Public perception and attitude towards people living with epilepsy in Nigeria

Perceived and self-stigma in people with epilepsy in East Africa: Systematic review and meta-analysis

BACKGROUND

People with stigmatizing conditions associated with epilepsy encounter many difficulties in their daily lives and are more likely to have low self-esteem, low levels of hope, internalize negative attitudes, decrease adherence to treatment, and experience unemployment. The purpose of this study was to quantify the extent of perceived stigma and self-stigma among people with epilepsy.

METHODOLOGY

This systematic review and meta-analysis followed the Preferred Reporting Item Review and Meta-analysis (PRISMA) guideline. PubMed, PsycINFO, Web of Science, Cochrane Library, Google Scholar, and HINARI were major search databases. The included literature reports the prevalence of perceived stigma and self-stigma among people with epilepsy in East Africa. The quality of each study was evaluated using the Newcastle-Ottawa Quality Assessment Scale (NOS). Data were extracted using a Microsoft Excel spreadsheet, and data analysis was performed using STATA version 11. The pooled prevalence of perceived stigma and self-stigma was determined using a random effect model. Heterogeneity between studies was checked using the I2 statistical test. Publication bias was checked using Egger's statistical test and funnel plot.

RESULTS

The pooled prevalence of perceived stigma and self-stigma in people with epilepsy was 43.9 % with a 95 % CI (29.2, 58.7) and 41.2 % with a 95 % CI (12.1, 70.3), respectively. Based on the country, sub-group analysis revealed that the prevalence of perceived stigma among people with epilepsy shows a notable difference between the countries. In Ethiopia, the prevalence was 51.8 % with a 95 % CI of 29.8 to 73.8; in Uganda, 39.4 % with a 95 % CI of 27.1 to 51.3; in Tanzania, 27.4 % with a 95 % CI of 27.9 to 36.9; and in Kenya, 33.2 % with a 95 % CI of 28.2 to 38.2.

CONCLUSION

Roughly 30 % of people with epilepsy experience self-stigma, while approximately 44 % of people with epilepsy experience perceived stigma. As a result, the relevant authorities ought to focus on reducing the prevalence of stigma among people who have epilepsy.

Barriers and facilitators to treatment seeking behaviors for depression, epilepsy, and schizophrenia in low- and middle-income countries: A systematic review

Despite the severe consequences, the treatment gap for depression, epilepsy, and schizophrenia continues to be a major concern in low and middle-income countries (LMICs). We conducted a systematic review of literature on barriers and facilitators of treatment-seeking behaviors from the perspective of individuals living with depression, epilepsy, and schizophrenia and stakeholders in LMICs. Knowledge deficits, beliefs, and stigma were barriers to treatment-seeking across disorders. The most cited facilitators were demographics, socioeconomic status, and collaboration with traditional healers. Culturally sensitive interventions in collaboration with stakeholders within the community can facilitate treatment-seeking behaviors among people living with depression, epilepsy, and schizophrenia.

Social support for and features of Chinese adults with epilepsy

Background

The lack of social support for adults with epilepsy (AWEs) is receiving increased attention, as it may result in low quality of life. This study was aimed to confirm the demographic characteristics of and clinical factors associated with social support for AWEs.

Methods

AWEs were consecutively recruited from our hospital. The 10-term Social Support Rating Scale (SSRS) was used to measure social support. A linear regression analysis with stepwise selection was performed to analyze the independent variables associated with social support for AWEs.

Results

In total, 165 AWEs were consecutively included in the present study. Linear regression analysis showed that the marital status (t = -3.550, β = -0.272, P = 0.001), the age at onset (t = 2.545, β = 0.192, P = 0.012), and the QOLIE-31 score (t = 3.144, β = 0.221, P = 0.002) were independent variables associated with social support for AWEs.

Conclusions

Our findings suggest that the poor social support is associated with childhood onset of epilepsy and the unmarried status. This study also confirmed a negative influence of low social support on quality of life in AWEs.

Evaluation of Health Science Students' Health Fatalism and Perception Towards Patients With Epilepsy: A Cross-Sectional Global Study

Introduction The social acceptance of patients with epilepsy is largely determined by society's opinion of epilepsy; therefore, individuals with epilepsy could face prejudice and stigma as a result of negative impressions. Religious beliefs and mystical notions have been shown to influence attitudes toward epilepsy. Health fatalism could also be detrimental to society's and caregivers' approach toward such patients. In extreme settings, this could hinder them from obtaining an adequate treatment process. Methods A cross-sectional exploratory study was conducted from February 2022 to May 2022 in Saudi Arabia, Spain, Scotland, and Italy using an online questionnaire consisting of 33 questions concerning the Health Fatalism Scale (HFS), the Epilepsy Knowledge Scale (EKS), and the Epilepsy Attitude Scale (EAS). Results A total of 735 health science students (HSS) participated in the present study. The majority of participants were females (64.1%) while male participants represented 34.6% of the study. Health science students currently studying in Saudi Arabia represented the majority of participants with a percentage of 58.5%. Among the four countries, students in Saudi Arabia presented with the highest knowledge mean score. Students in Spain had the highest mean attitude score. Muslim students had the highest mean fatalism scores followed by Christian students. Conclusion In general, a high level of knowledge was observed among the participants, most notably, among Saudis who presented with the highest level of knowledge across the four countries. Regarding attitude, Spanish students presented the best attitude towards patients with epilepsy. Low fatalism scores were commonly observed across all countries regardless of their different demographic characteristics. Fatalism perception should be further detailed to ensure optimal services are delivered without prejudgment by future healthcare workers.

Investigation of factors associated with stigma and social support in patients with epilepsy in Turkey: A cross-sectional study

AIM

The purpose of this study was to identify the stigma and multidimensional perceived social support levels of patients with epilepsy, as well as the factors affecting them.

METHOD

The sample of the study consisted of 115 patients with epilepsy followed up in a university hospital in eastern Turkey. The data of the study were collected using the descriptive information form, the Jacoby Stigma Scale, and the Multidimensional Scale of Perceived Social Support. Data analysis was performed using t-test, one-way analysis of variance (ANOVA), and Pearson correlation coefficient.

RESULTS

The rate of exposure to stigma of the patients in the study was 62.4%. Those under 30 years of age, single, with low economic status, and living with their parents and siblings had higher stigma scale mean scores than the other groups (p = 0.001, p < 0.001, p = 0.001, p = 0.019, respectively). Multidimensional Scale of Perceived Social Support total scores were higher in women and married people (p = 0.020, p = 0.01, respectively). A statistically significant negative moderate correlation was found between the patients' Stigma scale mean values and Multidimensional Perceived Social Support Scale mean values (r = -0.568. p < 0.01).

CONCLUSION

According to the study's findings, stigma is prevalent among patients with epilepsy. Increasing social awareness in order to augment social support in patients with epilepsy and providing the patient with positive coping strategies may be effective in reducing stigma in patients with epilepsy.

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

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.

Anti-seizure effects of medicinal plants in Malawi on pentylenetetrazole-induced seizures in zebrafish larvae

ETHNOPHARMACOLOGICAL RELEVANCE

Medicinal plants are used to manage and treat epilepsy in Malawi because of traditional beliefs and barriers to conventional anti-seizure drugs. Among the plants prescribed by traditional medical practitioners are Margaritaria discoidea, Dalbergia boehmii, Dalbergia nitidula, Catunaregam spinosa, and Lannea discolor. Despite the wide use of these plants, there is a lack of scientific evidence to support their anti-seizure efficacy.

AIM OF THE STUDY

This study used the pentylenetetrazole (PTZ)-induced larval zebrafish seizure model to screen for anti-seizure effects of a collection of medicinal plants traditionally used in Malawi.

MATERIALS AND METHODS

Zebrafish larvae were incubated in decoctions at maximum tolerated concentrations for 18 h and exposed to PTZ. As a primary screen, the effects of the decoctions on seizure-induced locomotor activity were determined. Decoctions that significantly reduced total distance traveled were further checked for effects on seizure latency and frequency, brain activity, immediate early gene expression, and c-fos protein expression.

RESULTS

M. discoidea male leaves, D. boehmii roots, and D. nitidula leaves showed significant anti-seizure effects in the primary screen and were selected for further study. Electrophysiological and immediate early gene analyses corroborated anti-seizure effect of D. boehmii and D. nitidula. The results of c-fos protein expression further suggested that the anti-seizure effects in the larval brain may be mediated by the suppression of neurons localized in midbrain regions.

CONCLUSIONS

These findings provide pioneering scientific evidence of the presence of anti-seizure activity in M. discoidea, D. boehmii, and D. nitidula, prescribed by traditional Malawian medical practitioners. Further studies are needed to identify and isolate compounds responsible for such biological activities and elucidate the possible mechanisms of action.

Long-Term Impact of Single Epilepsy Training on Knowledge, Attitude and Practices: Comparison of Trained and Untrained Rwandan Community Health Workers

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.

Attitudes of individuals in Eastern Turkey toward epilepsy and the factors associated with these attitudes

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.

Quality of Life and Stigma among Women with Epilepsy during Their Reproductive Years

Background and Purpose

The purpose of this study was to understand the relationship between quality of life and stigma among reproductive age group women with epilepsy.

Methods

A cross-sectional descriptive study was conducted to assess the data from the 49 women with epilepsy from a tertiary care hospital in India. Quality of life was evaluated with the quality of life in epilepsy-31 questionnaire and stigma was evaluated with the stigma scale of epilepsy. Data also included socio-demographic and clinical characteristics.

Results

The mean age of the participants was 24.67±3.72 years. Quality of life total score (r=−0.485**) and seizure worry domain (r=−0.427**) were significantly negatively correlated with stigma total score at p<0.01 level. Being uneducated, married, unemployed, having children, having generalized tonic-clonic seizures, duration of illness (>10 years), and consuming levetiracetam, anti-epileptic drug (AED), were the significant contributing factors for low quality of life among women with epilepsy during the reproductive age group. Belonging to lower socio-economic status and taking more than two AEDs were also associated with lower quality of life among women with epilepsy, which are trending towards significance.

Conclusions

The study assessed the relationship between the quality of life and the Stigma scale of epilepsy and demonstrated the impact of stigma and quality of life on socio-demographic and clinical variables of women with epilepsy under the reproductive age group. To enhance the quality of life and reduce the stigma levels among women with epilepsy, some of the modifiable parameters can be considered by the multidisciplinary health care professionals from the findings of the current research.

Knowledge about epilepsy and factors associated with attitudes toward marrying, employing, and driving people with epilepsy: A cross-sectional survey of Asokore Mampong community dwellers in Ghana

BACKGROUND

Due to lack of information and illiteracy, epilepsy remains a stigmatized disease in sub-Saharan Africa.

OBJECTIVES

The main aim of the study was to determine, among community dwellers in Asokore Mampong Municipality (Ghana): (i) the knowledge on risk factors, signs and symptoms, management of epilepsy, and (ii) factors associated with attitudes toward marrying, employing, or driving people with epilepsy (PWE).

METHODS

A cross-sectional study of 100 randomly selected individuals aged 18 years and older in Asokore Mampong Municipality was conducted in February 2019. A self-administered questionnaire was used to assess the knowledge about epilepsy and attitudes toward marrying, employing, and driving people with epilepsy. Frequencies and corresponding percentages were used to describe the study participants, their knowledge regarding epilepsy and attitudes toward marrying, employing, or driving people with epilepsy. Univariate and multivariate logistic regression analyses were used to determine the factors associated with attitudes toward marrying, employing, or driving people with epilepsy.

RESULTS

Majority (33%) of the respondents indicated that epilepsy is caused by possession of evil spirits or witchcraft. More than 60% of the respondents correctly identified all signs and symptoms presented in the survey. Almost half (45%) of the respondents selected orthodox/medical treatment as the treatment for epilepsy. The odds of marrying PWE among Akans and Ewe/Ga Adangbe were 90% [adjusted Odds ratio (aOR) = 0.10, 95% CI: 0.01-0.67] and 84% lower [aOR = 0.16, 95% CI: 0.04-0.62] compared to odds of marrying PWE among Northerners, respectively. Compared to respondents with no formal education, the odds of employing PWE were 88% lower [aOR = 0.12, 95% CI: 0.03-0.40] among those with tertiary education. In addition, the odds of driving a person with an epileptic attack among Muslims/Traditionalists were 81% lower [aOR = 0.19, 95% CI: 0.05-0.68] than Christians. Respondents between 18 and 30 years old had more than 5 times higher odds of driving a person with an epileptic attack [aOR 5.28, 95% CI: 1.15-24.84] compared to respondents above 30 years.

CONCLUSIONS

Individuals in Asokore Mampong have less knowledge about the risk factors and treatment of epilepsy. Generally, they have negative attitudes toward marrying, employing, and driving PWE. Findings from this study highlight the need to increase education to reduce the stigma associated with epilepsy. We recommend that a massive educational campaign should be organized by the Ghana Health Service to address deficiencies in knowledge as well as the negative attitudes toward PWE.

Evaluation of attitudes toward epilepsy and health fatalism in northeastern Turkey

PURPOSE

This study was carried out to identify the attitudes toward epilepsy, health fatalism, and the factors affecting these in individuals living in Artvin in the northeast of Turkey.

METHOD

This descriptive and cross-sectional study involved 1443 healthy individuals at a hospital in Artvin in northeastern Turkey between January and March 2020. An individual information form, an epilepsy attitude scale, and a religious health fatalism scale were used to assess their views. An independent sample t-test, Mann-Whitney U test, one-way analysis of variance (ANOVA), and Pearson correlation analysis were used to analyze the data.

RESULTS

The mean score of participants' attitudes on epilepsy was 48.17 (standard deviation (SD) = 12.93), while the mean of their health fatalism score was 48.43 (SD = 17.41). There was a significant negative correlation between attitude scores and health fatalism (r = -0.084, p = 0.001). Significant differences were found among attitude, health fatalism mean scores, and misconceptions associated with religion about epilepsy being a contagious, psychiatric, and incurable disease that should be hidden. Significant differences were additionally observed among attitude, health fatalism mean scores, and education, marital status, income, employment status, and presence of chronic disease (p < 0.05).

CONCLUSION

It was found that most individuals had moderate level attitude toward epilepsy and had high health fatalism. Individuals with a high degree of health fatalism were found to have more negative attitude toward epilepsy. Attitude was found to be more negative, and health fatalism was found to be higher in individuals with low education level, low-income level, who were married, who were unemployed, who had a chronic disease, and in those who thought epilepsy was a contagious, psychiatric, and incurable disease associated with religion that should be hidden.

IMPLICATIONS

It is recommended that health professionals organize training programs to increase public understanding of epilepsy, improving individual attitudes toward the condition, and minimizing health fatalism.