Enquête sur l’épilepsie chez des enseignants d’un pays en développement : exemple du Sénégal

Makkah female teachers' knowledge of seizure first aid

BACKGROUND

Epilepsy is a common disorder in Saudi Arabia, with a prevalence of 6.54/1000 people. Most patients with epilepsy in the country are younger than 19 years of age, and thus, many occurrences of epileptic seizures can occur in schools. As such, teachers are often faced with the challenge of responding to the attack and providing first aid and post-event care to the child with epilepsy.

OBJECTIVES

The objective of this study was to assess the knowledge school teachers in the Makkah region possess about seizure first aid.

METHODS

A self-administered questionnaire was distributed electronically among school teachers in the Makkah region, with the aim to assess basic demographic data about the teachers as well as their knowledge about epilepsy, seizure first aid, and postseizure care.

RESULTS

Out of the teachers who responded to the questionnaire (n = 426), 89% were female teachers; 85.7% recognized epilepsy as a neurological disease. The majority (55%) stated that they would open a patient's mouth and insert an object during a seizure. Those with less teaching experience (1-10 years) correctly identified how to ensure safety in comparison with the more experienced teachers (≫10 years) (P value ≪ 0.001), and 45% of the overall participants recognized when to transfer patients to a medical facility. Both teachers with postgraduate degrees and the more experienced teachers recognized when to transfer students to hospital.

CONCLUSION

Female school teachers in the Makkah region significantly lack adequate training and knowledge of seizure first aid. A health education policy targeting teachers may improve this.

The efficacy of a pharmacist implemented educational treatment programme for people with epilepsy: A report of a randomised controlled trial

PURPOSE

To evaluate the efficacy of a pharmacist implemented educational treatment programme in improving knowledge and perception of epilepsy among people with the condition.

METHOD

A randomized controlled study was conducted on patients with epilepsy recruited from the medical and neurology out-patient clinics of two tertiary hospitals. Patients in the intervention group were offered an educational treatment programme implemented by a clinical pharmacist. The impact of the educational intervention was evaluated by using an epilepsy knowledge scale and the brief illness perception questionnaire.

RESULTS

There was a statistical significant difference between the control and intervention group over time on the knowledge of epilepsy, as the knowledge of epilepsy among patients in the intervention group significantly increased; F (2154) = 150.15, p = 0.000, Partial η² = 0.661. Also, there was a statistical significant difference between the control and intervention group over time on the perception of epilepsy, as the perception of epilepsy among patients in the intervention group significantly improved; F (2, 154) = 12.386, p = 0.000, Partial η² = 0.138.

CONCLUSION

The Pharmacist implemented educational intervention improved patients' knowledge and perception of epilepsy. This finding has revealed the potential positive impact of pharmacists' involvement in the management of epilepsy.

The effects of epilepsy on child education in Sierra Leone

Epilepsy is associated with a significant burden of false beliefs and social stigma in the setting of Sub-Saharan Africa. To assess the impacts of epilepsy on child education in Sierra Leone (SL), we carried out a cross-sectional descriptive study examining its effects on school attendance, participation in physical activities, and social acceptance among classmates. We also assessed the knowledge, beliefs, and attitudes regarding epilepsy of both the children's caregivers and teachers. The data were collected at various epilepsy clinics and schools in Freetown, SL. A total of 50 patients were interviewed and questionnaires administered to their caregivers and teachers, making a total of 150 respondents. Fifty-one percent of the children were absent from school for >5 days per month. Ninety percent did not participate in games and sports, with the commonest reason being fear of occurrence of seizures. Thirty-six percent claimed having experienced negative attitude from their classmates. Regarding the caregivers, 48% believed that epilepsy was a medical illness, while 34% considered it a demonic manifestation. Forty-eight percent were apprehensive about sending their children to school, with 83% of these caregivers stating fear of seizures and potential injuries. Only 8% of the caregivers did not prevent their children from taking part in any physical activity at school. Regarding the teachers, 16% believed that epilepsy was a demonic manifestation, and 10% thought that it was contagious. Fourteen percent did not think that children with epilepsy should go to school, and 80% would prevent children with epilepsy from participating in games and sports. When faced with a child having a seizure, 48% would hold the child down, 12% would place a hard object in the child's mouth, and 12% would avoid any physical contact. In total, 20% of the children ceased attending school permanently; daily occurrence of seizures (p<0.05), negative attitude of classmates (p<0.001), and having an illiterate caregiver (p<0.02) all showed a significant association with permanent cessation of schooling. The study demonstrates significant negative impacts of epilepsy on child education. Notably, the reasons for permanent exclusion from school appear to be as much related to attitudes as to the medical aspects of the disease itself. The data thus highlight the need for educational programs to address the widely prevalent misconceptions among both caregivers and teachers.

Knowledge, attitude and practices of school teachers towards epileptic school children in Karachi, Pakistan

Objective: To assess the knowledge and attitude of school teachers towards an epileptic child.

Methods: This cross-sectional study was conducted among teachers of primary, middle and high schools from different communities in Karachi, Pakistan. A total of 120 self-administered KAP questionnaires were distributed in schools selected through convenience sampling. Data was analyzed using SPSS version 19.

Results: Out of the total sample size, 90.9% (n=100) had heard about epilepsy. Sixteen (14.5%) teachers considered epilepsy to be contagious while 72.7% (n=80) teachers were of the view that epileptics can succeed as other normal children and sixty nine (62.7%) teachers were willing to help a child experiencing a fit, though only 15.5% (n=17) received knowledge about epilepsy during their training years.

Conclusion: The research was conclusive for assessing the knowledge and attitude of teachers towards epileptic children. It highlighted the lack of awareness and negative attitude still existing among teachers. However, many were in the favor of mass education through awareness programs.

Cultural beliefs among people with epilepsy or physical impairment in Guinea-Bissau: Differences and similarities

People living with a disability in sub-Saharan Africa have poorer health outcomes, lower educational successes, less economic participation, and higher levels of poverty than people without disability. Disability-inclusive development promotes the involvement of people with disabilities in programs that reduce these inequalities. This requires a good understanding of how individuals with disability perceive their condition. In this study, we identified cultural beliefs among 31 individuals with epilepsy or physical impairment, known to a community-based rehabilitation service in Guinea-Bissau, using face-to-face interviews. We related these beliefs to religious background and type of disability. We found poor knowledge of and attitudes towards disability among persons with epilepsy and physical impairment. Cultural beliefs were significantly shaped by religious background. Islamic respondents were more positive about their disability as compared to Christians and traditional believers. A better understanding of cultural beliefs among people with disabilities may help to launch and adapt disability-inclusive community-based rehabilitation services.

Epilepsy prevalence, potential causes and social beliefs in Ebonyi State and Benue State, Nigeria

Epilepsy is a common neurological disorder in Nigeria. Many individuals are affected in rural areas, although prevalence data is not available. In this study we aimed to establish the prevalence of epilepsy in a rural community in south-east Nigeria, a community suspected for having a high number of people living with epilepsy. We compared this with the prevalence in a nearby semi-urban community in north-central Nigeria. In both communities we identified potential causes of epilepsy and obtained information on the social beliefs regarding epilepsy. We used door-to-door surveys and focus group discussions. The epilepsy prevalence in the rural community was 20.8/1000 [95% confidence interval (CI): 15.7-27.4]. The prevalence in the semi-rural community was lower, namely 4.7/1000 [CI: 3.2-6.9]. The difference in prevalence was highly significant (χ(2)-test, p<0.0001). In both communities most people with epilepsy were in the age range of 7-24 years. Causes that might be contributory to the prevalence of epilepsy in both communities included poor obstetric practices, frequent febrile convulsions, head trauma, meningitis and neurocysticercosis. In both communities we found stigma of people with epilepsy. In conclusion, the epilepsy prevalence in the semi-urban community is similar to that in industrialized countries. In contrast, the rural community has a much higher prevalence. This may require the establishment of specific community-based epilepsy control programs. Community interventions should focus on treatment of acute epilepsy and on stigma reduction.

Understanding of and attitudes towards people with epilepsy among community-based rehabilitation volunteers in Guinea-Bissau

BACKGROUND

Community-based epilepsy care programs improve access to epilepsy treatment in resource-poor settings. Community volunteers are important to these services. Most studies on familiarity with, understanding of, and attitudes towards people with epilepsy (PWE), however, ignore these volunteers.

METHODS

We explored these issues among 15 community volunteers involved in a community-based rehabilitation child epilepsy service recently initiated in Guinea-Bissau using face-to-face interviews.

RESULTS

We found that the volunteers had a reasonable understanding of epilepsy, moderate attitudes towards PWE, and a good understanding of difficulties PWE encounter in society.

CONCLUSION

Evaluation of understanding and attitudes of community volunteers may be useful to improve low-cost community-based epilepsy programs. A correct understanding of epilepsy among community volunteers may increase effective treatment of and support to children with epilepsy through community-based epilepsy programs.

Association between knowledge and attitudes of educators towards epilepsy and the risk of accidents in Greek schools

Accidents in children with epilepsy are an actual concern of teachers and parents in Greece and internationally. The aim of this study was to investigate the relationship between the knowledge and attitudes of teachers and the frequency of accidents caused by epilepsy in Greece. The study surveyed 1404 public elementary school teachers from all prefectures of the country by an anonymous questionnaire. Results showed that teachers cannot always recognize the manifestations of an epileptic seizure or an injury caused by it, making it difficult for them to report such incidents, and, sometimes, they use wrong or even dangerous manipulations during seizures. Furthermore, the knowledge and attitudes of teachers were associated with the occurrence of accidents. It is, therefore, of major importance that the responsible authorities provide teachers with appropriate guidelines to respond to such incidents, especially in schools where a school nurse is not present.

Knowledge and attitudes toward epilepsy among primary and secondary schoolteachers in Italy

A nationwide telephone interview was conducted on a random sample of Italian schoolteachers (300 from primary and 300 from secondary schools) to ascertain knowledge and attitudes about epilepsy. Included were 516 women and 84 men aged 22 to 70 years. Thirty-seven percent of the teachers believed epilepsy starts only in childhood, 55% considered it hereditary, 46.8% declared it incurable, and only 10.5% knew surgery is a therapeutic option. Thirty-three percent considered epilepsy a moderate-to-strong limitation for marriage, 24.6% for having children, 39.7% for regular employment, and 32.8% for sports and leisure activities. Among the teachers, 66.4% declared they were unable to manage a seizing child, 24.7% were convinced that epilepsy impairs learning, 26.0% believed that it carries mental/behavioral alterations, and 36.4% thought it requires support at school. Differences in knowledge and attitudes were predicted by teachers' age and area of residency. There were no major differences between teachers and the Italian population in their knowledge and attitudes.

Myths, misconceptions, and misunderstandings about epilepsy in a Nigerian rural community: implications for community health interventions

Face-to-face interviews were conducted with 365 persons without epilepsy. Seventy-four (12%) attributed epilepsy to brain disorder, witchcraft (81.4%), destiny (49.8%), heredity (27.8%), and demonic possession (26.8%). Beliefs about modes of spread included saliva (28.8%), sharing utensils (19.5%), and making fun of a person with epilepsy (12.1%). Traditional medicine was the first preferred treatment option in 80.5% of participants; treatment approaches included herbal preparations (67.7%), spiritual exorcism (33.7%), special cultural diets (29.3%), charms (26.2%), and sacrificial offerings (24.1%). Reasons for preferring traditional treatment included the health facility being too far (86.1%), health personnel not being readily available (83%), and epileptic drugs not being readily available (79.6%). Incorrect local perceptions and cultural beliefs about epilepsy and inadequacies of the modern health care systems in developing countries might jointly contribute to the treatment gap. Local health staff, if appropriately strengthened, could take on additional tasks and bridge the treatment gap. Collaboration between modern and traditional health care systems may also improve treatment accessibility.

Link between Epilepsy and Malnutrition in a Rural Area of Benin

PURPOSE

Epilepsy and malnutrition are both important public health problems in sub-Saharan Africa. A relationship between epilepsy and malnutrition has been suspected for many years. Our objective was to investigate the association between epilepsy and malnutrition in Djidja, Benin.

METHODS

A matched population-based cross-sectional case-control survey was performed: cases (patients with epilepsy) were matched to controls according to sex, age +/- 5 years, and village of residence. The World Health Organization's criteria for malnutrition was used. Anthropometric measurements (weight, height, mid arm upper circumference, triceps skinfold thickness) were taken. Bioelectrical impedance analysis, a standardized food and social questionnaire and a clinical examination were done. Statistical analysis (conditional logistic regression) was performed using SAS 8.0.

RESULTS

A total of 131 cases and 262 controls were included. The prevalence of malnutrition was higher in cases than in controls (22.1% vs. 9.2%, p = 0.0006). Social factors were significantly different between cases and controls. Feeding difficulties were more frequent and health status was worse in cases. Seven variables were associated with epilepsy: (i) nutritional factors: mid arm upper circumference (prevalence odds ratio (pOR) = 0.7, CI: 0.6-0.9), cereal consumption <3 times during the 3 days before the study (pOR = 4.2, CI: 1.8-10.0), <3 meals/day (pOR = 4.2, CI: 1.6-10.9), tooth decay (pOR = 2.9, CI: 1.1-7.4), food taboos (pOR = 25.0, CI: 8.3-100.0), (ii) social factors: surrogate respondent (pOR = 16.8, CI: 3.1-90.3) and no second job (pOR = 7.1, CI: 2.3-22.3).

CONCLUSION

Epilepsy and nutritional status are linked in sub-Saharan Africa. Programs to improve the nutritional status of people with epilepsy are needed.

Zambian health care workers' knowledge, attitudes, beliefs, and practices regarding epilepsy

OBJECTIVE

Zambia suffers from a physician shortage, leaving the provision of care for those with epilepsy to nonphysician health care workers who may not be adequately trained for this task. These individuals are also important community opinion leaders. Our goal in this study was to determine the knowledge, attitudes, beliefs, and practices of these health care workers with respect to epilepsy.

METHODS

Health care workers in urban and rural districts of Zambia completed a self-administered, 48-item questionnaire containing items addressing demographics, personal experience with epilepsy, social tolerance, willingness to provide care, epilepsy care knowledge, and estimates of others' attitudes. Analyses were conducted to assess characteristics associated with more epilepsy care knowledge and social tolerance.

RESULTS

The response rate was 92% (n=276). Those who had received both didactic and bedside training (P=0.02) and more recent graduates (P=0.007) had greater knowledge. Greater knowledge was associated with more social tolerance (P=0.005), but having a family member with epilepsy was not (P=0.61). Health care workers were generally willing to provide care to this patient population, but approximately 25% would not allow their child to marry someone with epilepsy and 20% thought people with epilepsy should not marry or hold employment. Respondents reported that people with epilepsy are feared and/or rejected by both their families (75%) and their community (88.8%).

CONCLUSIONS

Knowledge gaps exist particularly in acute management and recognition of partial epilepsy. More recent graduates were more knowledgeable, suggesting that curriculum changes instituted in 2000 may be improving care. Health care workers expressed both personal and professional reservations about people with epilepsy marrying. In addition to improving diagnosis and treatment skills, educational programs must address underlying attitudes that may worsen existing stigmatizing trends.

The social and economic impact of epilepsy in Zambia: a cross-sectional study

BACKGROUND

Among the 40 million people with epilepsy worldwide, 80% reside in low-income regions where human and technological resources for care are extremely limited. Qualitative and experiential reports indicate that people with epilepsy in Africa are also disadvantaged socially and economically, but few quantitative systematic data are available. We sought to assess the social and economic effect of living with epilepsy in sub-Saharan Africa.

METHODS

We did a cross-sectional study of people with epilepsy concurrently matched for age, sex, and site of care to individuals with a non-stigmatised chronic medical condition. Verbally administered questionnaires provided comparison data for demographic characteristics, education, employment status, housing and environment quality, food security, healthcare use, personal safety, and perceived stigma.

FINDINGS

People with epilepsy had higher mean perceived stigma scores (1.8 vs 0.4; p<0.0001), poorer employment status (p=0.0001), and less education (7.1 vs 9.4 years; p<0.0001) than did the comparison group. People with epilepsy also had less education than their nearest-age same sex sibling (7.1 vs 9.1 years; p<0.0001), whereas the comparison group did not (9.4 vs 9.6 years; p=0.42). Housing and environmental quality were poorer for people with epilepsy, who had little access to water, were unlikely to have electricity in their home (19%vs 51%; p<0.0001), and who had greater food insecurity than did the control group. During pregnancy, women with epilepsy were more likely to deliver at home rather than in a hospital or clinic (40%vs 15%; p=0.0007). Personal safety for people with epilepsy was also more problematic; rape rates were 20% among women with epilepsy vs 3% in the control group (p=0.004).

INTERPRETATION

People with epilepsy in Zambia have substantially poorer social and economic status than do their peers with non-stigmatised chronic medical conditions. Suboptimum housing quality differentially exposes these individuals to the risk of burns and drowning during a seizure. Vulnerability to physical violence is extreme, especially for women with epilepsy.

Zambian teachers: what do they know about epilepsy and how can we work with them to decrease stigma?

PURPOSE

Teachers play a central role in determining access to education and may mediate epilepsy-associated stigma. We developed and administered a teacher-specific survey to assess teachers' knowledge, attitudes, behaviors, and practices (KABPs) regarding epilepsy in Zambia and social and demographic determinants of KABPs.

METHODS

In 2004, we surveyed 171 teachers in urban and rural regions using a 46-item questionnaire. Knowledge and tolerance composite scores were developed and analyses completed to identify demographic and social determinants of KABPs and evaluate whether generic tolerance questions were associated with stigmatizing practices.

RESULTS

The response rate was 93% (n=159). Knowledge regarding epilepsy ranged broadly. Misattribution was evident for etiology (spirit possession 17.3%; contagion 28.2%; witchcraft 16.8%), and individuals with poorer knowledge were more likely to recommend traditional healers (p=0.0004) rather than physicians for epilepsy care. Higher knowledge was associated with higher tolerance (p=0.01). Tolerance was highest among urban residents (p=0.002) and individuals with personal familiarity/experience with epilepsy. More tolerant teachers were less likely to report stigmatizing practices, such as ejecting children with seizures from school.

CONCLUSIONS

Teacher-targeted interventions aimed at reducing epilepsy-associated stigma and its sequelae in Zambia should include both an educational component and a social component in which teachers are exposed to a person or persons with the condition. Education programs led by person(s) with epilepsy may be ideal.

Knowledge, attitudes, behaviors, and practices regarding epilepsy among Zambian clerics

BACKGROUND

Epilepsy carries a high burden of social morbidity. An understanding of who propagates stigma and the determinants of stigmatizing attitudes is needed to develop effective interventions. Clerics represent an especially influential social group in Africa. Therefore, we conducted a survey of the knowledge, attitudes, behavior, and practices of Zambian clerics with respect to epilepsy.

METHODS

We studied clerics in one large rural region as well as in the capital city. The rural survey was conducted door-to-door. In the urban areas, central administration for multiple denominations assisted in survey delivery. The survey, adapted from previously published instruments, included cleric-specific questions and demographic data. Composite scores for knowledge and tolerance were developed. Determinants of higher knowledge and tolerance were assessed.

RESULTS

Almost all Zambian clerics know someone with epilepsy and have witnessed a seizure. More than 40% report having a family member with epilepsy. Unfortunately, this familiarity is not associated with more knowledge or tolerance for the condition. Younger clerics, urban dwellers, those with fewer children, and those with more years of formal education were significantly more tolerant. More knowledgeable clerics are more likely to recommend that a person with epilepsy seek care from a physician rather than a traditional healer. Formal education was the most important factor in determining tolerance toward epilepsy.

CONCLUSIONS

Zambian clerics are very familiar with epilepsy, yet have relatively little knowledge of the etiology. Many view traditional healers as the appropriate care provider for epilepsy. To decrease stigma and improve the quality of advice offered by clerics to their congregations, educational programs focusing on the biomedical nature of the disorder are needed, particularly in rural regions.