLUSIONS ALE in this rural area are from the poorest households, are more likely to drop out of school and have the lowest QoL. Those with poorer seizure control are most affected. ALE should be included among vulnerable population groups and in addition to schooling, strategies for seizure control and addressing the epilepsy treatment gap in affected homes should be specifically targeted in state poverty eradication programs.
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Affiliation(s)
- Ronald Anguzu
- Makerere University College of Health Sciences, Kampala, Uganda,Centre for Tropical Neuroscience, Kampala, Uganda,Institute of Health and Equity, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Pamela Akun
- Makerere University College of Health Sciences, Kampala, Uganda,Centre for Tropical Neuroscience, Kampala, Uganda
| | - Thomas Katairo
- Makerere University College of Health Sciences, Kampala, Uganda
| | - Catherine Abbo
- Makerere University College of Health Sciences, Kampala, Uganda
| | - Albert Ningwa
- Makerere University College of Health Sciences, Kampala, Uganda,Centre for Tropical Neuroscience, Kampala, Uganda
| | - Rodney Ogwang
- Makerere University College of Health Sciences, Kampala, Uganda,Centre for Tropical Neuroscience, Kampala, Uganda,Kenya Medical Research Institute-Wellcome Trust Collaborative Programme, Kilifi, Kenya
| | | | - Kevin Marsh
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
| | - Charles R. Newton
- Kenya Medical Research Institute-Wellcome Trust Collaborative Programme, Kilifi, Kenya,Department of Psychiatry, University of Oxford, Oxford, UK
| | - Richard Idro
- Makerere University College of Health Sciences, Kampala, Uganda; Centre for Tropical Neuroscience, Kampala, Uganda; Kenya Medical Research Institute-Wellcome Trust Collaborative Programme, Kilifi, Kenya; Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK.
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11
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Smith CE, Kajumba M, Bobholz S, Smith PJ, Kaddumukasa M, Kakooza-Mwesige A, Chakraborty P, Sinha DD, Kaddumukasa MN, Gualtieri A, Nakasujja N, Onuoha E, Nakku J, Muhumuza C, Sanchez N, Fuller AT, Haglund MM, Koltai DC. Pluralistic and singular causal attributions for epilepsy in Uganda. Epilepsy Behav 2021; 114:107334. [PMID: 32839144 DOI: 10.1016/j.yebeh.2020.107334] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 06/24/2020] [Accepted: 06/28/2020] [Indexed: 01/22/2023]
Abstract
OBJECTIVE In Uganda, causal attributions for epilepsy reflect a variety of beliefs and impact care-seeking behavior, perpetuate stigma, and undermine the effectiveness of interventions to narrow the epilepsy treatment gap. The objective of this study was to characterize beliefs about seizure etiology to gain a better understanding of how epilepsy is conceptualized in the community in order to inform culturally appropriate educational policies and interventions. METHODS In a community-based study, 15,383 participants were surveyed about beliefs related to 15 potential causes for epilepsy. Principal axis factor analysis (PFA) was performed to identify causative factors and then utilized to classify singular versus pluralistic belief systems related to epilepsy etiology. Analysis of variance (ANOVA) and Mann-Whitney U-tests were conducted to examine the differences in background characteristics across the etiology belief groups. RESULTS Three main causative factors emerged from the PFA: biological, sociospiritual, and biospiritual. Among those endorsing at least one factor (n = 13,036), the biological factor was endorsed most frequently as a potential cause for epilepsy (88.0%), followed by the sociospiritual (63.4%), then biospiritual (47.6%). Review of the patterns of endorsement found that only 22.2% endorsed the biological factor alone, 6.7% the sociospiritual factor alone, and 2.8% the biospiritual factor alone (total 31.7%). The remainder endorsed a combination of two or all three factors as being potentially causal, and most (65.7%) endorsed a pluralistic combination inclusive of a biological etiology. Group comparisons showed that endorsing only the biological factor was associated with the highest levels of education (p < 0.01), the pluralistic group had the highest ratio of people in the household who needed assistance to those that could provide aid (p < 0.01), and there were significant differences in income across specific groups (p < 0.01). CONCLUSIONS Pluralistic attributions for epilepsy are common in Uganda, with the majority of community members drawing from biomedical and traditional concepts to construct complex explanations for seizures that transcend discrete belief categories traditionally depicted in the literature. These findings emphasize the need to understand cultural beliefs about epilepsy in order to design contextually specific interventions and education programs, which respect the fundamental beliefs and values of the community. This article is part of the Special Issue "The Intersection of Culture, Resources, and Disease: Epilepsy Care in Uganda".
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Affiliation(s)
- Caleigh E Smith
- Duke University Trinity College of Arts & Sciences, Durham, NC 27708, USA
| | - Mayanja Kajumba
- Department of Mental Health and Community Psychology, Makerere University School of Psychology, P.O. Box 7062, Kampala, Uganda
| | - Samuel Bobholz
- University of Wisconsin - Madison, Department of Neurology, 1685 Highland Avenue, Madison, WI 53705-2281, USA
| | - Patrick J Smith
- Duke University School of Medicine, Department of Psychiatry and Behavioral Sciences, DUMC Box 3119, Trent Drive, Durham, NC, USA
| | - Mark Kaddumukasa
- School of Medicine, College of Health Sciences, Makerere University. P.O. Box 7072, Kampala, Uganda
| | - Angelina Kakooza-Mwesige
- Department of Paediatrics and Child Health, Makerere University College of Health Sciences, Mulago Hill Road, P.O. Box 7072, Kampala, Uganda; Department of Pediatrics and Child Health, Mulago National Referral Hospital, Pediatric Neurology Unit, Kampala, Uganda
| | - Payal Chakraborty
- Duke Division of Global Neurosurgery and Neurology, Department of Neurosurgery, Box 3807 Duke University Medical Center, Durham, NC 27705, USA; Duke Global Health Institute, 310 Trent Dr, Durham, NC 27710, USA
| | - Drishti D Sinha
- Duke University Trinity College of Arts & Sciences, Durham, NC 27708, USA
| | - Martin N Kaddumukasa
- School of Medicine, College of Health Sciences, Makerere University. P.O. Box 7072, Kampala, Uganda; Department of Medicine, Mulago National Referral Hospital, Neurology Unit, Kampala, Uganda
| | - Alex Gualtieri
- Duke University Medical Center, Clinical Neuropsychology Service, Box 3333, Durham, NC, USA
| | - Noeline Nakasujja
- Department of Psychiatry, School of Medicine, Makerere University College of Health Sciences, P.O. Box 7072, Kampala, Uganda
| | - Erica Onuoha
- Duke University Trinity College of Arts & Sciences, Durham, NC 27708, USA
| | - Juliet Nakku
- Butabika National Referral Mental Hospital, P.O. Box 7017, Kampala, Uganda
| | - Christine Muhumuza
- Duke Division of Global Neurosurgery and Neurology, Department of Neurosurgery, Box 3807 Duke University Medical Center, Durham, NC 27705, USA; Makerere University School of Public Health, Department of Epidemiology and Biostatistics, New Mulago complex, P.O. Box 7072, Kampala, Uganda
| | - Nadine Sanchez
- Duke Division of Global Neurosurgery and Neurology, Department of Neurosurgery, Box 3807 Duke University Medical Center, Durham, NC 27705, USA; Duke Global Health Institute, 310 Trent Dr, Durham, NC 27710, USA
| | - Anthony T Fuller
- Duke Division of Global Neurosurgery and Neurology, Department of Neurosurgery, Box 3807 Duke University Medical Center, Durham, NC 27705, USA; Duke Global Health Institute, 310 Trent Dr, Durham, NC 27710, USA; Duke University, School of Medicine, 3100 Tower Blvd, Durham, NC 27707, USA
| | - Michael M Haglund
- Duke Division of Global Neurosurgery and Neurology, Department of Neurosurgery, Box 3807 Duke University Medical Center, Durham, NC 27705, USA; Duke Global Health Institute, 310 Trent Dr, Durham, NC 27710, USA; Duke University, School of Medicine, 3100 Tower Blvd, Durham, NC 27707, USA
| | - Deborah C Koltai
- Duke Division of Global Neurosurgery and Neurology, Department of Neurosurgery, Box 3807 Duke University Medical Center, Durham, NC 27705, USA; Duke University, Department of Neurology, 3116 N Duke St, Durham, NC 27704, USA; Duke University School of Medicine, Department of Psychiatry and Behavioral Sciences, DUMC Box 3119, Trent Drive, Durham, NC, USA.
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12
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Koltai DC, Smith CE, Cai GY, Ratliff O, Kakooza-Mwesige A, Najjuma JN, Muhindo R, Rukundo GZ, Teuwen DE, Kayanja A, Kalubi P, Haglund MM, Fuller AT. Healthcare provider perspectives regarding epilepsy care in Uganda. Epilepsy Behav 2021; 114:107294. [PMID: 32763023 DOI: 10.1016/j.yebeh.2020.107294] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 06/23/2020] [Accepted: 06/28/2020] [Indexed: 01/29/2023]
Abstract
OBJECTIVE Epilepsy is the most common chronic neurological disorder in the world and imposes a large economic burden on global healthcare systems, especially in low-income settings and rural areas as is found in sub-Saharan Africa (SSA). Despite the high epilepsy prevalence, there are no systematic descriptions of healthcare provider (HCP) perceptions and needs in managing people with epilepsy (PWE) in Uganda. Identifying these perceptions and needs is crucial for understanding community priorities, thereby enhancing the development of culturally sensitive communications, interventions, and research approaches. METHODS In this qualitative study, we used semistructured interview guides to conduct focus group discussions that explored the perspectives of 32 providers of epilepsy care from health facilities around Mbarara, Uganda. Our sample included nonspecialized general physicians (n = 3), medical residents (n = 8), medical clinical officers (n = 3), psychiatric clinical nurses (n = 6), medical nurses and nursing assistants (n = 9), and other providers (n = 3), who were loosely grouped into discussion groups based on level or type of training. Self-assessed proficiency ratings were also administered to gain a better understanding of participants' confidence in their training, preparedness, and capabilities regarding epilepsy care. Thematic analysis of the focus group transcripts was conducted to ascertain commonly occurring themes about perceptions and challenges in epilepsy care. RESULTS Our analyses identified nine major themes that dominated the perspectives of the study participants: care management, medications, diagnostics, HCP training, human resources, location, patient education, social support, and community knowledge and beliefs. Proficiency ratings prioritized areas of confidence as knowledge related to referrals, psychosocial impacts, and seizure neurophysiology. Areas of need were revealed as knowledge of diagnostic tools and antiepileptic drug (AED) regimens. CONCLUSIONS Our findings delineate the perspectives of providers caring for PWE, with consistent recognition of challenges centering around resource augmentation, infrastructure strengthening, and education. Participants emphasized the urgent need to augment these resources to address limitations in medication types and access, trained human resources, and diagnostic tools. They overwhelmingly recognized the need for infrastructure strengthening to address human, diagnostic, medicinal, and capital resource limitations that place undue burden on patients with epilepsy and physicians. Providers indicated a clear desire to learn more about different diagnostic tools and medical management practices, potentially through continuing education, specialized training, or more intentional in-school diagnostic preparation. They also advocated for the powerful influence of patient and family education and clearly articulated the need for community sensitization and support. This article is part of the Special Issue "The Intersection of Culture, Resources, and Disease: Epilepsy Care in Uganda".
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Affiliation(s)
- Deborah C Koltai
- Duke Division of Global Neurosurgery and Neurology, Department of Neurosurgery, Box 3807 Duke University Medical Center, Durham, NC 27705, USA; Duke University School of Medicine, Department of Neurology, Durham, NC, USA; Duke University School of Medicine, Department of Psychiatry and Behavioral Sciences, DUMC, Box 3119, Trent Drive, Durham, NC, USA.
| | - Caleigh E Smith
- Duke University Trinity College of Arts & Sciences, Durham, NC 27708, USA
| | - Grace Y Cai
- Duke University Trinity College of Arts & Sciences, Durham, NC 27708, USA
| | - Olivia Ratliff
- Duke University Trinity College of Arts & Sciences, Durham, NC 27708, USA
| | - Angelina Kakooza-Mwesige
- Department of Paediatrics and Child Health, Makerere University College of Health Sciences, Mulago Hill Road, P.O. Box 7072, Kampala, Uganda; Department of Paediatrics and Child Health, Mulago National Referral Hospital, Pediatric Neurology Unit, Kampala, Uganda
| | - Josephine N Najjuma
- Mbarara University of Science and Technology Department of Nursing, Plot 8 - 18 Kabale Road, PO Box 1410, Mbarara, Uganda; Mbarara Regional Referral Hospital, Mbarara, Uganda
| | - Rose Muhindo
- Mbarara Regional Referral Hospital, Mbarara, Uganda; Mbarara University of Science and Technology, Department of Medicine, Plot 8 - 18 Kabale Road, PO Box 1410, Mbarara, Uganda
| | - Godfrey Z Rukundo
- Mbarara University of Science and Technology, Department of Psychiatry, Faculty of Medicine, Plot 8 - 18 Kabale Road, PO Box 1410, Mbarara, Uganda
| | - Dirk E Teuwen
- UCB, Allée de la recherche 60, 1070 Brussels, Belgium
| | - Adrian Kayanja
- Mbarara Regional Referral Hospital, Mbarara, Uganda; Mbarara University of Science and Technology, Department of Medicine, Plot 8 - 18 Kabale Road, PO Box 1410, Mbarara, Uganda
| | - Peter Kalubi
- Mbarara University of Science and Technology, Department of Paediatrics and Child Health, Plot 8 - 18 Kabale Road, P. O Box 1410, Mbarara, Uganda
| | - Michael M Haglund
- Duke Division of Global Neurosurgery and Neurology, Department of Neurosurgery, Box 3807 Duke University Medical Center, Durham, NC 27705, USA; Duke Global Health Institute, 310 Trent Dr, Durham, NC 27710, USA; Duke University, School of Medicine, Durham, NC, USA
| | - Anthony T Fuller
- Duke Division of Global Neurosurgery and Neurology, Department of Neurosurgery, Box 3807 Duke University Medical Center, Durham, NC 27705, USA; Duke Global Health Institute, 310 Trent Dr, Durham, NC 27710, USA; Duke University, School of Medicine, Durham, NC, USA
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Kaddumukasa MN, Kaddumukasa M, Kajumba M, Smith PJ, Bobholz S, Kakooza-Mwesige A, Sinha DD, Almojuela A, Chakraborty P, Nakasujja N, Nakku J, Gualtieri A, Onuoha E, Kolls BJ, Muhumuza C, Smith CE, Sanchez N, Fuller AT, Haglund MM, Koltai DC. Barriers to biomedical care for people with epilepsy in Uganda: A cross-sectional study. Epilepsy Behav 2021; 114:107349. [PMID: 32962922 DOI: 10.1016/j.yebeh.2020.107349] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 07/17/2020] [Accepted: 07/17/2020] [Indexed: 01/10/2023]
Abstract
OBJECTIVE Epilepsy, a neurological disorder with effective biomedical treatment, remains largely untreated in Uganda. Potential reasons for this treatment gap (TG) include limited access to trained providers and clinics, social stigmata of seizures, cultural beliefs, or lack of public understanding of epilepsy as a treatable condition. The current study aimed to formally evaluate barriers faced by people with epilepsy (PWE) in Uganda when seeking biomedical care. METHODS In a cross-sectional study, 435 participants drawn from a community prevalence study were enrolled. We included participants reporting a history of recurrent seizures suggestive of epilepsy, who completed a survey about barriers to obtaining care for their symptoms. Principal axis factor analysis (PFA) using a promax rotation was conducted for data reduction. Frequencies of barrier factors were compared across those who did not seek care for epilepsy (n = 228), those who sought care from biomedical facilities (n = 166), and those who sought care from a traditional or pastoral healer (n = 41). RESULTS The PFA yielded a five-factor solution: 1) logistical and actual costs; 2) treatment effectiveness; 3) influence of the opinion of others; 4) doctors' care; and 5) contextual factors impacting decision-making. Variables related to logistical and actual costs were most endorsed. Comparison of groups by care sought did not reveal a difference in endorsement of factors, with the exception that those who sought biomedical care were more likely to endorse factors related to doctors' care compared with those that sought care from traditional or pastoral healers (P = .005). CONCLUSIONS People with repetitive seizures in Uganda report several barriers to obtaining biomedical care in Uganda, with those related to practical and actual costs endorsed the most. It is imperative that interventions developed to reduce the TG in Uganda consider these practical issues to improve access to effective epilepsy care. This article is part of the Special Issue "The Intersection of Culture, Resources, and Disease: Epilepsy Care in Uganda.
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Affiliation(s)
- Martin N Kaddumukasa
- Department of Medicine, Mulago National Referral Hospital, Neurology Unit, Kampala, Uganda; School of Medicine, College of Health Sciences, Makerere University, P.O. Box 7072, Kampala, Uganda
| | - Mark Kaddumukasa
- School of Medicine, College of Health Sciences, Makerere University, P.O. Box 7072, Kampala, Uganda
| | - Mayanja Kajumba
- Department of Mental Health and Community Psychology, Makerere University School of Psychology, P.O. Box 7062, Kampala, Uganda
| | - Patrick J Smith
- Duke University School of Medicine, Department of Psychiatry and Behavioral Sciences, DUMC Box 3119, Trent Drive, Durham, NC, USA
| | - Samuel Bobholz
- University of Wisconsin - Madison, Department of Neurology, 1685 Highland Avenue, Madison, WI 53705-2281, USA
| | - Angelina Kakooza-Mwesige
- Department of Paediatrics and Child Health, Makerere University College of Health Sciences, Mulago Hill Road, P.O. Box 7072, Kampala, Uganda; Department of Paediatrics and Child Health, Mulago National Referral Hospital, Pediatric Neurology Unit, Kampala, Uganda
| | - Drishti D Sinha
- Duke University Trinity College of Arts & Sciences, Durham, NC 27708, USA
| | - Alysa Almojuela
- Section of Neurosurgery, Rady Faculty of Health Sciences, University of Manitoba, GB1-820 Sherbrook Street, Health Sciences Centre, Winnipeg, MB R3A 1R9, Canada
| | - Payal Chakraborty
- Duke Division of Global Neurosurgery and Neurology, Department of Neurosurgery, Box 3807 Duke University Medical Center, Durham, NC 27705, USA; Duke Global Health Institute, 310 Trent Dr, Durham, NC 27710, USA
| | - Noeline Nakasujja
- Department of Psychiatry, School of Medicine, Makerere University College of Health Sciences, P.O. Box 7072, Kampala, Uganda
| | - Juliet Nakku
- Butabika National Referral Mental Hospital, P.O. Box 7017, Kampala, Uganda
| | - Alex Gualtieri
- Duke University Medical Center, Clinical Neuropsychology Service, Box 3333, Durham, NC, USA
| | - Erica Onuoha
- Duke University Trinity College of Arts & Sciences, Durham, NC 27708, USA
| | - Brad J Kolls
- Duke Division of Global Neurosurgery and Neurology, Department of Neurosurgery, Box 3807 Duke University Medical Center, Durham, NC 27705, USA; Duke University School of Medicine, Department of Neurology, Durham, NC, USA; Duke Clinical Research Institute, Neuroscience Medicine, 300 W Morgan St, Durham, NC 27701, USA
| | - Christine Muhumuza
- Duke Division of Global Neurosurgery and Neurology, Department of Neurosurgery, Box 3807 Duke University Medical Center, Durham, NC 27705, USA; Makerere University School of Public Health, Department of Epidemiology and Biostatistics, New Mulago Complex, P.O. Box 7072, Kampala, Uganda
| | - Caleigh E Smith
- Duke University Trinity College of Arts & Sciences, Durham, NC 27708, USA
| | - Nadine Sanchez
- Duke Division of Global Neurosurgery and Neurology, Department of Neurosurgery, Box 3807 Duke University Medical Center, Durham, NC 27705, USA; Duke Global Health Institute, 310 Trent Dr, Durham, NC 27710, USA
| | - Anthony T Fuller
- Duke Division of Global Neurosurgery and Neurology, Department of Neurosurgery, Box 3807 Duke University Medical Center, Durham, NC 27705, USA; Duke Global Health Institute, 310 Trent Dr, Durham, NC 27710, USA; Duke University, School of Medicine, Durham, NC, USA
| | - Michael M Haglund
- Duke Division of Global Neurosurgery and Neurology, Department of Neurosurgery, Box 3807 Duke University Medical Center, Durham, NC 27705, USA; Duke Global Health Institute, 310 Trent Dr, Durham, NC 27710, USA; Duke University, School of Medicine, Durham, NC, USA
| | - Deborah C Koltai
- Duke Division of Global Neurosurgery and Neurology, Department of Neurosurgery, Box 3807 Duke University Medical Center, Durham, NC 27705, USA; Duke University School of Medicine, Department of Psychiatry and Behavioral Sciences, DUMC Box 3119, Trent Drive, Durham, NC, USA; Duke University School of Medicine, Department of Neurology, Durham, NC, USA.
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Kaddumukasa M, Smith PJ, Kaddumukasa MN, Kajumba M, Almojuela A, Bobholz S, Chakraborty P, Sinha DD, Nakasujja N, Kakooza-Mwesige A, Gualtieri A, Onuoha E, Nakku J, Sanchez N, Muhumuza C, Fuller AT, Haglund MM, Koltai DC. Epilepsy beliefs and misconceptions among patient and community samples in Uganda. Epilepsy Behav 2021; 114:107300. [PMID: 32758405 DOI: 10.1016/j.yebeh.2020.107300] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 06/23/2020] [Accepted: 06/28/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE The objective of the study was to characterize and compare the attitudes, beliefs, and perceptions about epilepsy across community and patient cohorts in Uganda. METHODS This was a descriptive study utilizing two samples: a randomly selected, national survey community sample and a hospital-based patient sample of people with epilepsy (PWE) and their caregivers attending clinic settings in Kampala and Mbarara, Uganda for epilepsy care. Both samples were surveyed about their beliefs about epilepsy, its treatment, and people who have the illness. Multivariate linear regression was used to examine group differences and variables associated with specific beliefs. RESULTS Among the 15,818 community survey participants who participated in this study, 435 study participants reported symptoms suggestive of recurrent seizures, and all 626 subjects in the hospital-based sample had confirmed epilepsy. Results revealed significant differences across groups in their endorsement of epilepsy as a contagion; 37% of people in the community unaffected by epilepsy, and 39% of people with suspected epilepsy who did not seek care believed that epilepsy was contagious by touch, in contrast to 8% of PWE or their caregivers attending regular hospital-based care. Higher educational attainment and income, and seeking regular hospital-based medical care were associated with less endorsement of epilepsy as a contagion, while age, education, income, area of residence, and presence of seizure symptoms, were significant predictors of support or belief in the basic rights of PWE. Study participants within the community who screened negative for seizures placed the most restrictions on rights for PWE. To varying degrees, the samples all endorsed the effectiveness of allopathic, traditional, and religious providers, and the use of pharmaceutical drugs, traditional rituals and herbs, and prayer. CONCLUSIONS People with epilepsy who are attending biomedical care for routine epilepsy care think differently about epilepsy, its treatment, and the rights of those with the disease than the general population. Within the community setting, more erroneous beliefs and negative attitudes about epilepsy and PWE persist, and they not only contribute to stigma but also interfere with the patients' health-seeking behavior. Further confounding the care of PWE, the pluralistic healthcare system in Uganda is evident in endorsements spanning biomedical, traditional, and religious treatment methods. Focused awareness campaigns utilizing local epilepsy societies are needed to promote epilepsy health literacy, to favorably impact acceptance and opportunities for PWE in Uganda, and to facilitate efficient uptake of biomedical care. This article is part of the Special Issue "The Intersection of Culture, Resources, and Disease: Epilepsy Care in Uganda".
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Affiliation(s)
- Mark Kaddumukasa
- School of Medicine, College of Health Sciences, Makerere University, P.O. Box 7072, Kampala, Uganda
| | - Patrick J Smith
- Duke University School of Medicine, Department of Psychiatry and Behavioral Sciences, DUMC Box 3119; Trent Drive, Durham, NC, USA
| | - Martin N Kaddumukasa
- School of Medicine, College of Health Sciences, Makerere University, P.O. Box 7072, Kampala, Uganda; Department of Medicine, Mulago National Referral Hospital, Neurology Unit, Kampala, Uganda
| | - Mayanja Kajumba
- Department of Mental Health and Community Psychology, Makerere University School of Psychology, P.O. Box 7062, Kampala, Uganda
| | - Alysa Almojuela
- Section of Neurosurgery, Rady Faculty of Health Sciences, University of Manitoba, GB1-820 Sherbrook Street, Health Sciences Centre, Winnipeg, MB R3A 1R9, Canada
| | - Samuel Bobholz
- University of Wisconsin - Madison, Department of Neurology, 1685 Highland Avenue, Madison, WI 53705-2281, USA
| | - Payal Chakraborty
- Duke Division of Global Neurosurgery and Neurology, Department of Neurosurgery, Box 3807, Duke University Medical Center, Durham, NC 27705, USA; Duke Global Health Institute, 310 Trent Dr, Durham, NC 27710, USA
| | - Drishti D Sinha
- Duke University Trinity College of Arts & Sciences, Durham, NC 27708, USA
| | - Noeline Nakasujja
- Department of Psychiatry, School of Medicine, Makerere University College of Health Sciences, P.O. Box 7072, Kampala, Uganda
| | - Angelina Kakooza-Mwesige
- Department of Paediatrics and Child Health, Makerere University College of Health Sciences, Mulago Hill Road, P.O.Box 7072, Kampala, Uganda; Department of Paediatrics and Child Health, Mulago National Referral Hospital, Pediatric Neurology Unit, Kampala, Uganda
| | - Alex Gualtieri
- Duke University Medical Center, Clinical Neuropsychology Service, Box 3333, Durham, NC, USA
| | - Erica Onuoha
- Duke University Trinity College of Arts & Sciences, Durham, NC 27708, USA
| | - Juliet Nakku
- Butabika National Referral Mental Hospital, P.O.Box 7017, Kampala, Uganda
| | - Nadine Sanchez
- Duke Division of Global Neurosurgery and Neurology, Department of Neurosurgery, Box 3807, Duke University Medical Center, Durham, NC 27705, USA; Duke Global Health Institute, 310 Trent Dr, Durham, NC 27710, USA
| | - Christine Muhumuza
- Duke Division of Global Neurosurgery and Neurology, Department of Neurosurgery, Box 3807, Duke University Medical Center, Durham, NC 27705, USA; Makerere University School of Public Health, Department of Epidemiology and Biostatistics, New Mulago Complex, P.O. Box 7072, Kampala, Uganda
| | - Anthony T Fuller
- Duke Division of Global Neurosurgery and Neurology, Department of Neurosurgery, Box 3807, Duke University Medical Center, Durham, NC 27705, USA; Duke Global Health Institute, 310 Trent Dr, Durham, NC 27710, USA; Duke University, School of Medicine, 3100 Tower Blvd, Durham, NC 27707, USA
| | - Michael M Haglund
- Duke Division of Global Neurosurgery and Neurology, Department of Neurosurgery, Box 3807, Duke University Medical Center, Durham, NC 27705, USA; Duke Global Health Institute, 310 Trent Dr, Durham, NC 27710, USA; Duke University, School of Medicine, 3100 Tower Blvd, Durham, NC 27707, USA
| | - Deborah C Koltai
- Duke University School of Medicine, Department of Psychiatry and Behavioral Sciences, DUMC Box 3119; Trent Drive, Durham, NC, USA; Duke Division of Global Neurosurgery and Neurology, Department of Neurosurgery, Box 3807, Duke University Medical Center, Durham, NC 27705, USA; Duke University School of Medicine, Department of Neurology, Durham, NC, USA.
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Chakraborty P, Sanchez NA, Kaddumukasa M, Kajumba M, Kakooza-Mwesige A, Van Noord M, Kaddumukasa MN, Nakasujja N, Haglund MM, Koltai DC. Stigma reduction interventions for epilepsy: A systematized literature review. Epilepsy Behav 2021; 114:107381. [PMID: 32883610 DOI: 10.1016/j.yebeh.2020.107381] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 06/23/2020] [Accepted: 07/26/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Epilepsy is a disease that is stigmatized globally. Several studies have introduced sensitization efforts to reduce stigma towards people with epilepsy (PWE) in various settings. Although sensitization efforts have shown some evidence of improved attitudes towards epilepsy, progress has been limited. This systematized literature review summarizes the existing literature concerning interventions that reduce stigma towards PWE. By conducting an overview of existing interventions, we aimed to consolidate knowledge and outcomes of existing efforts as well as highlight gaps and directions for future interventions. METHODS We searched MEDLINE (via PubMed) and Embase for English-language studies published between January 1, 1970 and November 15, 2017 that focused on stigma reduction strategies for PWE in any global setting. Studies were included if they described a stigma reduction intervention for epilepsy. Studies were excluded if they were reviews, editorials, conference proceedings, abstracts, or did not discuss a stigma reduction intervention. We thematically grouped studies based on type(s) of intervention(s) addressed and summarized interventions, outcome measures, and results for each study included in the review. RESULTS Of the 1975 initial citations, 32 studies met our inclusion criteria. Interventions clustered into four broad categories including public awareness interventions, policy-based interventions, school-based interventions, and interventions that targeted PWE themselves as well as their caregivers and peers. Efficacy of these interventions as reported by the authors was mixed. Many studies did not use validated outcome measures to assess stigma. CONCLUSIONS Although intervention efforts have been made towards epilepsy stigma reduction at many levels, stigma towards and discrimination against PWE prevail worldwide. About 75% of the studies included in this review were conducted in high-income countries (HICs) despite the disproportional need in low- and middle-income countries (LMICs). Furthermore, robust outcome measures to assess efficacy in stigma reduction for interventions are lacking, calling into question the validity of reported outcomes for both positive and null findings. Therefore, more work is needed in both developing effective stigma reduction strategies, especially in LMICs, and validating tools to measure their efficacy. This article is part of the Special Issue "The Intersection of Culture, Resources, and Disease: Epilepsy Care in Uganda".
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Affiliation(s)
- Payal Chakraborty
- Duke Division of Global Neurosurgery and Neurology, Department of Neurosurgery, Box 3807 Duke University Medical Center, Durham, NC 27705, USA; Duke Global Health Institute, 310 Trent Dr, Durham, NC 27710, USA; Duke University School of Medicine, Department of Psychiatry and Behavioral Sciences, Durham, NC, USA
| | - Nadine A Sanchez
- Duke Division of Global Neurosurgery and Neurology, Department of Neurosurgery, Box 3807 Duke University Medical Center, Durham, NC 27705, USA; Duke Global Health Institute, 310 Trent Dr, Durham, NC 27710, USA
| | - Mark Kaddumukasa
- College of Health Sciences, Makerere University, Kampala, Uganda
| | - Mayanja Kajumba
- Department of Mental Health and Community Psychology, Makerere University School of Psychology, P.O. Box 7062, Kampala, Uganda
| | - Angelina Kakooza-Mwesige
- Department of Paediatrics and Child Health, Makerere University College of Health Sciences, Mulago Hill Road, P.O.Box 7072, Kampala, Uganda; Department of Paediatrics and Child Health, Mulago National Referral Hospital, Pediatric Neurology Unit, Kampala, Uganda
| | - Megan Van Noord
- Duke University Medical Center Library, Duke University School of Medicine, Durham, NC, USA
| | - Martin N Kaddumukasa
- College of Health Sciences, Makerere University, Kampala, Uganda; Department of Medicine, Mulago National Referral Hospital, Neurology Unit, Kampala, Uganda
| | - Noeline Nakasujja
- Department of Psychiatry, School of Medicine, Makerere University College of Health Sciences, P.O. Box 7072, Kampala, Uganda
| | - Michael M Haglund
- Duke Division of Global Neurosurgery and Neurology, Department of Neurosurgery, Box 3807 Duke University Medical Center, Durham, NC 27705, USA; Duke University School of Medicine, Department of Psychiatry and Behavioral Sciences, Durham, NC, USA; Duke University School of Medicine, Durham, NC, USA
| | - Deborah C Koltai
- Duke Division of Global Neurosurgery and Neurology, Department of Neurosurgery, Box 3807 Duke University Medical Center, Durham, NC 27705, USA; Duke University School of Medicine, Department of Psychiatry and Behavioral Sciences, Durham, NC, USA; Department of Neurology, Duke University School of Medicine, Durham, NC, USA.
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Chakraborty P, Vissoci JRN, Muhumuza C, Fuller AT, Koltai DC, Nshemerirwe S, Haglund MM, Kaddumukasa MN. Validity of the Personal Impact of Epilepsy Scale (PIES) in patients with epilepsy in Uganda. Epilepsy Behav 2021; 114:107303. [PMID: 32718815 DOI: 10.1016/j.yebeh.2020.107303] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 06/23/2020] [Accepted: 06/28/2020] [Indexed: 01/08/2023]
Abstract
PURPOSE We sought to address the construct validity and reliability of the Personal Impact of Epilepsy Scale (PIES), an epilepsy-specific quality-of-life measure, in patients with epilepsy in Uganda. We also sought to assess the applicability of the scale across three languages: English, Luganda, and Runyankole. METHODS Patients with epilepsy (N = 626) were recruited at the time of care seeking from Mulago National Referral Hospital (MNRH), Butabika National Referral Mental Hospital (BNRMH), and Mbarara Regional Referral Hospital (MRRH), and were given the English, Runyankole, and Luganda versions of the PIES as a part of a larger interview. Reliability, internal consistency specifically, was assessed using three parameters: Cronbach's alpha, McDonald's Omega, and composite reliability. Construct validity (internal structure) was evaluated with principal component analysis (PCA) for three factors, as well as confirmatory factor analysis (CFA) for a three-factor structure of the scale. We also assessed correlations between the three PIES subscales and the seizure severity question in the Liverpool Seizure Severity Scale (LSSS) and reported seizure frequency. RESULTS The three-factor model of the PIES had adequate reliability, with Cronbach's Alpha, McDonald's Omega, and composite reliability values over 0.7, except for the Cronbach's Alpha and McDonald's Omega values for the second factor, which was slightly lower than 0.7 in the full sample as well as when stratified by study language. The PCA and CFA models for the scale demonstrated adequate fit with the Tucker-Lewis index (TLI), comparative fit index (CFI), and root mean square error of approximation (RMSEA), with TLI and CFI values above 0.9 and RMSEA values less than 0.08. However, the model demonstrated inadequate fit with the Chi-square indicator, which yielded a significant p-value. Individual factor loadings ranged from 0.50 to 0.95 in the full sample, 0.45 to 0.98 in the English sample, and 0.45 to 0.93 in the Luganda sample. Finally, the three PIES subscales aligned with reported seizure frequency and the seizure severity question from the LSSS. CONCLUSIONS This study presents the first Luganda and Runyankole versions of the PIES, and the first validation of this scale in English and Luganda with patients with epilepsy in Uganda. The PIES was found to have acceptable psychometric properties for reliability and validity parameters. Thus, the scale is recommended for use and for further investigation in patients with epilepsy in Uganda. This article is part of the Special Issue "The Intersection of Culture, Resources, and Disease: Epilepsy Care in Uganda".
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Affiliation(s)
- Payal Chakraborty
- Duke Division of Global Neurosurgery and Neurology, Department of Neurosurgery, Box 3807, Duke University Medical Center, Durham, NC 27705, USA; Duke Global Health Institute, 310 Trent Dr, Durham, NC 27710, USA; Duke University School of Medicine, Department of Psychiatry and Behavioral Sciences, Durham, NC, USA
| | - Joao Ricardo Nickenig Vissoci
- Duke Division of Global Neurosurgery and Neurology, Department of Neurosurgery, Box 3807, Duke University Medical Center, Durham, NC 27705, USA; Duke Global Health Institute, 310 Trent Dr, Durham, NC 27710, USA; Duke University School of Medicine, Department of Surgery, Emergency Medicine, Durham, NC, USA
| | - Christine Muhumuza
- Duke Division of Global Neurosurgery and Neurology, Department of Neurosurgery, Box 3807, Duke University Medical Center, Durham, NC 27705, USA; Makerere University School of Public Health, Department of Epidemiology and Biostatistics, New Mulago complex, P.O.BOX 7072, Kampala, Uganda
| | - Anthony T Fuller
- Duke Division of Global Neurosurgery and Neurology, Department of Neurosurgery, Box 3807, Duke University Medical Center, Durham, NC 27705, USA; Duke Global Health Institute, 310 Trent Dr, Durham, NC 27710, USA; Duke University School of Medicine, Durham, NC, USA
| | - Deborah C Koltai
- Duke Division of Global Neurosurgery and Neurology, Department of Neurosurgery, Box 3807, Duke University Medical Center, Durham, NC 27705, USA; Duke University School of Medicine, Department of Psychiatry and Behavioral Sciences, Durham, NC, USA; Duke University School of Medicine, Department of Neurology, Durham, NC, USA.
| | - Sylvia Nshemerirwe
- Butabika National Referral Mental Hospital, P.O.BOX 7017, Kampala, Uganda
| | - Michael M Haglund
- Duke Division of Global Neurosurgery and Neurology, Department of Neurosurgery, Box 3807, Duke University Medical Center, Durham, NC 27705, USA; Duke Global Health Institute, 310 Trent Dr, Durham, NC 27710, USA; Duke University School of Medicine, Durham, NC, USA
| | - Martin N Kaddumukasa
- Department of Medicine, Mulago National Referral Hospital, Neurology Unit, Kampala, Uganda; School of Medicine, College of Health Sciences, Makerere University, P.O. Box 7072, Kampala, Uganda
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Mamo Y, Asefa A, Qanche Q, Dhuguma T, Wolde A, Nigussie T. Perception Toward Quarantine for COVID-19 Among Adult Residents of Selected Towns in Southwest Ethiopia. Int J Gen Med 2020; 13:991-1001. [PMID: 33154661 PMCID: PMC7608547 DOI: 10.2147/ijgm.s277273] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Accepted: 10/01/2020] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND COVID-19 is a global pandemic caused by a transmissible respiratory virus, SARS-Cov-2. Because it is a novel pathogen, limited information is available to characterize the spectrum of clinical illness, transmission efficiency, and the duration of viral shedding for patients with COVID-19. Quarantine is an important component of a multilayered strategy to prevent sustained spread of COVID-19 everywhere. The aim of this study was to assess public perceptions toward quarantine for COVID-19 and associated factors among adult residents of selected towns in Southwest Ethiopia, 2020. METHODS The community-based cross-sectional study was conducted from 1 to 15 June 2020 among adult residents of selected towns in south west Ethiopia. Systematic random sampling was used to select 844 participants. A structured and interviewer-administered questionnaire was used to collect data. Descriptive statistics were used to describe different variables. Multiple linear regression was carried out to determine the predictors of outcome variables. In multiple linear regression, variables with p-value <0.05 were taken as statistically significant association with community perception toward quarantine. RESULTS The total of 816 study participants were interviewed from which 450 (55.1%) were male. The median age of respondents was 30 years. Four hundred and twenty-seven (52.3%) of the respondents have a positive perception toward quarantine. Factors associated with perception toward quarantine were having training on COVID-19 (β=2.76, p=0.005), educational status of secondary (β=2.73, p=0.001), educational status to above secondary (β=2.24, p=0.011), occupational status of merchant (β=1.73, p=0.020), and knowledge of COVID-19 (β=0.23, p=0.001). CONCLUSION Only 52.3% of the respondents have a positive perception toward quarantine. Having training on COVID-19, educational status of secondary and above, being a merchant, knowledge of COVID-19 and knowledge of quarantine were significantly associated with a positive perception toward quarantine. Concerned bodies should work on enhancing the awareness of the community through information education and communication/behavior changing communication materials.
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Affiliation(s)
- Yitagesu Mamo
- Department of Pharmacy, College of Health Science, Mizan-Tepi University, Mizan-Aman, Ethiopia
| | - Adane Asefa
- Department of Public Health, College of Health Science, Mizan-Tepi University, Mizan-Aman, Ethiopia
| | - Qaro Qanche
- Department of Public Health, College of Health Science, Mizan-Tepi University, Mizan-Aman, Ethiopia
| | - Tadesse Dhuguma
- Department of Medical Laboratory Science, College of Health Science, Mizan-Tepi University, Mizan-Aman, Ethiopia
| | - Asrat Wolde
- Department of Nursing, College of Health Science, Mizan-Tepi University, Mizan-Aman, Ethiopia
| | - Tadesse Nigussie
- Department of Public Health, College of Health Science, Mizan-Tepi University, Mizan-Aman, Ethiopia
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Uslu FI, Gökçal E, Gelişin Ö. Epilepsy-related knowledge and attitudes toward people with epilepsy among hospital staff in Van City, Turkey. Epilepsy Behav 2020; 103:106261. [PMID: 31645313 DOI: 10.1016/j.yebeh.2019.04.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2019] [Revised: 04/10/2019] [Accepted: 04/10/2019] [Indexed: 02/02/2023]
Affiliation(s)
- Ferda Ilgen Uslu
- Bezmialem Vakıf University Medical Faculty, Neurology, Vatan Cad, 34093 Fatih/İstanbul, Turkey; Bezmialem Vakıf University, İskender Paşa Mh Adnan Menderes Bulvarı, Vatan Cad, 34093 Fatih/İstanbul, Turkey.
| | - Elif Gökçal
- Bezmialem Vakıf University Medical Faculty, Neurology, Vatan Cad, 34093 Fatih/İstanbul, Turkey; Bezmialem Vakıf University, İskender Paşa Mh Adnan Menderes Bulvarı, Vatan Cad, 34093 Fatih/İstanbul, Turkey
| | - Özlem Gelişin
- Bezmialem Vakıf University Medical Faculty, Neurology, Vatan Cad, 34093 Fatih/İstanbul, Turkey; Bezmialem Vakıf University, İskender Paşa Mh Adnan Menderes Bulvarı, Vatan Cad, 34093 Fatih/İstanbul, Turkey
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Kaddumukasa M, Nalubwama H, Kaddumukasa MN, Lhatoo S, Sewankambo N, Katabira E, Sajatovic M, Blixen C. Barriers to epilepsy care in Central Uganda, a qualitative interview and focus group study involving PLWE and their caregivers. BMC Neurol 2019; 19:161. [PMID: 31315592 PMCID: PMC6635990 DOI: 10.1186/s12883-019-1398-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Accepted: 07/09/2019] [Indexed: 12/12/2022] Open
Abstract
Background Epilepsy is a common neurological disease with substantial impact on the subject and their caretakers. This exploratory study identified barriers to care for persons living with epilepsy (PLWE) to develop a culturally acceptable nurse led self-management intervention for PLWE previously developed in the United States. Methods The study involving 48 participants (31 PLWE and 17 caregivers) with in depth interviews and focus groups was conducted. We obtained insights into barriers to care in PLWE and their caregivers. Using a thematic analytic procedure emphasizing the dominant themes the qualitative responses were analyzed. Median age of PLWE was 24 years (IQR 19–30), and10 (52.6%) were male. The median age of epilepsy onset was 12 years (IQR 6–18), range of 1–37 years. The median age of caregivers was 50 years (IQR 45–50.5), with a range of 18–78 years. Seventy five percent of caregivers (6/8) were females. Results Three major areas of perceived barriers involving individual, family or community and provider and healthcare system barriers to epilepsy care emerged. Individual factors like limited epilepsy knowledge and medication non-adherence were reported to be key barriers to epilepsy care. Caregiver burden and lack of family support as well as poor health care access were identified from the family and health care systems. Conclusions The main barrier to epilepsy care is limited epilepsy knowledge in PLWE and their caregivers. Improving epilepsy care awareness and knowledge within communities and appropriate health care provider service for epilepsy would help reduce epilepsy barriers and improve care.
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Affiliation(s)
- Mark Kaddumukasa
- Department of Medicine, School of Medicine, College of Health Sciences, Makerere University, P.O. Box 7072, Kampala, Uganda.
| | - Haddy Nalubwama
- School of Public Health, Makerere University College of Health Sciences, P.O. Box 7072, Kampala, Uganda
| | - Martin N Kaddumukasa
- Department of Medicine, School of Medicine, College of Health Sciences, Makerere University, P.O. Box 7072, Kampala, Uganda
| | - Samden Lhatoo
- McGovern medical School and Health Science Center at Houston, The University of Texas, Houston, USA
| | - Nelson Sewankambo
- Department of Medicine, School of Medicine, College of Health Sciences, Makerere University, P.O. Box 7072, Kampala, Uganda
| | - Elly Katabira
- Department of Medicine, School of Medicine, College of Health Sciences, Makerere University, P.O. Box 7072, Kampala, Uganda
| | - Martha Sajatovic
- Neurological and Behavioral Outcomes Center, University Hospitals Cleveland Medical Center & Case Western Reserve University School of Medicine, 11100 Euclid Avenue, Cleveland, OH, 44106, USA
| | - Carol Blixen
- Neurological and Behavioral Outcomes Center, University Hospitals Cleveland Medical Center & Case Western Reserve University School of Medicine, 11100 Euclid Avenue, Cleveland, OH, 44106, USA
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Stigma and epilepsy in onchocerciasis-endemic regions in Africa: a review and recommendations from the onchocerciasis-associated epilepsy working group. Infect Dis Poverty 2019; 8:34. [PMID: 31109376 PMCID: PMC6526597 DOI: 10.1186/s40249-019-0544-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Accepted: 04/21/2019] [Indexed: 01/24/2023] Open
Abstract
Background In onchocerciasis-endemic areas, particularly in those with a sub-optimal onchocerciasis control programme, a high prevalence of epilepsy is observed. Both onchocerciasis and epilepsy are stigmatizing conditions. The first international workshop on onchocerciasis-associated epilepsy (OAE) was held in Antwerp, Belgium (12–14 October 2017) and during this meeting, an OAE alliance was established. In this paper, we review what is known about epilepsy-associated stigma in onchocerciasis-endemic regions, and present the recommendations of the OAE alliance working group on stigma. Main body For this scoping review, literature searches were performed on the electronic databases PubMed, Scopus and Science Direct using the search terms “epilepsy AND onchocerciasis AND stigma”. Hand searches were also undertaken using Google Scholar, and in total seven papers were identified that addressed epilepsy-related stigma in an onchocercisasis-endemic area. Due to the limited number of published research papers on epilepsy-associated stigma in onchocerciasis-endemic areas, other relevant literature that describes important aspects related to stigma is discussed. The thematic presentation of this scoping review follows key insights on the barriers to alleviating the social consequences of stigma in highly affected onchocerciasis-endemic areas, which were established by experts during the working group on stigma and discrimination at the first international workshop on OAE. These themes are: knowledge gaps, perceived disease aetiology, access to education, marriage restrictions, psycho-social well-being, burden on the care-giver and treatment seeking behaviour. Based on the literature and expert discussions during the OAE working group on stigma, this paper describes important issues regarding epilepsy-related stigma in onchocerciasis-endemic regions and recommends interventions that are needed to reduce stigma and discrimination for the improvement of the psycho-social well-being of persons with epilepsy. Conclusions Educating healthcare workers and communities about OAE, strengthening onchocerciasis elimination programs, decreasing the anti-epileptic treatment gap, improving the care of epilepsy-related injuries, and prioritising epilepsy research is the way forward to decreasing the stigma associated with epilepsy in onchocerciasis-endemic regions. Electronic supplementary material The online version of this article (10.1186/s40249-019-0544-6) contains supplementary material, which is available to authorized users.
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Millogo A, Kongnyu Njamnshi A, Kabwa-PierreLuabeya M. Neurocysticercosis and epilepsy in sub-Saharan Africa. Brain Res Bull 2019; 145:30-38. [DOI: 10.1016/j.brainresbull.2018.08.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Revised: 06/20/2018] [Accepted: 08/16/2018] [Indexed: 10/28/2022]
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Public Awareness, Attitudes, and First-Aid Measures on Epilepsy in Tehran. IRANIAN JOURNAL OF CHILD NEUROLOGY 2019; 13:91-106. [PMID: 30598677 PMCID: PMC6296695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/14/2018] [Revised: 04/26/2018] [Accepted: 07/30/2018] [Indexed: 11/24/2022]
Abstract
OBJECTIVES People with epilepsy generally encounter misconceptions and negative attitudes on different aspects of the disease. They are also prone to physical injuries during seizures. Lack of awareness about first-aid measures results in taking inappropriate first-aid measures. We aimed to determine the public awareness, attitudes, and first-aid measures about epilepsy in Tehran. MATERIALS & METHODS This population-based cross-sectional survey was conducted from Dec 2016 to May 2017 in Tehran, Iran. Random stratified cluster sampling was used. Data were collected through interviews using a questionnaire. The awareness section included general awareness, causes, symptoms, seizure triggers, first-aid measures, and recommended treatments. The Likert scale was used for the attitudes section which included 20 statements. The answers about first-aid measures were categorized as helpful, or harmful. RESULTS Overall, 833 adults participated in the survey. The level of total awareness score of 41 (4.9%) participants was very good, 194 (23.3%) good, 255 (30.6%) fair, 210 (25.2%) low, and 133(16.0%) very low. The mean (SD) score about general awareness was 4.6 (3.0), range=0 to 11; causes 5.8 (3.4), range=0 to 13; symptoms of seizures 7.0 (4.0), range=0 to 13; first-aid measures 7.5 (3.4), range=0 to 14. Among all participants, 260 (31.2%), named at least one superstitious cause for epilepsy. Attitudes were generally positive except for marriage and having kids. The level of first-aid measures score of 74(42.5) was very good, 79(45.4) good, and 21(12.1) low. CONCLUSION The awareness of people of Tehran about epilepsy was insufficient, attitudes were generally positive but rather conservative, and first-aid measures at the last witnessed seizure were fairly helpful.
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Adjei P, Nkromah K, Akpalu A, Laryea R, Osei Poku F, Ohene S, Puplampu P, Twumasi Aboagye E. A cross-sectional comparative study of perceived stigma between patients with epilepsy and patients living with HIV/AIDS in Accra, Ghana. Epilepsy Behav 2018; 89:1-7. [PMID: 30384093 DOI: 10.1016/j.yebeh.2018.10.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 10/09/2018] [Accepted: 10/10/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Health-related stigma is a great challenge to the treatment of diseases. In epilepsy like other conditions, it causes affected individuals to conceal their illness. In this study, we described stigma perceived by patients with epilepsy at the Korle Bu Teaching Hospital (KBTH), a tertiary referral facility, and the Accra Psychiatry Hospital in Ghana (APH). We then compared the perception of stigma in patients with epilepsy to stigma perceived by persons living with human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) (PLWHA), a chronic communicable disease stigmatized in Ghana. METHODS A total of 351 patients with epilepsy were recruited from both sites by systematic random sampling and interviewed. The Kilifi Stigma Scale for Epilepsy was used to determine individual patient's stigma score. Statistical analysis was done using multiple logistic regression analysis to control for the effect of measured independent variables that were significant on univariate analysis: age, gender, marital status, income, type of epilepsy, and the frequency of seizures, on the outcome variable. Comparative analysis of the mean stigma score in patients with epilepsy and persons living with HIV/AIDS was done using the Student's t-test and Mann-Whitney U test (Wilcoxon rank sum test). RESULTS The presence of perceived stigma using the Kilifi Stigma Score Estimation was 32.02% (62), 33.33% (49), and 28.88% (54) among respondents from KBTH, APH, and PLWHA respectively. Results from Wilcoxon rank sum test showed that the median stigma score between the three groups was significant; KBTH and APH (p-value; 0.0258), KBTH and PLWHA (p-value; 0.00001), and APH and PLWHA (p-value; 0.0000). Age (<40 years), seizure frequency, ethnic group (Ewe and Guan), and being divorced showed high odds for perceived stigma among KBTH patients with epilepsy. Having tertiary education led to lower odds for perceived stigma in epilepsy for APH patients with epilepsy. CONCLUSION This study showed that epilepsy is associated with a high stigma perception. The perceived stigma was greater than stigma in PLWHAs in Accra. Stigma was affected by unemployment, ethnicity (Ewe and Guan), and uncontrolled seizures. Increasing age reduced perceived stigma and the management of patients with epilepsy in a psychiatric facility might have impacted negatively on the perceived stigma.
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Affiliation(s)
- Patrick Adjei
- Department of Medicine and Therapeutics, School of Medicine and Dentistry, College of Health Sciences, University of Ghana, Accra, Ghana; Korle Bu Teaching Hospital, Accra, Ghana.
| | | | - Albert Akpalu
- Department of Medicine and Therapeutics, School of Medicine and Dentistry, College of Health Sciences, University of Ghana, Accra, Ghana; Korle Bu Teaching Hospital, Accra, Ghana
| | - Ruth Laryea
- Department of Medicine and Therapeutics, School of Medicine and Dentistry, College of Health Sciences, University of Ghana, Accra, Ghana
| | | | - Sammy Ohene
- Department of Medicine and Therapeutics, School of Medicine and Dentistry, College of Health Sciences, University of Ghana, Accra, Ghana; Korle Bu Teaching Hospital, Accra, Ghana
| | - Peter Puplampu
- Department of Medicine and Therapeutics, School of Medicine and Dentistry, College of Health Sciences, University of Ghana, Accra, Ghana; Korle Bu Teaching Hospital, Accra, Ghana
| | - Elvis Twumasi Aboagye
- Department of Medicine and Therapeutics, School of Medicine and Dentistry, College of Health Sciences, University of Ghana, Accra, Ghana
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Kaddumukasa M, Kaddumukasa MN, Buwembo W, Munabi IG, Blixen C, Lhatoo S, Sewankambo N, Katabira E, Sajatovic M. Epilepsy misconceptions and stigma reduction interventions in sub-Saharan Africa, a systematic review. Epilepsy Behav 2018; 85:21-27. [PMID: 29906697 PMCID: PMC6355646 DOI: 10.1016/j.yebeh.2018.04.014] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Revised: 03/14/2018] [Accepted: 04/20/2018] [Indexed: 01/21/2023]
Abstract
OBJECTIVE This systematic review identified papers that described epilepsy misconceptions or stigma in sub-Saharan Africa (SSA) and research interventions focused on reducing these misconceptions. MATERIALS AND METHODS Publications in the English language from January 2000 to October 2017 that described original research conducted in SSA on misconceptions about epilepsy were utilized. RESULTS Twenty-three publications were identified. Studies were from Nigeria (N = 4), Cameroon (N = 4), Uganda (N = 3), Zambia (N = 2), Ethiopia (N = 2), Tanzania (N = 2), Kenya (N = 2), Ghana, Zimbabwe, Benin, and Mali (N = 1 each). The studies included assessments of misconceptions among healthcare providers and medical students (N = 3), high school students (N = 2), teachers (N = 2), the general public (N = 10), people with epilepsy (N = 7), and traditional healers (N = 1). Only two studies had stigma-focused interventions. Majority of the studies reported limitations to socialization with people with epilepsy and various beliefs associated with epilepsy. CONCLUSIONS Epilepsy misconceptions, stigmatizing cultural beliefs, and perceptions were widely prevalent in SSA, and there are a few studies targeting epilepsy stigma. Existing stigma-reduction educational approaches may be impractical for general population implementation. Scalable approaches to reduce stigma are urgently needed within SSA.
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Affiliation(s)
- Mark Kaddumukasa
- Department of Medicine, School of Medicine, College of Health Sciences, Makerere University, P.O. Box 7072, Kampala, Uganda.
| | - Martin N Kaddumukasa
- Department of Medicine, School of Medicine, College of Health Sciences, Makerere University. P.O. Box 7072, Kampala, Uganda
| | - William Buwembo
- School of Biomedical Sciences, Makerere University, P.O. Box 7072, Kampala, Uganda
| | - Ian. G. Munabi
- School of Biomedical Sciences, Makerere University, P.O. Box 7072, Kampala, Uganda
| | - Carol Blixen
- Neurological and Behavioral Outcomes Center, University Hospitals Cleveland Medical Center & Case Western Reserve University School of Medicine, 11100 Euclid Avenue, Cleveland, OH 44106, USA..
| | - Samden Lhatoo
- Epilepsy Center, UH Case Medical Center, 11100 Euclid Avenue, Cleveland, OH, 44106, USA.
| | - Nelson Sewankambo
- Department of Medicine, School of Medicine, College of Health Sciences, Makerere University. P.O. Box 7072, Kampala, Uganda
| | - Elly Katabira
- Department of Medicine, School of Medicine, College of Health Sciences, Makerere University. P.O. Box 7072, Kampala, Uganda
| | - Martha Sajatovic
- Neurological and Behavioral Outcomes Center, University Hospitals Cleveland Medical Center & Case Western Reserve University School of Medicine, 11100 Euclid Avenue, Cleveland, OH 44106, USA..
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Giuliano L, Cicero CE, Padilla S, Camargo M, Sofia V, Zappia M, Bartoloni A, Crespo Gómez EB, Nicoletti A. Knowledge and attitudes towards epilepsy among nonmedical health workers in rural Bolivia: Results after a long-term activity in the Chaco region. Epilepsy Behav 2018; 85:58-63. [PMID: 29908385 DOI: 10.1016/j.yebeh.2018.05.026] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2018] [Revised: 05/11/2018] [Accepted: 05/12/2018] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Epilepsy represents a major global healthcare issue, particularly in low- and middle-income countries (LMIC), where nonmedical health workers play a key role in providing care to people with epilepsy (PWE). Over the last 20 years, many projects have been carried out by our group in the Chaco region, Plurinational State of Bolivia, with the aim of enhancing knowledge about epilepsy. However, the level of knowledge of epilepsy that nonmedical health workers have reached has never been assessed until now. The main objective of our study was to assess the level of knowledge, attitudes, and practices (KAP) towards epilepsy among nonmedical health staff of the rural communities of the Chaco region in Bolivia. METHODS The study was conducted in three departments of Bolivia. The nonmedical health personnel were invited to participate in a training program. They answered a validated questionnaire to evaluate their knowledge and attitudes towards epilepsy before and after the courses. RESULTS One hundred nineteen subjects [42 men (36.2%); mean age 29.3 ± 1.1 years] were interviewed among community health workers and nurses before the courses, demonstrating a very good level of knowledge regarding epilepsy and its causes. Only 55 health workers participated in the second training module, and their answer did not significantly differ from the baseline. CONCLUSION Our study confirms the usefulness of continuous educational campaigns, especially directed to nonspecialist healthcare providers of rural communities of LMIC, as they may be the only persons responsible for providing healthcare to PWE in that setting. Moreover, the importance of the baseline assessment of KAP was highlighted in order to adapt the educational campaigns to the baseline level of knowledge found.
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Affiliation(s)
- Loretta Giuliano
- Department of Medical and Surgical Sciences and Advanced Technologies "G.F. Ingrassia", Section of Neurosciences, University of Catania, Catania, Italy
| | - Calogero Edoardo Cicero
- Department of Medical and Surgical Sciences and Advanced Technologies "G.F. Ingrassia", Section of Neurosciences, University of Catania, Catania, Italy
| | - Sandra Padilla
- Center of Anthropological Researches of the Teko Guaraní, Gutierrez, Bolivia
| | - Mario Camargo
- The Bolivian League Against Epilepsy, Santa Cruz, Bolivia
| | - Vito Sofia
- Department of Medical and Surgical Sciences and Advanced Technologies "G.F. Ingrassia", Section of Neurosciences, University of Catania, Catania, Italy
| | - Mario Zappia
- Department of Medical and Surgical Sciences and Advanced Technologies "G.F. Ingrassia", Section of Neurosciences, University of Catania, Catania, Italy
| | - Alessandro Bartoloni
- Department of Experimental and Clinical Medicine, Infectious and Tropical Diseases Unit, University of Florence, Florence, Italy
| | | | - Alessandra Nicoletti
- Department of Medical and Surgical Sciences and Advanced Technologies "G.F. Ingrassia", Section of Neurosciences, University of Catania, Catania, Italy.
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Parfenova EV, Rider FK, Gersamia AG. Sociocultural aspects and different types of stigmatization in epilepsy. NEUROLOGY, NEUROPSYCHIATRY, PSYCHOSOMATICS 2018. [DOI: 10.14412/2074-2711-2018-1s-89-95] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
This literature review deals with knowledge and beliefs about epilepsy and with the attitude of patients, relatives, and society as a whole towards epilepsy. It discusses the stigma that is associated with the disease and has a strong impact on patients with epilepsy and their families. The problems of stigma or related concepts in different countries are analyzed.
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Manchishi SM. Recent Advances in Antiepileptic Herbal Medicine. Curr Neuropharmacol 2018; 16:79-83. [PMID: 28521703 PMCID: PMC5771388 DOI: 10.2174/1570159x15666170518151809] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Revised: 03/26/2016] [Accepted: 04/27/2017] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Epilepsy is one of the most common neurological disorders worldwide, with about 80 percent of cases thought to be in developing nations where it is mostly linked to superstition. The limited supply, high cost as well as low efficacy and adverse side effects of antiepileptic drugs (AEDs) is a matter of major concern. Herbal medicine has always been traditionally part of treatment of epilepsy. Herbal medicines are generally well tolerated, with fewer side effects. METHOD To highlight some herbal extracts that have been studied for their anticonvulsant activity in animal models, literature search from PubMed and Science Direct, was performed. The keywords for the search consisted of combinations of the following terms: Herbal antiepileptic and/or anticonvulsant, botanicals + epilepsy. Literature published in the last five years was considered. RESULTS Eighteen (18) anticonvulsant herbal agents are reported and discussed. Experiments mostly consisted of phenotypic screens in rodents, with little diversity in screening methods. In most experiments, the tested extracts prolonged the time to onset of seizures and decreased their duration. Most experimenters implicate potentiation of GABAergic activity as the mode of action of the extracts, even though some experimenters did not fully characterise the bioactive chemical composition of their extracts. CONCLUSION Potential herbal remedies have shown positive results in animal models. It remains unclear how many make it into clinical trials and eventually making part of the AED list. More rigorous research, applying strict research methodology with uniform herbal combinations, as well as clinical studies are urgently needed.
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Al-Dossari KK, Al-Ghamdi S, Al-Zahrani J, Abdulmajeed I, Alotaibi M, Almutairi H, BinSwilim A, Alhatlan O. Public knowledge awareness and attitudes toward epilepsy in Al-Kharj Governorate Saudi Arabia. J Family Med Prim Care 2018; 7:184-190. [PMID: 29915757 PMCID: PMC5958566 DOI: 10.4103/jfmpc.jfmpc_281_17] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Introduction: Epilepsy is one of the most stigmatizing disorders. Stigmas and negative attitudes associating epilepsy are due to poor public awareness and knowledge. This study evaluated Saudi public Knowledge, awareness, and attitude towards epilepsy. Materials and Methods: A cross-sectional study conducted during the period from September 16, 2014 to January 1st 2015. A 20-item questionnaire adapted from the literature was validated and distributed to 422 adults living in Al-Kharj governorate, and 22 participants were excluded as they have never heard or read about epilepsy. Results: About 94.79% of participants have heard or read about epilepsy, 63% of them knew someone with epilepsy, and 49.75% have witnessed a seizure attack. Seventy per cent of subjects thought that epilepsy is a neurological disease and 59% believed it is a brain disease. Almost 46.5% selected possession by demons or evil spirits and 51.25% cited envy or evil eye. More than half of subjects selected the medical treatment and follow-up as the most effective treatment of epilepsy. Rather, 41% believed in the faith healing. Most of respondents (81.5%) believed that epileptic children could be successful in normal classes. The vast majority agreed with that epileptic woman can get married and have children. Moreover, 65.25% would allow their offspring to play with epileptic persons and surprisingly, 59% would let their offspring marrying a person with epilepsy. As much as 82.75% agreed to work with epileptic persons and 85.5% would easily become a close friend of them. The equal job opportunity for epileptic and normal persons should be practiced to about 53.75% of subjects. The predictors of good knowledge, limited misconception, and positive attitudes were female gender, being a relative of an epileptic person, and having high educational level. Conclusion: The public knowledge, awareness of and attitudes toward epilepsy were acceptable with regard to this study. However, the negative attitudes and misconceptions still exist.
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Affiliation(s)
- Khaled K Al-Dossari
- Department of Family Medicine, College of Medicine, Prince Sattam Bin Abdulaziz University, Al-Kharj, Saudi Arabia
| | - Sameer Al-Ghamdi
- Department of Family Medicine, College of Medicine, Prince Sattam Bin Abdulaziz University, Al-Kharj, Saudi Arabia
| | - Jamaan Al-Zahrani
- Department of Family Medicine, College of Medicine, Prince Sattam Bin Abdulaziz University, Al-Kharj, Saudi Arabia
| | - Imad Abdulmajeed
- Department of Community Medicine, King Abdulaziz Medical City, National Guard Health Affairs, Riyadh, Saudi Arabia, Community Medicine, King Abdulaziz Medical City, National Guard Health Affairs, Riyadh, Kingdom of Saudi Arabia
| | - Maher Alotaibi
- Department of Medical Student, College of Medicine, Prince Sattam Bin Abdulaziz University, Al-Kharj, Saudi Arabia
| | - Humoud Almutairi
- Department of Medical Student, College of Medicine, Prince Sattam Bin Abdulaziz University, Al-Kharj, Saudi Arabia
| | - Abdulrahman BinSwilim
- Department of Medical Student, College of Medicine, Prince Sattam Bin Abdulaziz University, Al-Kharj, Saudi Arabia
| | - Omar Alhatlan
- Department of Medical Student, College of Medicine, Prince Sattam Bin Abdulaziz University, Al-Kharj, Saudi Arabia
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Kiyak E, Dayapoglu N. An evaluation of knowledge and attitudes toward epilepsy in Eastern Turkey. Epilepsy Behav 2017; 75:241-245. [PMID: 28843950 DOI: 10.1016/j.yebeh.2017.06.036] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Accepted: 06/24/2017] [Indexed: 11/28/2022]
Abstract
PURPOSE This study was designed to determine the knowledge and attitudes regarding epilepsy among individuals in eastern Turkey. METHOD This descriptive study involved 530 healthy individuals who came to the Research and Application Hospital of Ataturk University in Erzurum, Turkey. A questionnaire and the epilepsy knowledge and attitude scale were administered to collect data. Mann-Whitney U, Kruskal-Wallis, and Spearman's correlation tests were used to analyze the data. RESULTS The participants' epilepsy knowledge mean score was 6.34 (SD=3.71), and their attitude mean score was 50.22 (SD=11.17). There was a positive (r=0.404) correlation between the knowledge and the attitude scores (p<0.001), and negative correlations between age and the knowledge (p=0.036) and the attitude scores (p<0.001). The mean knowledge and attitude scores were higher for the participants who were high school and university graduates, had expenses equal to income, and lived in nuclear families and in the city center (p<0.001). Civil servants and housewives had significantly higher mean knowledge scores, and students had significantly higher mean attitude scores (p<0.001). Significantly higher knowledge and attitude mean scores were also found for those who knew patients with epilepsy, had witnessed epileptic seizures, obtained information from healthcare personnel, and did not believe that epilepsy was associated with religion (p<0.001). CONCLUSIONS The study participants had low knowledge about epilepsy but displayed positive attitudes toward it. Higher knowledge positively affected attitude, and younger individuals had greater knowledge and, thus, more positive attitudes. Women, civil servants, and housewives had higher knowledge, whereas singles and students had better attitudes. The participants who had high educational levels and expenses equal to income and lived in nuclear families and the city center had more knowledge and displayed more positive attitudes. Greater knowledge and more positive attitudes were also found among the participants who knew patients with epilepsy, had witnessed epileptic seizures, obtained the information from healthcare personnel, and did not believe that epilepsy was associated with religion.
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Affiliation(s)
- Emine Kiyak
- Facility of Nursing, Ataturk University, Erzurum, Turkey.
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Mokaya J, Gray WK, Carr J. Beliefs, knowledge and attitudes towards Parkinson's disease among a Xhosa speaking black population in South Africa: A cross-sectional study. Parkinsonism Relat Disord 2017; 41:51-57. [DOI: 10.1016/j.parkreldis.2017.05.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Revised: 04/17/2017] [Accepted: 05/10/2017] [Indexed: 01/26/2023]
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Barriers to access to education for young people with epilepsy in Northern Tanzania: A qualitative interview and focus group study involving teachers, parents and young people with epilepsy. Epilepsy Behav 2017; 72:145-149. [PMID: 28578216 DOI: 10.1016/j.yebeh.2017.04.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Revised: 03/27/2017] [Accepted: 04/03/2017] [Indexed: 01/10/2023]
Abstract
OBJECTIVE Educational outcomes for young people with epilepsy (YPE) in Hai District, Tanzania, are poor, as is commonly observed elsewhere in Sub-Saharan Africa. The reasons for this finding are not well understood, though stigma arising from supernatural concepts of epilepsy is frequently cited as a barrier to YPE accessing education. In this study, we aimed to explore the reasons why many YPE in Tanzania experience poor access to education, and elicit ways in which education could be improved for YPE according to teachers, parents and YPE. METHODS Ten focus group discussions with teachers were organized in Hai schools between March and May 2016. The themes arising from these discussions were identified, coded, analyzed and tested in semi-structured interviews with 19 YPE and 17 parents identified from a prevalent cohort of YPE identified in 2009. RESULTS Behavioral problems and learning difficulties were cited as the main barriers to education for YPE. Other barriers included parental stigmatization, teachers' inadequate seizure management, and limited access to specialist schools. Teachers perceived that parents and YPE believe in spiritual etiology and traditional management for epilepsy. However, the majority of teachers, parents, and YPE cited biological etiology and management options, although understanding of epilepsy etiology and management could be improved amongst all groups. SIGNIFICANCE A multidimensional approach is needed to improve educational access, and hence outcomes, for YPE. Widespread community education is needed to improve knowledge of epilepsy etiology and management. Teachers require seizure management training, and parents need help to recognize YPE's right to education. Educational needs assessments would help to identify YPE requiring specialist schooling, and access to this could be improved. These interventions will likely reduce stigma, ensure appropriate academic and pastoral care at school, and thus enable YPE to attend, and succeed, in education.
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Guekht A, Gersamiya A, Kaimovskiy I, Mizinova M, Yakovlev A, Shpak A. Attitudes towards people with epilepsy in Moscow. Epilepsy Behav 2017; 70:182-186. [PMID: 28431365 DOI: 10.1016/j.yebeh.2017.03.020] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2016] [Revised: 03/08/2017] [Accepted: 03/08/2017] [Indexed: 01/04/2023]
Abstract
PURPOSE To assess the knowledge and attitudes in Moscow towards people with epilepsy (PWE). METHODS Data were collected from 1167 adults, permanent residents of Moscow, who were interviewed. A 10-item questionnaire was used addressing three major domains: familiarity with epilepsy (2 questions), understanding of epilepsy (5 questions), and attitude towards the PWE (3 questions). Results were standardized to the Moscow population. RESULTS The study population was generally well informed about epilepsy. About 80% "has heard" of epilepsy; however, personal acquaintance with PWE was reported by less than half of the study participants. The level of understanding of the disease and its etiology was quite low. About 60% of the survey participants believed that epilepsy was a type of mental retardation. One-third (34%) of respondents were afraid to stay in the proximity of PWE. Only 38% of the survey participants considered epilepsy to be curable; men significantly less frequently than women. Overall, the level of understanding of epilepsy was proportional to the level of education of respondents. Negative attitudes towards PWE were demonstrated in a significant part of the population. Almost half of the respondents would object to their child playing or studying with a child who has epilepsy and more than half (57%) were against the marriage of their daughter or son to a person with epilepsy. Two-fifths of the respondents ranked epilepsy as the "least preferred" of the six chronic diseases for a colleague. CONCLUSION This is the first study on awareness and attitudes to PWE in the adult population of Moscow. The study demonstrated that the general public is familiar with epilepsy, but has a rather low level of understanding of essential aspects of the disease. There is an overall high level of negative attitudes towards PWE in Russia, creating a need for targeted interventions. These results reinforced the importance of public education in reducing the stigma of epilepsy.
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Affiliation(s)
- Alla Guekht
- Moscow Research and Clinical Center for Neuropsychiatry of the Healthcare Department of Moscow, 43, Donskaya ul., Moscow 115419, Russian Federation; Department of Neurology, Neurosurgery and Medical Genetics, Pirogov Russian National Research Medical University, 8, Leninsky prospect, bl.8, Moscow 119049, Russian Federation.
| | - Anna Gersamiya
- Moscow Research and Clinical Center for Neuropsychiatry of the Healthcare Department of Moscow, 43, Donskaya ul., Moscow 115419, Russian Federation.
| | - Igor Kaimovskiy
- V.M.Buyanov City Clinical Hospital, 26, Bakinskaya ul., 115516, Moscow, Russian Federation.
| | - Maria Mizinova
- Department of Neurology, Neurosurgery and Medical Genetics, Pirogov Russian National Research Medical University, 8, Leninsky prospect, bl.8, Moscow 119049, Russian Federation.
| | - Alexander Yakovlev
- Institute of Higher Nervous Activity and Neurophysiology of Russian Academy of Sciences, 5A Butlerova ul., 117485 Moscow, Russian Federation.
| | - Alexander Shpak
- The S. Fyodorov Eye Microsurgery Federal State Institution, 59A, Beskudnikovsky Blvd., Moscow 127486, Russian Federation.
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