Treatment-Seeking Behavior Towards Epilepsy Among Rural Residents in Ethiopia: A Cross-Sectional Study

Sociodemographic determinants of epilepsy and treatment-seeking behavior among patients with epilepsy - A hospital-based study from western India

BACKGROUND

Epilepsy ranks among the major noncommunicable diseases that confer significant morbidity and mortality. A lack of knowledge about epilepsy, coupled with negative attitude and false practices, has been shown to be influenced by sociodemographic parameters and in turn impacts healthcare-seeking behavior.

METHODS

An observational single-center study was conducted at a tertiary care center in western India. Data on sociodemographic parameters, clinical and healthcare-seeking patterns were recorded from all patients above 18 years with a diagnosis of epilepsy. A pre-validated questionnaire was then administered to assess the knowledge, attitude, and practices related to epilepsy. Data collected were evaluated.

RESULTS

A total of 320 patients with epilepsy were recruited for the study. Majority of the study subjects were young Hindu males from urban and semi-urban areas. Idiopathic generalized epilepsy was the most common diagnosis with significant number of patients showing poor seizure control. The knowledge, attitude, and practice (KAP) responses showed serious gaps in various aspects. Prevalent misconceptions were that epilepsy is a mental problem (40%), is a hereditary disorder (24.1%), is contagious (13.4%), and is a result of previous life sin (38.8%). With respect to discrimination in epilepsy using KAP questionnaire, most of the respondents (>80%) did not object to sitting or playing with a child with epilepsy. A significant proportion of patients (78.8%) feared from the side effects of long-term antiepileptic drug treatment. Almost one-third persons (31.6%) did not know the correct response in terms of first aid measures. The mean KAP score was 14.33 (±3.017 SD), significantly higher in better educated people from urban areas (p < 0.001 for both). Healthcare-seeking behavior with preference for early allopathic care had a positive correlation with various sociodemographic characteristics as well as with higher mean KAP scores.

CONCLUSION

Despite improved literacy and urbanization, knowledge regarding epilepsy still remains poor with wide prevalence of traditional wisdom and practices. Though better education, employment, and awareness may partially overcome the impediments resulting in delay in seeking early appropriate healthcare after first seizure, the issue is more complex and multifactorial, and a multipronged approach is need of the hour.

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.

Treatment outcome and associated factors among epileptic patients at ambulatory clinic of Mettu Karl Comprehensive Specialized Hospital: A cross-sectional study

Objective

The study was aimed to assess the magnitude and associated factors of 2-year seizure-free status of epileptic patients at Mettu Karl Comprehensive Specialized Hospital (MKCSH).

Methods

A retrospective cross-sectional study was conducted at MKCSH from 12 February 2020 to 11 August 2020. Treatment outcome was measured in terms of seizure control status and seizure frequency. Accordingly, good treatment outcome was declared if the patients had a 2-year seizure-free status and poor if the patient had episodes of seizure in the last 2 years. The pharmaceutical care network Europe guideline was used to assess the presence of medication-related problems. Multivariable logistic regression was used to analyze the variables by using crude odds ratio (COR) and adjusted odds ratio (AOR) with 95% confidence interval (CI). Finally, the predictors of epilepsy treatment outcome were declared if a P-value was ⩽0.05.

Results

Over the study period, more than half of the participants (172 (57.7%)) were males. The median age of participants was 29 and majorly distributed to 18-30 classes. More than one-fourth of the patients were suffering from absent seizure 85 (28.5%) and general tonic-clonic seizure 83 (27.9%). The most commonly prescribed medication was Phenobarbitone which accounts 34 (11.41%), whereas Valproic acid 8 (2.68%) was the least prescribed. Overall, less than half 131 (43.96%) of patients developed poor treatment outcomes. The predictors of treatment outcomes were having head the injury (AOR = 5.7; 95% CI: 3.18, 10.31), family history of epilepsy (AOR = 5.6; 95% CI: 3.07, 10.46) and the presence of drug therapy problems (AOR = 5.2; 95% CI: 2.79, 9.69).

Conclusion

The magnitude of poor epilepsy treatment outcome was found to be high. The predictors of epilepsy treatment outcome were the history of head injury, family history of epilepsy and drug therapy problems. Therefore, to improve the treatment outcome of epileptic patients, health care providers should pay close attention to the identified factors. Besides this, the clinical pharmacy service should be implemented to minimize any medication-related problems.

What is the community's knowledge and understanding regarding epilepsy? Epilepsy knowledge and its determinants among residents of Debub Bench District, Bench Sheko Zone, Southwest Ethiopia, 2019: a cross-sectional study

OBJECTIVE

Epilepsy is a neurological condition marked by recurring seizures. People with epilepsy, particularly in low-income and middle-income countries, are stigmatised due to a lack of understanding and a negative attitude towards the disease. Increased public awareness of epilepsy will aid in the search for therapy and the quality of life of the patients. The study aimed to assess knowledge about epilepsy and the associated factors among residents of Debub Bench District, Bench Sheko Zone, Southwest Ethiopia in 2020.

SETTING

This community-based, cross-sectional study triangulated with qualitative method was conducted from 25 April 2020 to 20 May 2020. Multistage sampling technique was used to select 601 participants. A structured and interviewer-administered questionnaire was used to collect data. Data were entered in EpiData Manager V.4.0.2.101 and exported to SPSS V.23 for analyses. Multivariable logistic regression was carried out to identify the factors associated with knowledge of epilepsy. A p value of <0.05 was taken to indicate statistical significance.

RESULTS

A total of 601 respondents participated, of whom 340 (56.6%) were male. The mean age of the respondents was 34.84±11.42 years. The proportion with good knowledge of epilepsy was 55.1%. Factors associated with good knowledge of epilepsy were attending primary education (adjusted OR (AOR)=2.06, 95% CI 1.27 to 3.34), secondary education (AOR=5.01, 95% CI 2.62 to 9.58), above secondary education (AOR=5.67, 95% CI 2.35 to 13.69), being in high wealth index (AOR=1.74, 95% CI 1.09 to 2.78), being a government employee (AOR=3.69, 95% CI 1.39 to 9.83), being a merchant (AOR=3.16, 95% CI 1.80 to 5.54) and being an urban resident (AOR=2.15, 95% CI 1.36 to 3.42).

CONCLUSION

Only 55% of the residents have sufficient knowledge about epilepsy. Factors associated with knowledge of epilepsy were educational status, wealth index, occupation and residence.

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.

Concepts behind epilepsy among Egyptian patients. Is it a disease or a possession?!

BACKGROUND

Many epileptic patients visit traditional healers secondary to unaffordability, inaccessibility of medical service and being refractory. This may lead to delay in seeking medical advice and may influence prognosis.

OBJECTIVES

Studying concepts behind epilepsy among Egyptian epilepsy sufferers including beliefs behind epilepsy and whether there is difference in these beliefs as regards gender, education and urban to rural socioeconomic status.

METHODS

A semi structured questionnaire designed according to the guidelines of the 9th edition of research methods in psychology and applied to 393 cases presenting to epilepsy clinics at three hospitals representing rural delta, capital, and upper rural Egypt between November 2019 and April 2020. Inclusion criteria included a fulfillment of the international league against epilepsy operational definition and availability of an electroencephalogram supporting the diagnosis of epilepsy.

RESULTS

30 % of patients visited traditional healers within the course of their illness with males accounting for 55.9 %, and relatives' impact was more obvious in this decision (83.9 % visited traditional healers secondary to a relative influence). 43.2 % of traditional healers' visitors had a basic education. Low education level was significantly correlated with visiting traditional healers (rho=-0.126, p = 0.012). 43 patients (36.4 %) received traditional therapy and only 3 patients (2.5 %) out of them improved. More males (55.9 %) than females (29.5 %) were found to seek non-medical help with no significant difference (p = 0.852). Additionally, it was noticed that males who lived in rural areas visited traditional healers significantly more than those who lived in urban (72.2 % vs 27.3 %, p = 0.011) while in females, it seems that residency did not affect traditional healers seeking behavior (50 % urban vs 50 % rural). Rural residents were seeking non-medical advice more than urban (28.3 % vs 22 %, p < 0.001) as well as receiving traditional treatments (19.7 % vs 11 %, p = 0.017).

CONCLUSIONS

Seeking traditional healers in epilepsy sufferers is not uncommon in Egypt. Education, gender, and residency may affect concepts and beliefs regarding epilepsy. Although awareness of epilepsy as a medical condition is also questionable, yet it is needed.

Stigma and associated factors among people with epilepsy in Ethiopia: A systematic review and meta-analysis

This systematic review and meta-analysis was aimed to summarize the pooled prevalence of stigma and associated factors among people with epilepsy in Ethiopia. A systematic search of articles was conducted in PubMed, SCOPUS, African Journals Online (AJOL), and Journal Storage (JSTOR). A standardized data extraction format was used to extract data. The analysis was conducted using STATA version 11 software. Cochrane Q statistic was used to assess the presence of significant between-study heterogeneity. I² was used to quantify between-study heterogeneity. A leave-one-out sensitivity analysis was done. Subgroup analysis was conducted. Funnel plot, Begg's test, and Egger's regression tests were used to measure the presence of publication bias. Since the studies showed heterogeneity, the pooled estimated prevalence of stigma of people with epilepsy was conducted using DerSimonian-Laird's random-effects model. The estimated pooled prevalence of stigma was 44.65(95%CI; 29.37-59.94). Begg's rank correlation test (Z = 0.15, P = 0.881) and Egger's linear regression test (t = 0.14, P = 0.894) showed the absence of publication bias. Factors associated with an increased likelihood of stigma were 6-10 years of duration of illness (p = 0.003), ≥11 years of duration of illness (p = 0.008), and ≥1/month of seizure frequency (p = 0.01). Comprehensive care that involves psychological, social, and medical components is required. Health education on effective coping mechanisms is recommended.

Magnitude, Symptom Presentation and Correlates of Psychological Distress Among People with Epilepsy in Southern Ethiopia: A Cross-Sectional Study

BACKGROUND

Psychological distress is a common co-morbid condition among people with epilepsy. Untreated comorbid psychosocial problems are associated with increased morbidity and health-care costs, and negatively affects treatment outcome of people with epilepsy. Therefore, the aim of this study was to describe the prevalence of psychological distress and to identify its associated factors among people with epilepsy attending outpatient treatment in Gedeo zone public hospitals, Southern Ethiopia.

PATIENTS AND METHODS

This was an institution-based cross-sectional study conducted at Gedeo zone public hospitals from July 1st to October 1st, 2019. Self-reporting questionnaire was used to screen individuals with epilepsy for the presence of co-morbid psychological distress. A face to face interview was conducted among 321 anti-epileptic medication followers. The collected data were entered into Epi-Data version 3.1 and then exported to SPSS version 20 for further analysis. Binary logistic regression was computed to identify factors associated with psychological distress. Statistically, significant association was set at p-values of <0.05 in the final model with a corresponding 95% confidence interval.

RESULTS

The prevalence of psychological distress was found to be 38.3% with 95% CI (34.1, 42.7) among people with epilepsy attending outpatient follow-up in Gedeo zone public hospitals. Being female [OR=1.57 (95% CI: 1.01-4.80)], uncontrolled seizures [OR=1.96 (95% CI: 1.21-3.18)], and longer duration of illness [OR= 3.16 (95% CI: 1.75-5.73)] were variables found to have statistically significant association with psychological distress.

CONCLUSION

The findings of this study revealed that more than one-third of people with epilepsy screened positive for psychological distress. Therefore, this demonstrates a need to design and implement programs focusing on the prevention, early screening, and providing appropriate interventions for psychological distress among people with epilepsy.

Epilepsy Treatment Outcome and Its Predictors among Ambulatory Patients with Epilepsy at Mizan-Tepi University Teaching Hospital, Southwest Ethiopia

Background

Epilepsy is among the most common neurological disorders which is highly treatable with currently available antiepileptic drugs at a reasonable price. In Ethiopia, despite a number of studies revealed high prevalence of epilepsy, little is known on predictors of poorly controlled seizures. Thus, the aim of this study was to assess epilepsy treatment outcome and its predictors among patients with epilepsy on follow-up at the ambulatory care unit of Mizan-Tepi University Teaching Hospital, Southwest Ethiopia.

Methods

A hospital-based cross-sectional study involving patient interview and chart review was conducted from March 10 to April 10, 2018. Drug use patterns and sociodemographic data of the study participants were accustomed to descriptive statistics. Backward logistic regression analysis was done to identify predictors of poor seizure control. Statistical significance was considered at p value <0.05.

Results

From a total of 143 studied patients with epilepsy, 60.8% had uncontrolled seizures. Monotherapy (79%) was commonly used for the treatment of seizures, of which phenobarbital was the most commonly utilized single anticonvulsant drug (62.9%). The majority (72.7%) of the patients had developed one or more antiepileptic-related adverse effects. Medium medication adherence (adjusted odds ratio (AOR) = 5.4; 95% CI = 1.52–19.23; p=0.009), poor medication adherence (AOR = 8.16; 95% CI = 3.04–21.90; p=0.001), head injury before seizure occurrence (AOR = 4.9; 95% CI = 1.25–19.27; p=0.02), and seizure attacks ≥4 episodes/week before AEDs initiation (AOR = 8.52; % CI = 2.41–13.45; p=0.001) were the predictors of uncontrolled seizure.

Conclusions

Based on our findings, more than half of the patients with epilepsy had poorly controlled seizures. Nonadherence to antiepileptic drugs, high frequency of seizure attack before AEDs initiation, and history of a head injury before the occurrence of seizure were predictors of uncontrolled seizure. Patient medication adherence should be increased by the free access of antiepileptic drugs and attention should be given for the patients with a history of head injury and high frequency of seizure attacks before AEDs initiation.