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Magili PF, Kakoko DC, Bhwana D, Akyoo WO, Amaral LJ, Massawe IS, Colebunders R, Mmbando BP. Accessibility to formal education among persons with epilepsy in Mahenge, Tanzania. Epilepsy Behav 2023; 148:109445. [PMID: 37778222 DOI: 10.1016/j.yebeh.2023.109445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 09/07/2023] [Accepted: 09/11/2023] [Indexed: 10/03/2023]
Abstract
BACKGROUND Epilepsy is estimated to affect 50 million people globally, with 80% living in sub-Saharan Africa (SSA). Children with epilepsy (CWE) in SSA are often socially isolated, and many do not get access to school. This study aimed to explore the barriers hindering accessibility to formal education among CWE in Mahenge, Tanzania. METHODS The study was conducted in June 2022 in four villages (Mdindo, Msogezi, Mzelezi and Sali) using quantitative and qualitative methods. The quantitative included 203 persons with epilepsy (PWE), while the qualitative involved six focus group discussions and 17 in-depth interviews. Quantitative and qualitative data were analyzed using Stata and Nvivo software, respectively. RESULTS Of the 203 PWE, 62 (30.5%) had never enrolled in school, while 77 (54.6%) of those enrolled dropped-out before completing it. The perceived barriers to accessing education were categorized as individual barriers (such as frequent seizures, learning difficulties, anti-seizure medication side effects and perceived stigma), Community barriers (such as stigma and discrimination, negative beliefs and misconceptions, relocation to farms and poor socio-economic status), and Institutional barriers (including lack of knowledge about epilepsy among stake-holders, topography and distance to schools). CONCLUSION There is a high rate of dropouts and non-enrolment of CWE in schools within the Mahenge area. Negative beliefs and low awareness of the community about epilepsy and formal education contribute to this issue. This calls for more advocacy to raise community awareness on epilepsy. The government should enforce an inclusive education policy and provide free and uninterrupted anti-seizure medication for seizure control.
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Affiliation(s)
- Pendo F Magili
- National Institute for Medical Research, Tanga Research Centre, Tanga, Tanzania.
| | - Deodatus C Kakoko
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
| | - Dan Bhwana
- National Institute for Medical Research, Tanga Research Centre, Tanga, Tanzania.
| | - Winfrida O Akyoo
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
| | | | - Isolide S Massawe
- National Institute for Medical Research, Tanga Research Centre, Tanga, Tanzania.
| | | | - Bruno P Mmbando
- National Institute for Medical Research, Tanga Research Centre, Tanga, Tanzania.
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Egan R, Wilson R, Robertson M, Scandiffio J, Ross-White A, Coderre-Ball AM. Barriers and facilitators to education experienced by students with disabilities in low- and middle-income African countries: a systematic review of qualitative evidence. JBI Evid Synth 2022; 20:2475-2511. [PMID: 35916170 DOI: 10.11124/jbies-21-00153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVE This review sought to collect and synthesize studies that investigated the lived experience of barriers and facilitators to educational access and excellence for students with disabilities in low- and middle-income African countries. INTRODUCTION Access to education in low- and middle-income African countries for students with disabilities is often inequitable. Although governments have developed policies and programs for student with disabilities, much of the literature guiding policy and program development has focused on the views of academics, parents, teachers, and political figures. INCLUSION CRITERIA This systematic review considered studies that included participants who were students or trainees at the time of the study, have a disability, and were located in a low- and middle-income African country. The phenomena of interest were barriers and facilitators to educational success for students with disabilities. This review included qualitative, interpretive, and critical studies that drew on the experiences of students with disabilities. METHODS An initial search was conducted in CINAHL and MEDLINE, followed by development of a full search strategy that was used for AMED, Embase, CINAHL, Global Health, MEDLINE, and Epub Ahead of Print, In-Process and Other Non-Indexed Citations, Daily and Versions, spanning from 1910-2021. Articles were limited to those published in English. The JBI approach was followed for study selection, critical appraisal, data extraction, data synthesis, and assessing confidence in the findings with ConQual. RESULTS Thirteen qualitative studies were included from seven African countries, and included primary, secondary and postsecondary students. The data were qualitatively synthesized into 64 findings, within six categories, which then formed two synthesized findings. The synthesized findings were: barriers and challenges to engaging in education, and supports for educational success. CONCLUSIONS This review is a synthesis of the lived experiences of students with disabilities in low- and middle-income African countries to understand, in their own words, the challenges and supports they encounter during their educational journeys. Although many barriers and supports reported by students with disabilities and other stakeholders (eg, parents, teachers, administrators) are similar to those identified in this review, our findings identify that integrated research that includes students with disabilities will provide contextual and individual factors that are crucial for students to achieve equitable access to education. SYSTEMATIC REVIEW REGISTRATION NUMBER PROSPERO CRD42019137951.
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Affiliation(s)
- Rylan Egan
- Health Quality Programs, Queen's University, Kingston, ON, Canada.,Queen's Collaboration for Health Care Quality: A JBI Centre of Excellence, Queen's University, Kingston, ON, Canada
| | - Rosemary Wilson
- Queen's Collaboration for Health Care Quality: A JBI Centre of Excellence, Queen's University, Kingston, ON, Canada.,School of Nursing, Queen's University, Kingston, ON, Canada
| | | | - Jillian Scandiffio
- School of Kinesiology and Health Studies, Queen's University, Kingston, ON, Canada
| | - Amanda Ross-White
- Queen's Collaboration for Health Care Quality: A JBI Centre of Excellence, Queen's University, Kingston, ON, Canada.,Bracken Health Science Library, Queen's University, Kingston, ON, Canada
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Community knowledge, attitudes, and practices regarding epilepsy in Mahenge, Tanzania: A socio-anthropological study in an onchocerciasis-endemic area with a high prevalence of epilepsy. Epilepsy Behav 2022; 128:108568. [PMID: 35101841 DOI: 10.1016/j.yebeh.2022.108568] [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: 11/01/2021] [Revised: 01/09/2022] [Accepted: 01/09/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND Throughout Africa, epilepsy is a highly stigmatized condition. It is often considered to be contagious. This study aimed to assess community knowledge, attitude, and practices toward epilepsy in four villages namely Mdindo, Msogezi, Mzelezi, and Sali within Mahenge division, in Morogoro region, Tanzania. These villages are located in an onchocerciasis-endemic area with a high prevalence of epilepsy. METHODS A qualitative cross-sectional study was conducted between June and July 2019 within the framework of a multi-disciplinary research project investigating the association between onchocerciasis and epilepsy. Focus group discussions (FGDs) and in-depth interviews (IDIs) were held with persons with epilepsy (PWE) and their caretakers, community resource persons, and program coordinators of the neglected tropical diseases program. RESULTS The main symptoms of epilepsy were well described by all participants in all villages. PWE and caretakers in all villages considered epilepsy to be a major health problem and some participants ranked it second in importance after malaria. The reported perceived causes of epilepsy included febrile seizures during childhood (locally known as degedege), heredity, evil spirits, and inhaling flatus or touching secretions from PWE, especially during seizures. Knowledge about the association between epilepsy and onchocerciasis was low. People with epilepsy are disregarded, stigmatized, and marginalized from various opportunities such as conjugal rights, schooling, leadership roles, and property inheritance. Traditional healers are often the first contact when seeking care after a person develops epilepsy. CONCLUSION Epilepsy is a major health burden and public health concern in the Mahenge area. The negative attitudes toward PWE and misconceptions about the causes of epilepsy contribute to delays in seeking care at health facilities. Findings from this study will be used to optimize the comprehensive community-based epilepsy treatment program that was recently initiated in the area.
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Dedeken P, Muhumuza SN, Sebera F, Umwiringirwa J, Bitunguhari L, Tierens H, Teuwen DE, Boon PAJM. Long-Term Impact of Single Epilepsy Training on Knowledge, Attitude and Practices: Comparison of Trained and Untrained Rwandan Community Health Workers. Int J Public Health 2021; 66:645598. [PMID: 34867136 PMCID: PMC8636829 DOI: 10.3389/ijph.2021.645598] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 10/20/2021] [Indexed: 01/26/2023] Open
Abstract
Objectives: To close the epilepsy treatment gap and reduce related stigma, eradication of misconceptions is importantIn 2014, Community Health Workers (CHWs) from Musanze (Northern Rwanda) were trained on different aspects of epilepsy. This study compared knowledge, attitude and practices (KAPs) towards epilepsy of trained CHWs 3 years after training, to untrained CHWs from Rwamagana (Eastern Rwanda). Methods: An epilepsy KAP questionnaire was administered to 96 trained and 103 untrained CHWs. Demographic and intergroup KAP differences were analysed by response frequencies. A multivariate analyses was performed based on desired and undesired response categories. Results: Epilepsy awareness was high in both groups, with better knowledge levels in trained CHWs. Negative attitudes were lowest in trained CHWs, yet 17% still reported misconceptions. Multivariate analysis demonstrated the impact of the training, irrespective of age, gender and educational level. Knowing someone with epilepsy significantly induced more desired attitudes. Conclusion: Despite demographic differences between trained and untrained CHWs, a single epilepsy training resulted in significant improvement of desired KAPs after 3 years. Nation-wide CHW training programs with focus on training-resistant items, e.g., attitudes, are recommended.
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Affiliation(s)
- Peter Dedeken
- Department of Neurology, Ghent University Hospital, Ghent, Belgium
- Department of Neurology, Heilig Hart Ziekenhuis, Lier, Belgium
- UCB Pharma, Brussels, Belgium
| | - Stephen N. Muhumuza
- School of Medicine and Pharmacy, University of Rwanda, Kigali, Rwanda
- Kabgayi District Hospital, Kabgayi, Rwanda
| | - Fidele Sebera
- Department of Neurology, Ghent University Hospital, Ghent, Belgium
- CARAES Neuro-psychiatric Hospital, Brothers of Charity, Department of Neurology, Kigali, Rwanda
- Centre Hospitalier Universitaire (CHU-K), Kigali, Rwanda
| | - Josiane Umwiringirwa
- CARAES Neuro-psychiatric Hospital, Brothers of Charity, Department of Neurology, Kigali, Rwanda
| | | | | | - Dirk E. Teuwen
- Department of Neurology, Ghent University Hospital, Ghent, Belgium
- UCB Pharma, Brussels, Belgium
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Seizure and social outcomes in patients with non-surgically treated temporal lobe epilepsy. Epilepsy Behav 2021; 122:108227. [PMID: 34343960 DOI: 10.1016/j.yebeh.2021.108227] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Revised: 07/07/2021] [Accepted: 07/16/2021] [Indexed: 11/21/2022]
Abstract
OBJECTIVES To investigate the seizure outcome with medical treatment in patients with temporal lobe epilepsy (TLE) and its associated factors. We also investigated the social outcome of the patients. METHODS This was a retrospective study of a prospectively built electronic database of patients with epilepsy. All patients with a diagnosis of TLE were studied at the outpatient epilepsy clinic at Shiraz University of Medical Sciences, Shiraz, Iran, from 2008 until 2019. In a phone call to the patients, at least 24 months after their diagnosis at our center, we investigated their current seizure control and social status. RESULTS Two hundred and twenty-two patients were studied; 101 patients (45.5%) were seizure free. A lower number of the prescribed drugs was the only factor with a significant association with the seizure-free outcome (Odds Ratio: 1.460; p = 0.001). At the time of the phone call, 76 patients (37.6%) reported having a college education, 103 patients (51%) were employed, 146 patients (72.3%) were married, and 81 patients (40%) reported driving a motor vehicle. The employment status, college education, and driving a motor vehicle were significantly associated with a seizure-free outcome status. The social achievements of the patients, who were partially responsive to medical therapy, were significantly worse than those who were seizure free. CONCLUSION Many patients with TLE may suffer from drug-resistant seizures. Ongoing seizures in these patients may affect their social lives substantially. Seizure reduction (not freedom) is not good enough to help the patients with TLE enjoy a healthy life with satisfactory social achievements.
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Tirukelem H, Nigatu SG, Angaw DA, Azale T. Community Attitude Towards Epilepsy Patients and Associated Factors in South Achefer District, Northwest Ethiopia: A Mixed-Methods Study. Neuropsychiatr Dis Treat 2021; 17:365-377. [PMID: 33603375 PMCID: PMC7881770 DOI: 10.2147/ndt.s292257] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 01/13/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Epilepsy, defined as seizure activity that is recurrent, unpredictable, and typically unprovoked. It is one of the most common disorders of the nervous system. Sociocultural attitudes in many African nations continue to have a negative impact on epilepsy management. It has been found that stigma and discrimination against people with epilepsy are more devastating and harmful than the illness itself. This is mainly attributed to misconceptions about the disease with fear and fright of the public on confronting an epileptic seizure. So, the current study assesses the community's attitude toward epilepsy patients and associated factors towards epilepsy in South Achefer District, Northwest Ethiopia. METHODS Community-based cross-sectional study triangulated with the qualitative method was conducted from March 1 to May 30, 2020 in South Achefer District. A systematic sampling technique was used to select a total of 762 individuals. Data were collected by face-to-face interview using a structured questionnaire and analyzed using SPSS version 23. Logistic regression analysis was performed and P < 0.05 with a 95% confidence interval was considered to measure statistically significant variables. For the qualitative study participants were selected purposively. Focus Group Discussion, key Informant Interview, and Individual Depth Interview were conducted until it reaches the point of saturation. Thematic analysis was done by using an open code software version 4.2. RESULTS A total of 753 respondents participated which gave a 98.8% response rate. Among those 60.8% (95% CI: 57.2-64.3) were found to have a favorable attitude towards epilepsy patients. Being informed about epilepsy (AOR=1.47; 95% CI, 1.02-2.11), witnessing seizure in the past (AOR=1.6; 95% CI, 1.14-2.27), and having good knowledge about epilepsy (AOR=2.08; CI, 1.49-2.89) were the variables that showed statistically significant association with a favorable attitude. CONCLUSION The favorable attitude of the community towards epilepsy patients was found high in the study area. Information about epilepsy, witnessing seizure, and knowledge about epilepsy showed a significant association with attitude. Therefore, health professional and health extension workers should provide a larger and comprehensive community-based education to enhance people's knowledge about epilepsy to bring attitude change against a negative attitude towards epilepsy.
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Affiliation(s)
- Hewan Tirukelem
- Department of Health Education and Behavioral Science, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Solomon Gedlu Nigatu
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Dessie Abebaw Angaw
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Telake Azale
- Department of Health Education and Behavioral Science, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Fitts W, Rahamatou NT, Abass CF, Vogel AC, Ghislain AH, Sakadi F, Hongxiang Q, Conde ML, Baldé AT, Hamani ABD, Bah AK, Anand P, Patenaude B, Mateen FJ. School status and its associations among children with epilepsy in the Republic of Guinea. Epilepsy Behav 2019; 97:275-281. [PMID: 31260925 PMCID: PMC6702082 DOI: 10.1016/j.yebeh.2019.05.040] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 05/19/2019] [Accepted: 05/28/2019] [Indexed: 12/23/2022]
Abstract
BACKGROUND In low-income countries (LICs), there are multiple barriers for children with epilepsy (CWE) to attend school. We examined potentially modifiable associations with poor school performance in CWE in the West African Republic of Guinea. METHODS Children with epilepsy of school age were recruited using public announcements and a clinical register of people with epilepsy at the Ignace Deen Hospital in Conakry in 2018. A team of Guinean and U.S. neurologists and neurologists-in-training interviewed each CWE and parent for his/her epilepsy history, household finances, educational attainment level, and perceived stigma using the Stigma Scale of Epilepsy (SSE). Each child was also tested using the Wechsler Nonverbal Scale of Ability (WNV). Low school performance was defined as either not attending school or being held back a grade level at least once. Potential predictors of low school performance were analyzed. FINDINGS Of 128 CWE (mean age: 11.6 years, 48.4% female), 11.7% (n = 15) never attended school, 23.3% (n = 30) dropped out, and 64.8% (n = 83) were currently enrolled. Of CWE attending school, 46.9% (n = 39) were held back a grade level. Overall, 54 children were defined as low performers (LPs) (42%). ;Greater than 100 lifetime seizures (odds ratio (OR) = 8.81; 95% confidence interval (CI) = 2.51, 37.4; p = 0.001) and lower total WNV score (OR = 0.954; 95% CI = 0.926, 0.977; p < 0.001) were significantly associated with poor school performance in separate models, when controlling for potential confounders. Given the strong relationship between seizure freedom and school performance, we estimated that 38 additional CWE (33.6%) could become high performers (HPs) if all CWE were adequately treated to achieve the lifetime seizure category of <10 seizures and could be cognitively intact again. Models examining SSE and household wealth quintile were not significantly associated with school performance. CONCLUSIONS Higher lifetime seizures and lower WNV score were significantly associated with low school performance in CWE in Guinea. In spite of our conservative definition of high school performance (attending without failing) and risk of referral bias at an academic center where patients were allowed to self-refer, we demonstrate that seizure control in this setting could increase the number of CWE who could attend and stay in school.
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Affiliation(s)
| | | | | | - Andre C Vogel
- Massachusetts General Hospital, Department of Neurology, Boston, MA, USA
| | | | - Foksouna Sakadi
- Ignace Deen Hospital, Department of Neurology, Conakry, Guinea
| | - Qiu Hongxiang
- University of Washington, Department of Biostatistics, Seattle, WA, USA
| | | | | | | | | | - Pria Anand
- Massachusetts General Hospital, Department of Neurology, Boston, MA, USA
| | - Bryan Patenaude
- Johns Hopkins, Bloomberg School of Public Health, Baltimore, MD, USA
| | - Farrah J Mateen
- Harvard Medical School, Boston, MA, USA; Massachusetts General Hospital, Department of Neurology, Boston, MA, USA.
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Yildirim Z, Ertem DH, Ceyhan Dirican A, Baybas S. Who is the bigger stigmatizor?: The loved one or the society. Epilepsy Behav 2019; 96:13-22. [PMID: 31077937 DOI: 10.1016/j.yebeh.2019.04.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2019] [Revised: 04/09/2019] [Accepted: 04/10/2019] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Epilepsy has long been considered by the society as a dangerous and frightening spiritual possession or even a contagious disease. This results in an unavoidable embarrassment for both the patient and the family leading to social isolation, seclusion, and secretiveness about the diagnosis. The aim of this study was to determine the stigmatizing level of the general Turkish population and to compare these results with the stigmatizing level of the patients' relatives group (PRG). METHODS This is a substudy of our main study which aimed to develop two scales for the quantification of the stigma level in patients with epilepsy (PWE) and their relatives [Stigma Scale for Epilepsy (SSE) -Self Report (SR) and -Informant Report (IR)]. First-degree relatives of the patients had been included in the main study. For the present study, 202 healthy people who were caregivers and relatives of neurologic patients other than epilepsy were recruited for the control group (CG). A sociodemographic and clinical data form and SSE-IR scale were administered to the CG as well. The relationship between sociodemographic characteristics and SSE-IR scores was evaluated, and a regression analysis was performed in order to analyze sociodemographic factors contributing to SSE-IR scores. Stigmatizing levels were compared between PRG and CG. Statistical analysis was performed using Statistical Package for the Social Sciences version 22.0 software. RESULTS Comparison of stigma scores among different sociodemographic strata of the CG showed that there was a statistically significant difference in terms of educational status and occupation (p < 0.01). Multivariate linear regression analysis revealed that education accounted for 10.8% and 8.9% of the variance in the SSE-IR scale respectively in the PRG and the CG. Prejudgment scores and total scores of the PRG were significantly higher than those of the CG. There was no statistically significant difference between two groups in terms of discrimination and false beliefs subscales scores. The proportion of highly stigmatizor participants in the PRG was statistically significantly higher than that of the CG. DISCUSSION/CONCLUSIONS This study showed us that the stigmatization levels in a group of subjects drawn from general population without acquaintance of epilepsy were lower than the relatives of the patients. This result may be partially explained by the ambivalent attitudes of the relatives, as those high scores may stem from not only enacted but also the felt stigma that they were experiencing themselves. It must be a warning sign for both of all the clinicians treating epilepsy and national association against epilepsy, as well as public health officials to increase efforts for awareness raising.
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Affiliation(s)
- Zerrin Yildirim
- Istanbul University, Aziz Sancar Institute of Experimental Medicine, Department of Neuroscience, Istanbul, Turkey; Bagcilar Education and Research Hospital, Department of Neurology, Istanbul, Turkey.
| | - Devrimsel Harika Ertem
- Sisli Hamidiye Etfal Education and Research Hospital, Department of Algology, Istanbul, Turkey
| | - Ayten Ceyhan Dirican
- Bakirkoy Prof. Dr. Mazhar Osman Mental Health and Neurological Diseases Education and Research Hospital, Department of Neurology, Istanbul, Turkey
| | - Sevim Baybas
- Bakirkoy Prof. Dr. Mazhar Osman Mental Health and Neurological Diseases Education and Research Hospital, Department of Neurology, Istanbul, Turkey
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Jones C, Atkinson P, Helen Cross J, Reilly C. Knowledge of and attitudes towards epilepsy among teachers: A systematic review. Epilepsy Behav 2018; 87:59-68. [PMID: 30173018 DOI: 10.1016/j.yebeh.2018.06.044] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Revised: 06/17/2018] [Accepted: 06/22/2018] [Indexed: 10/28/2022]
Abstract
The objective of this study was to systematically review research that has focused on knowledge of and attitudes towards epilepsy among teachers. Embase, PubMed, PsycINFO, Google Scholar, and Cochrane library databases from 2000 to 2017 were searched. Cross-sectional and interventional studies were included and analyzed for quality. Thematic analysis was used to identify common themes in the results. Fifty-four eligible studies (17,256 total participants in 27 different countries) were identified in the search period including seven studies that focused on assessing attitudes and knowledge before and after an educational intervention. It was not possible to systematically analyze levels of knowledge and nature of attitudes because of the wide variety of mostly bespoke study specific instruments used. Few studies employed valid and reliable instruments. Thematic analysis revealed three main themes in the results: 1.) deficits in knowledge and negative attitudes were pervasive across all studies; 2.) teachers often had a negative attitude towards participation of children with epilepsy in physical activities/sport; and 3.) teachers often expressed limited knowledge of seizure management/emergency procedures. There was a lower level of knowledge and more negative attitudes among teachers towards epilepsy compared with other conditions. All studies focusing on interventions showed that at least some aspects of knowledge and attitudes improved as a result of teacher participation in an educational intervention, but study quality was universally rated as low. A higher level of education and experience of teaching a child with epilepsy was significantly associated with greater knowledge in a number of studies. Additionally, having experience of teaching a child with epilepsy and greater assessed knowledge of epilepsy were associated with more positive attitudes. The wide range of methods used makes it difficult to generalize regarding level of attitudes and knowledge among teachers towards epilepsy. Nevertheless, all studies indicate that there are some deficits in knowledge of and negative attitudes towards epilepsy among teachers. It would appear that knowledge and attitudes can be improved by educational interventions. Future research should focus on developing psychometrically sound assessment instruments that can be used globally and on identifying the most effective ways of delivering efficacious educational initiatives employing robust study designs.
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Affiliation(s)
- Chloe Jones
- Research Department, Young Epilepsy, Lingfield, Surrey RH7 6PW, UK; UCL Great Ormond Street Institute of Child Health (ICH), 30 Guilford Street, London WC1N 1EH, UK
| | - Patricia Atkinson
- Child Development Centre, Crawley Hospital, Crawley, West Sussex RH11 7DH, UK
| | - J Helen Cross
- Research Department, Young Epilepsy, Lingfield, Surrey RH7 6PW, UK; UCL Great Ormond Street Institute of Child Health (ICH), 30 Guilford Street, London WC1N 1EH, UK; Great Ormond Street Hospital for Children NHS Trust, Great Ormond Street, London WC1N 3JH, UK
| | - Colin Reilly
- Research Department, Young Epilepsy, Lingfield, Surrey RH7 6PW, UK; UCL Great Ormond Street Institute of Child Health (ICH), 30 Guilford Street, London WC1N 1EH, UK.
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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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Mmbando BP, Suykerbuyk P, Mnacho M, Kakorozya A, Matuja W, Hendy A, Greter H, Makunde WH, Colebunders R. High prevalence of epilepsy in two rural onchocerciasis endemic villages in the Mahenge area, Tanzania, after 20 years of community directed treatment with ivermectin. Infect Dis Poverty 2018; 7:64. [PMID: 29921319 PMCID: PMC6009039 DOI: 10.1186/s40249-018-0450-3] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Accepted: 06/07/2018] [Indexed: 11/10/2022] Open
Abstract
Background Epilepsy is a neurological disorder with a multitude of underlying causes, which may include infection with Onchocerca volvulus, the parasitic worm that causes human onchocerciasis. A survey carried out in 1989 revealed a high prevalence of epilepsy (1.02% overall, ranging from 0.51 to 3.71% in ten villages) in the Mahenge area of Ulanga district, an onchocerciasis endemic region in south eastern Tanzania. This study aimed to determine the prevalence and incidence of epilepsy following 20 years of onchocerciasis control through annual community directed treatment with ivermectin (CDTI). Methods The study was conducted in January 2017 in two suburban and two rural villages in the Mahenge area. Door-to-door household visits were carried out by trained community health workers and data assistants to screen for persons suspected of having epilepsy, using a standardised questionnaire. Persons with suspected epilepsy were then interviewed and examined by a neurologist for case verification. Onchocerciasis associated epilepsy was defined as epilepsy without an obvious cause, with an onset of seizures between the ages of 3–18 years in previously healthy children. In each village, fifty males aged ≥20 years were tested for onchocerciasis antibodies using an OV16 rapid test and were examined for presence of onchocerciasis nodules. Children aged 6–10 years were also tested using OV16 tests. Results 5117 individuals (median age 18.5 years, 53.2% female) from 1168 households were screened. 244 (4.8%) were suspected of having epilepsy and invited for neurological assessment. Prevalence of epilepsy was 2.5%, with the rural villages having the highest rate (3.5% vs 1.5%), P < 0.001. Overall incidence of epilepsy was 111 cases (95% CI: 73–161) per 100 000 person-years, while that of onchocerciasis associated epilepsy was 131 (95% CI: 70–223). Prevalence of OV16 antibodies in adult males and among children 6–10 years old was higher in rural villages than in suburban villages (76.5% vs 50.6, and 42.6% vs 4.7% respectively), (P < 0.001), while overall prevalence of onchocerciasis nodules was 1.8%. Conclusions This survey revealed a high prevalence and incidence of epilepsy in two rural onchocerciasis endemic villages in the Mahenge area. Despite 20 years of CDTI, a high prevalence of OV16 antibodies in children aged 6–10 years suggests on-going O. volvulus transmission. Reasons for the persistence of on-going parasite transmission in the Mahenge area need to be investigated. Electronic supplementary material The online version of this article (10.1186/s40249-018-0450-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Bruno P Mmbando
- National Institute for Medical Research, Tanga Research Centre, Tanga, Tanzania.
| | | | | | | | - William Matuja
- Muhimbili University of Health and allied Sciences, Dar es Salaam, Tanzania
| | - Adam Hendy
- University of Texas Medical Branch, Galveston, TX, USA
| | - Helena Greter
- Global Health Institute, University of Antwerp, Antwerp, Belgium
| | - Williams H Makunde
- National Institute for Medical Research, Tanga Research Centre, Tanga, Tanzania
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Alhagamhmad MH, Shembesh NM. Investigating the awareness, behavior, and attitude toward epilepsy among university students in Benghazi, Libya. Epilepsy Behav 2018; 83:22-27. [PMID: 29635116 DOI: 10.1016/j.yebeh.2018.03.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Revised: 03/14/2018] [Accepted: 03/14/2018] [Indexed: 10/17/2022]
Abstract
OBJECTIVE The aim of this study was to explore the level of knowledge regarding epilepsy and attitudes prevalent toward people with epilepsy (PWE) among Libyan university students in comparison with international data. METHODS A self-administrated questionnaire on awareness regarding epilepsy and behaviors toward PWE was distributed among undergraduate students enrolled in the University of Benghazi. The collected data were analyzed against responses from an Italian survey that utilized a similar questionnaire to explore epilepsy-related knowledge and attitudes among Italian university students in Rome (Mecarelli et al., 2007). RESULTS Out of the 500 interviewed students, 96% successfully completed the survey. Further, 96.6% asserted that they possessed some knowledge regarding epilepsy, gained mainly from their families (76.6%). A total of 57.5% considered epilepsy to be a psychiatric disorder while 11.6% recommended psychological tests for the diagnosis of epilepsy. Moreover, 37.5% believed in ancient superstitions, such as possession by evil forces, as the underlying cause of the condition, and 31.8% recommended traditional remedies to cure it. Further, 66.6% deemed epilepsy as a barrier for career prospects, 41% indicated that it presents an impediment in participation in sports, and 35% considered it as an obstacle in marriage. Additionally, epilepsy was perceived as a severe illness by 53.3% of the respondents and considered to be a moderately severe condition by 43.7%. The responses were found to be statistically significant (P<0.05) against the responses from the Italian study. CONCLUSION There is a reasonable level of awareness regarding epilepsy among Libyan students, though a lack of accuracy in the acquired knowledge exists. The ancient misconceptions regarding the nature of epilepsy and negative attitudes toward PWE appear to be rather common among the Libyan students. Consequently, the discrepancies in the views between the two surveys concerning the ways in which epilepsy is perceived and PWE are treated were extremely evident, thus reflecting the already established view that epilepsy faces greater stigma as a health condition in developing countries in comparison with Western nations.
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Affiliation(s)
- Moftah H Alhagamhmad
- University of Benghazi (Al-Arab Medical), Faculty of Medicine, Paediatric discipline, Benghazi, Libya; Benghazi Children's Hospital, Benghazi, Libya.
| | - Nuri M Shembesh
- University of Benghazi (Al-Arab Medical), Faculty of Medicine, Paediatric discipline, Benghazi, Libya; Benghazi Children's Hospital, Benghazi, Libya
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