Intervention for reducing epilepsy-associated stigma

Affiliate stigma and caregiver burden in parents of children with epilepsy

Objective

This study aimed to investigate the current status of affiliated stigma and caregiver burden among parents of children with epilepsy, analyze their correlation, and identify factors influencing affiliated stigma.

Methods

A cross-sectional survey was conducted among 194 parents of children with epilepsy who met the inclusion and exclusion criteria in Shenzhen City, Guangdong Province, China. Data were collected through questionnaires, including a demographic information sheet, an affiliated stigma scale, and a caregiver burden scale.

Results

The results revealed that parents of children with epilepsy experienced a moderate level of affiliated stigma, with an average score of 54.92 ± 10.44. Similarly, caregiver burden scores fell within the moderate range, with an average score of 44.14 ± 16.02. Factors influencing affiliated stigma scores included the frequency of epileptic seizures in children, the types of anti-epileptic medications taken by children, and the place of residence. The total caregiver burden score and scores in various dimensions (emotional, cognitive, and behavioral) of caregivers for epilepsy patients were positively correlated with the affiliated stigma score. Affiliated stigma was found to independently explain 21.3 % of the variation in caregiver burden.

Conclusion

In the future, healthcare professionals should develop targeted interventions for children with epilepsy and their parents to reduce affiliated stigma, decrease caregiver burden, and enhance the caregiving capabilities of parents of children with epilepsy. These measures are essential to improve the overall well-being of both parents and children affected by epilepsy.

Community perception of epilepsy and its treatment in onchocerciasis-endemic villages of Maridi county, western equatoria state, South Sudan

OBJECTIVE

To assess the community's perception of epilepsy and its treatment in onchocerciasis-endemic villages of Maridi County, Western Equatoria State, South Sudan. The study was conducted prior to the setting up of a community-based intervention to manage the important disease burden caused by onchocerciasis-associated epilepsy in these villages.

METHOD

Five focus group discussions (FGD) were conducted with community leaders and with persons with epilepsy (PWE) and their families between November and December 2019.

RESULTS

Villages close to the Maridi dam were considered to be most affected by epilepsy. Misconceptions about the cause and treatment of epilepsy were identified. Most people believed that epilepsy is caused by bad spirits and is contagious, transmitted through saliva, air, and contact with PWE. Very few participants were aware of the link between onchocerciasis and epilepsy. Persons with epilepsy are restricted in their day-to-day activities and children with epilepsy are often denied going to school. Persons with epilepsy are stigmatized and seen as unfit for marriage. Most participants considered both traditional and medical treatment as ineffective. Uninterrupted anti-seizure treatment continuously was unaffordable for most families with one or more PWE.

CONCLUSION

There is a need to establish a comprehensive epilepsy treatment program which addresses misconceptions about epilepsy and reduces epilepsy-related stigma. Explaining the link between onchocerciasis and epilepsy could lead to a reduction in epilepsy-related stigma.

Evaluating the knowledge of and attitudes toward epilepsy among Turkish undergraduate nursing students: A cross-sectional study

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.

Agreement of Palestinian nursing students with recommendations to eliminate epilepsy stigma and change perception of the general public about epilepsy: A cross-sectional study

OBJECTIVE

This study was conducted to assess the degree of agreement of Palestinian nursing students with recommendations and key messages to eliminate/reduce epilepsy stigma and change perception of the general public about epilepsy and people with epilepsy (PWE).

METHODS

A cross-sectional observational study was conducted among undergraduate nursing students. The study tool was a questionnaire with 24 items which collected the sociodemographic and academic characteristics of the participants (6 items) and agreements with 18 recommendations and key messages to eliminate/reduce epilepsy stigma.

RESULTS

A total of 342 nursing students completed the questionnaire with a response rate of 68.4%. The participants agreed with the 6 recommendations to inform media, improve awareness, and educate the general public on epilepsy (agreement rates: 87.7% to 92.4%), 4 recommendations to coordinate efforts to improve awareness and educate the general public on epilepsy and PWE (agreement rates: 89.8% to 93.0%), and 8 key messages to eliminate/reduce epilepsy stigma (agreement rates: 70.2% to 93.9%). In general, female students tended to express significantly higher levels of agreement with the recommendations and key messages (p-value < 0.05).

CONCLUSION

Results of the present study highlighted the importance of involving nurses and future nurses in eliminating/reducing epilepsy stigma and changing perception of the general public about epilepsy and PWE. Further studies are to be conducted to investigate if these recommendations and messages can eliminate or significantly reduce epilepsy stigma and change perception of the general public about epilepsy and PWE.

Assessing knowledge and attitudes of Palestinian undergraduate nursing students toward epilepsy and patients with epilepsy: A cross-sectional study

OBJECTIVE

This study assessed knowledge and attitudes of undergraduate nursing students toward epilepsy and patients with epilepsy (PWEs). Associations between different sociodemographic and academic variables and knowledge and attitude scores were also assessed.

METHODS

The present study was conducted in a cross-sectional observational design among Palestinian undergraduate nursing students using a prevalidated and reliable questionnaire of 38 items. After collecting sociodemographic and academic characteristics, students answered a knowledge test (16 items) and attitude test (13 items).

RESULTS

The questionnaire was completed by 342 nursing students. The median knowledge score was 65.6 with an interquartile range (IQR) of 31.3, and the median attitude score was 81.5 with an IQR of 20.0. Multiple linear regression analyses showed that higher knowledge scores were predicted by being female in gender (p-value <0.05), had a course/studied about epilepsy (p-value <0.001), self-rated knowledge about epilepsy as high (p-value <0.05), and ever witnessing a PWE experiencing seizures (p-value <0.001). Higher attitude scores were predicted by self-rated knowledge about epilepsy as high (p-value <0.001), had a course/studied about epilepsy (p-value <0.05), and ever witnessed a PWE experiencing seizures (p-value <0.05).

CONCLUSION

Nursing students had moderate knowledge of epilepsy and had generally positive attitudes toward PWEs. Findings of this study highlighted knowledge gaps and areas for improvement. As knowledge scores were positively correlated with attitudes, probably, findings of this study might suggest that educational/training interventions can improve knowledge as well as positive attitudes of nursing students with regard to epilepsy and PWEs.

Stigma and epilepsy in onchocerciasis-endemic regions in Africa: a review and recommendations from the onchocerciasis-associated epilepsy working group

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.

Nodding syndrome research, lessons learned from the NSETHIO project

BACKGROUND

Until recently, nodding syndrome (NS) was considered as a mysterious disease of unknown etiology. A link between onchocerciasis and epilepsy was suspected for a long time. However, onchocerciasis was not considered as the cause of NS because NS was believed to occur only in onchocerciasis-endemic regions in Uganda, South Sudan, and Tanzania. In October 2015, with funding from the European Research Council, the NSETHIO group launched a trans-disciplinary, multi-country research project to identify the cause of NS and to study the link between onchocerciasis and epilepsy.

METHODS

We reviewed NSETHIO activities as well as all published papers, and compared project findings with results of previous research on NS.

RESULTS

Findings from the NSETHIO project showed that NS is only one of the clinical manifestations in the wide spectrum of onchocerciasis-associated epilepsy (OAE) that could be prevented by strengthening onchocerciasis elimination programs. NSETHIO demonstrated that OAE is an important neglected public health problem in onchocerciasis-endemic areas with no or a sub-optimally functioning onchocerciasis control strategies.

CONCLUSIONS

Today there is overwhelming evidence that NS together with the Nakalanga syndrome is clinical presentations of OAE, a condition that could be prevented by strengthening onchocerciasis elimination programs. While research needs to continue to elucidate the pathophysiological mechanisms causing NS, new strategies to accelerate onchocerciasis elimination coupled with community-based surveillance and treatment programs for epilepsy are urgently needed in areas of high Onchocerca volvulus transmission.