Therapeutic itinerary of children living with epilepsy in Kinshasa: Features, determinants, and relationships with behavioral problems and cognitive impairment

The association of perceived stigma, religiosity, and paranormal beliefs in parents of children with epilepsy

OBJECTIVE

The aim of this study is to investigate the relationship between stigma perception, religiosity, and paranormal beliefs in parents of children with epilepsy.

METHODS

The sample of this cross-sectional study consisted of 103 parents of children with epilepsy registered at a state hospital in a city with middle socio-economic status located in southeastern Türkiye. The data were collected using descriptive information forms for parents and children with epilepsy, the Parent Stigma Scale, the Religious Attitude Scale, and the Paranormal Belief Scale. The Mann-Whitney U test, Kruskal-Wallis analysis of variance, and Spearman's correlation analysis were used to assess the data.

RESULTS

The results of the study revealed that while 78.6 % of the parents were female, 59.2 % of the children with epilepsy were boys. Total mean scores of the participants were 18.48 ± 4.84 in the Parent Stigma Scale, 51.73 ± 14.15 in the Classical (Non-Religious) Paranormal Beliefs Dimension, and 33.89 ± 6.55 in the Religious Attitude Scale. A weak positive correlation was found between total mean scores of the Parent Stigma Scale, the Paranormal Belief Scale and the Religious Attitude Scale (p < 0.05). However, there was no statistically significant correlation between the mean scores of the Paranormal Belief Scale and the Religiosity Attitude Scale (p > 0.05). All of the three scales were positively correlated with the age of the parents and the duration of the illness (p < 0.05).

CONCLUSION

In this study, it was observed that while the parents had high levels of stigma perception and religious attitudes, they had moderate attitudes toward paranormal beliefs. While no direct correlation was found between religious attitudes and paranormal beliefs, cognitive inclinations toward religion were negatively correlated with paranormal beliefs. Additionally, the parents who perceived a higher level of stigma were more likely to hold stronger religious attitudes and beliefs related to various aspects of paranormal events. In the light of these findings, it is recommended to design educational programs and information campaigns aimed at reducing social stigma and raising awareness about epilepsy in such a way as to take individual belief systems into considerations.

High prevalence of epilepsy in Northern Rwanda: Exploring gender differences

INTRODUCTION

In sub-Saharan Africa (SSA), the prevalence of lifetime epilepsy varies widely between subregions and is higher in rural compared to urban regions. Observed versus expected numbers of patients with epilepsy (PwE) in the northern province of Rwanda did not match the prevalence of 49‰ reported in 2005 in Rwanda. We report a confirmatory prevalence study focused on gender-specific observations.

METHODS

A cross-sectional door-to-door approach was used in three rural villages. First, epilepsy screening using the Kinyarwanda version of the Limoges questionnaire was performed. Second, confirmation of epilepsy diagnosis was completed by trained physicians.

RESULTS

In total, 2681 persons (56.14% female) were screened. Of 168 positively screened, 128 persons were diagnosed with epilepsy confirming the prevalence of lifetime epilepsy of 47.7‰ (CI 39.8-56.8). The diagnosis gap was 62.5% with 80 newly diagnosed. The overall female:male ratio was 1.61:1.00. A male preponderance below 9 years of age inverted to a female preponderance above 20 years of age. Female PwE had an older age at first seizure, reported different reasons for not seeking care, and differed from male PwE in possible etiology. For previously diagnosed PwE, the treatment gap was more than 77%.

CONCLUSION

A high prevalence in rural areas was confirmed, with an observed female/male ratio among the highest of published door-to-door surveys in SSA. Gender differences in associated co-morbidities and age at first seizure warrant future research of underlying etiologies and possible survival bias. A better understanding and focus on gender-associated care-seeking patterns, education, and specific needs are recommended.

Epilepsy in a health district in North-West Cameroon: Clinical characteristics and treatment gap

INTRODUCTION

Epilepsy is a common yet misunderstood condition in Cameroon, including in the Batibo Health district.

METHODS

This cross-sectional study describes epilepsy clinical characteristics, the treatment gap, and associated factors in a rural district in Cameroon. After screening for epilepsy using a door-to-door survey, physicians confirmed suspected cases of epilepsy. Detailed information on the medical, seizure, and treatment history was collected from everyone with epilepsy, followed by a general and neurological examination.

RESULTS

We diagnosed 546 people with active epilepsy (at least one seizure in the previous 12 months). The mean age of people with active epilepsy was 25.2 years (SD: 11.1). The mean age at first seizure was 12.5 years (SD: 8.2). Convulsive seizures (uncertain whether generalized or focal) were the most common seizure types (60%), while 41% had focal-onset seizures. About 60% of people had seizures at least monthly. One-quarter of participants had had at least one episode of status epilepticus. Anti-seizure medication (ASM) was taken by 85%, but most were receiving inappropriate treatment or were non-adherent, hence the high treatment gap (80%). Almost a third had had seizure-related injuries. Epilepsy was responsible for low school attendance; 74% of school dropouts were because of epilepsy.

CONCLUSION

The high proportion of focal-onset seizures suggests acquired causes (such as neurocysticercosis and onchocerciasis, both endemic in this area). The high epilepsy treatment gap and the high rates of status epilepticus and epilepsy-related injuries underscore the high burden of epilepsy in this rural Cameroonian health district.

A painful journey to antivenom: The therapeutic itinerary of snakebite patients in the Brazilian Amazon (The QUALISnake Study)

Access to antivenoms is not guarranteed for vulnerable populations that inhabit remote areas in the Amazon. The study of therapeutic itineraries (TI) for treatment of snakebites would support strategies to provide timely access to users. A TI is the set of processes by which individuals adhere to certain forms of treatment, and includes the path traveled in the search for healthcare, and practices to solve their health problems. This study aims to describe TIs of snakebite patients in the Brazilian Amazon. This study was carried out at the Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, in Manaus, state of Amazonas, Brazil. The itinerary from the moment of the bite to the patient's admission to the reference unit was analyzed. Sample size was defined by saturation. After an exploratory survey to collect epidemiological variables, in-depth interviews were conducted following a semi-structured guide. Patients originated from rural areas of 11 different municipalities, including ones located >500 kilometers from Manaus. A great fragmentation was observed in the itineraries, marked by several changes of means of transport along the route. Four themes emerged from the analysis: exposure to snakebite during day-to-day activities, use of traditional therapeutic practices, and personal perception of the severity, as well as the route taken and its contingencies. Access to healthcare requires considerable effort on the part of snakebite patients. Major barriers were identified, such as the low number of hospitals that offer antivenom treatment, poor access to healthcare due to long distances and geographic barriers, low acceptability of healthcare offered in countryside, lack of use of personal protective equipment, common use of ineffective or deleterious self-care practices, late recognition of serious clinical signs and resistance to seeking medical assistance. Health education, promotion of immediate transport to health centers and decentralization of antivenom from reference hospitals to community healthcare centers in the Brazilian Amazon are more effective strategies that would to maximize access to antivenom treatment.