Keywords |
| Epilepsy, knowledge, attitude, practice, students |
Introduction |
| Epilepsy is basically a chronic brain disorder
characterized by recurrent derangement of the
nervous system due to sudden excessive
disorderly discharge of the cerebral neurons
[1,2] that results in almost instantaneous
disturbance of sensation and loss of
consciousness [2]. Epilepsy is one of the most
common neurological disorders that affect
approximately 70 million people worldwide
[3]. Nearly 80% of people with epilepsy are
found in developing countries, where epilepsy
remains a major public health problem, not
only because of its health implications but also
for its social, cultural, psychological and
economic effects [1,3]. However, worldwide
prevalence rate of epilepsy varies from 2.8 to
19.5 per 1,000 of the general population [4].
The incidence of epilepsy in Ethiopia was
reported to be 64/100,000 population as
indicated in a community-based study in rural
Central Ethiopia [5]. |
| Religious and socio-cultural beliefs influence
the nature of treatment and care received by
PWE [1,6,7]. Wrong perceptions and beliefs
about epilepsy create serious negative social
and psychological consequences for PWE
such as fear, humiliation, and limitations in
social interactions [8]. One of the greatest
challenges facing the optimal management of
epilepsy is stigma and discrimination [4,9-11].
In particular, incorrect information about the
causes and inheritability of epilepsy increase
the stigma and make the lives of PWE more
difficult [12]. Many communities in Africa
believe that epilepsy results from insanity,
witchcraft or possession by evil spirits [1,13].
Persons with epilepsy are shunned and
discriminated against education, employment
and marriage because epilepsy is seen as a
highly contagious and shameful disease in the
eyes of the public [1]. This discrimination
against epileptic patients could also be due to lack of knowledge and understanding about
epilepsy [13]. |
| Social discrimination against people with
epilepsy affects mainly school children [9,14]
as they are growing and have interactions at
multiple levels [15]. A necessary first step to
increasing the knowledge and changing
attitudes among students in particular and the
population in general, is to assess what they
already know [11]. Gauging the knowledge,
attitude and understanding of epilepsy is the
first measure towards alleviating
discrimination [13]. Therefore, the present
study was conducted to assess the knowledge,
attitude and practice towards epilepsy among
preparatory school students of Mekelle city. |
Methods |
Respondents |
| The ethical approval and clearance was
obtained from Research and Ethics Review
Committee of College of Health Sciences,
Mekelle University. We surveyed 391
students randomly selected from four
preparatory schools in Mekelle city. This
survey was carried out in one government
302(82.97%) and three private 62(17.03%)
preparatory schools students. Students who
did not give informed consent and those with
previous or current epileptic seizures were
excluded. |
Survey setting |
| This cross-sectional study was carried out in
Mekelle city. Mekelle is the largest town in
Northern Ethiopia and lies about 783 Km
North of Addis Ababa, the capital city of
Ethiopia. There were approximately 4,445
students who were studying grade eleven and
twelve in one government and four private
preparatory schools in Mekelle. The study
period was from March to June, 2011. |
Survey methods |
| As there was no previous study conducted in
Mekelle on the current topic, a 50% expected
prevalence of epilepsy was used. Sample size
calculation indicated that sample of 391
students were appropriate considering 95%
confidence interval, 5% margin of error and
10% contingency for non-response. The
number of selected students in each school
was proportionate to the school population.
Participating classes and students in each class
were randomly selected in each school.
Instruction on how to complete the
questionnaires was given to each class before
the distribution of the questionnaires. After
permission was obtained from the school
principals, a total of 391 questionnaires were
distributed to the four schools and selfadministered
by consenting students who were
present in campus. |
Survey questionnaire |
| The survey instrument was a 13-item
questionnaire in English, designed to evaluate
knowledge, attitudes and practices with
respect to epilepsy that had been used in
recent studies in Cameroon [7,10,11,16],
South Korea [2], Brazil [4], India [9],
Malaysia [13] and Turkey [15]. The
questionnaire was in two parts; the first
section elicited demographic information
including age, sex, school category,
educational level (grade) and religion; while
the second part elicited awareness of existence
of epilepsy, attitude toward epilepsy,
knowledge of cause, manifestation, first aid
measure and treatment option of epilepsy (see
Appendix). |
Data analysis |
| Data were recorded in a preceded
questionnaire and data entry was done using
the Excel program. Then MedCalc version
12.4 was used to do the data analysis. Continuous variables such as age were
expressed as the mean ± standard deviation,
whereas categorical variables were presented
as frequencies (%). Chi-square test was used
to examine the association between responses
and each demographic variable in a univariate
analysis. Significance level was set at P<0.05. |
Results |
Demographic data |
| A total of 364 out of 391 questionnaires
distributed were completely filled and
returned, giving a participation rate of 93.1%.
There were 212 females and 152 males giving
a female to male ratio 1.4. Average age was
17.3 years (range = 15–29); 235(64.56%) and
129(35.44%) of the participants were between
14 to 19 and 20 to 30, respectively. Most of
the participants said that they were Christians
353(96.98%). Majority, 302(82.94%) and
221(60.71%) of the students were from
government school and grad eleven,
respectively. The key demographic variables
are summarized in Table 1. |
Familiarity with epilepsy |
| About 85.70% of participants had heard about
epilepsy and 57.14% had witnessed a seizure
while 67.03% had known someone with epilepsy.
Approximately 19.23 % of them had read about
the condition. Students in the age range of 20 to
30 years (P<0.01), those in governmental
schools and those who declared to be
Christians were the most likely to have heard
about epilepsy (P< 0.001), as summarized in
Table 2. Students in the age range of 14 to 19
years and students of the higher classes were
more likely to know someone with epilepsy
(P<0.05); while female students were more
likely to have witnessed a seizure (P<0.05)
than male students. Students of private school
(P<0.001) and higher class (P<0.05) were more likely to have read about epilepsy
compared to their counterpart. |
Understanding and attitudes toward epilepsy |
| From the respondents, 16.8% would object to
association with PWE, 44.8% would not allow
marriage with PWE, 64% would offer equal
employment to PWE while 55.8% students
think that there are jobs that PWE can’t do.
On the other hand, 51.6% and 53% of students
think epilepsy is contagious and curable,
respectively; while 28.6% students believe
epilepsy is a form of insanity. Table 3 gives a
summary of how demographic variables relate
with understanding and attitudes with respect
to epilepsy. Muslims were more likely to
object to marriage with PWE compared to
Christians (P<0.05); likewise, females were
more likely to object association with PWE
(P<0.05). None of the variable studied seemed
to influence the attitudes that there are some
types of jobs not suitable for PWE. Students in
the age range of 20 to 30 years (P<0.05)
believed that PWE should be employed in jobs
like other people compared to the age group
14 to19. In similar fashion, female students
believed that epilepsy is a form of insanity
compared to male students (P<0.05).
Significantly, private school students were
more likely to think that epilepsy is contagious
(P<0.0001) than government school students.
Moreover, younger students (P<0.01), those of
higher level, private school and male students
were most likely to agree that epilepsy is
curable (P<0.05). |
Knowledge and practices with respect to
epilepsy |
| Concerning the understanding of and practice
toward epilepsy (Table 4), most participants
mentioned more than one cause,
manifestation, or treatment. About 55.8% of
students thought that epilepsy is a brain
disease. Evil spirit (33.24%), blood disorder
(31%), birth defect (25.50%), heredity
(23.60%) and punishment for wrong doing (17.6%) were the most cited causes. For those
who considered epilepsy to be contagious, the
main methods of transmission identified were:
physical contact (45.88%), saliva (14.56%),
waste gas (12.64%), blood and sexual
intercourse (11.30%). Concerning the
manifestation of an epileptic attack, most
respondents mention ‘‘foams from mouth”
(69.20%), convulsions (63.46%), change in
behavior (19%) and ‘‘screaming” (17.86%).
As first aid for a person having seizures,
81.90% of the students would provide match
stick smoke while 59%, 27.20%, 22.80% 14%
and 11.30% would take them to safe place,
force some medicine down the patients throat,
put a spoon or cloth in the patients mouth,
hold or tie them down and put their head in a
toilet hole, respectively (Table 4). Most
striking, 70.33% of participants would
recommend that PWE to use Holy water; and
up to 64.01% would prefer medical doctor for
management of epilepsy. Traditional healers
(44.78%), prayers (32.14%), and witchdoctors
(18.41%) were also recommended. |
Discussion |
| In Ethiopia, few studies do suggest that
epilepsy is a major problem within the country
[5,17]. Children with epilepsy not only have to
cope with the complex demands of a chronic
illness, but also have to deal with social
stigma and prejudice in physical activities and
education [15]. Despite this, psychosocial
studies on people with epilepsy are few or
nonexistent and this study is the first that to
assess knowledge, attitude and practice toward
epilepsy in preparatory school students within
the region. |
| On the whole, among those surveyed, 85.70%
and19.23% reported having heard and read
about epilepsy, respectively. This is somewhat
striking that almost 15% and 80% of school
students, the more educated in society, had never heard of and read about epilepsy,
respectively. That was remarkably consistent
with a study among college students done in
Trinidad and Tobago (86%) [18] and
significantly better than the study among
upper-middle school students done in Turkey
(49.9%) [15]. On the other hand, awareness on
epilepsy significantly lower in this study
compare to findings among similar
respondents in Egypt (100%) [19], India
(97.7%) [9] and Cameroon (94.7, 95.1%)
[11,16]; as well as among college students in
Cameroon (100%) [7]. It was also lower than
among the general public reported in Ethiopia
(89%) [17], Italy (93.4%) [21], Cameroon
(100%, 99.3%) [6,10], Croatia (97%) [22],
South Korea (94%) [2]; and among school
teachers reported in Egypt (100%) [20] and
Brazil (100%) [4]. Students attending the
private preparatory schools were more likely
to have read (P<0.001) than government
schools that contrasts other works reported
elsewhere among health students in Cameroon
[7]. |
| Moreover, more students had witnessed a
seizure (57.14%) and had known someone
with epilepsy (67.03%) in this study than
among college students in India (43.4%,
38.5%) [23] and Trinidad and Tobago (51%,
44%) [18]. While lower than among
secondary school (73.3%, 76.4%) [16] and
college students (86.5%, 85.5%) [7] in
Cameroon; that was expected as epilepsy is
not taught in preparatory schools in Ethiopia.
This figure was comparable with findings
among similar study in Cameroon (77.2%,
55.2%) [11]. Familiarity with epilepsy was
significantly low among the young (P<0.01),
similar to other works reported in Cameroon
[7,11,16]. |
| As far as attitudes toward epilepsy are
considered, more would object to marriage
(44.8%) than to association (16%) with PWE.
Compared to similar studies conducted in Cameroon (47.8%, 64.2%) [11,16] and college
students in Trinidad and Tobago (81%) [18],
Cameroon (52.1%) [7] and India (49.7%) [23],
attitudes were more positive. On the other
hand, attitudes were more negative compared
to the study in Egypt (8%) [19]. Among the
variables examined, females and Muslims
influenced attitudes regarding association with
and marriage to PWE (P<0.05), respectively;
while in another finding none of the variables
influenced attitudes of health students in
Cameroon [7]. Almost two-third of
respondents thought that people PWE could
be employed in jobs like other people.
Participants portrayed more favorable
attitudes as compared to other works done
among students in Cameroon (70.6%, 77.2%)
[7,11], India (77.7%) [23] and Trinidad and
Tobago (93%) [18]; and less favorable
attitudes compared to reports elsewhere in
Egypt (30.1%) [19] and Cameroon (58.6%)
[16]. Contrary to this, approximately half of
respondents believed that there are jobs PWE
can’t do. None of the variable studied seemed
to influence the attitudes that there are some
types of jobs not suitable for PWE (P>0.05).
In view of this, it could be suggested that
reluctance to offer employment to epileptic
patients in this study could be attributed to
concerns about safety and ability rather than
prejudices towards such patients. |
| Up to 28.6% of students considered epilepsy
to be a form of insanity that indicates a better
understanding compared to those findings
among similar participants in Cameroon
(38%) [16] as well as among population
studies done in Cameroon (35.1%, 62.2%)
[6,10] and Italy (54.2%) [21]. Furthermore,
this misconception was high compared to the
surveys conducted among similar participants
in Egypt (15%) [19] and Cameroon (13.2%)
[11], particularly, compared to the population
study in Croatia (2.5%) [22]. About 51.60% of
students considered epilepsy to be contagious.
Similar findings were reported in Cameroon (49.90%) [16] as well as among populations
study in Cameroon (46.20%) [6] and Ethiopia
(45%) [17]. This belief was better compared
to that reported among similar participants in
Cameroon (58%) [11], but worst compared to
that reported in Egypt (19%) [19] and among
populations study in Cameroon (23.20%) [10].
These findings showed that misconception is
very much present in Africa and seems to be
responsible for the high level of
discrimination. Furthermore, almost half of
respondents believed epilepsy can be cured
comparable to other findings elsewhere among
similar respondents in India (47.30%) [9] and
public study in Italy (53.90%) [21]. The
finding, however, was lower compared to the
results reported in Cameroon (62.2%) [16]. |
| In the present study, majority of respondents
gave reasonable answers to the questions
about causes of epilepsy. The understanding
of epilepsy as a brain disease (55.8%) was
higher in this study than among similar
participants in Egypt (8.5%) [19], Cameroon
(18.5%) [11] and India (50.4%) [9]. The result
was less than the previous study in Cameroon
[10], 86.1% of population believed that cause
of epilepsy is brain disease. The proportion of
respondents who thought that epilepsy is a
hereditary disease (23.60%) was higher than
among similar respondents in Egypt (7.9%)
[19] and Cameroon (12.5%) [11].
Furthermore, evil spirit (33.24%), punishment
for wrong doing (17.6%) and witchcraft
(9.6%) were among causes of epilepsy cited
by respondents. The prevalence of this belief
was higher compared to studies in Cameroon
[11], punishment for wrong doing (1.1%) and
witchcraft (3.3%); and Egypt [19] punishment
for wrong doing (2.6%). Results indicated that
though most of the students were aware of
epilepsy, their knowledge of the causes of
epilepsy was poor. This shows that traditional
beliefs and misconception about causes of
epilepsy are still deeply rooted in these
students and hence need to be addressed in both the student and society through meaning
full education. |
| Up to 51.6% of respondents thought epilepsy
was contagious, with the most incriminated
mode of transmission being physical contact
(45.88%), saliva (14.56%) and waste gas
(12.64%). A similar study in Cameroon [11]
indicated that waste gas (27.5%) and saliva
(14.2%) were among the mode of
transmission; while a community based study
in Cameroon [10] showed also saliva (21.2%)
and waste gas (13.3%) as common mode of
epilepsy transmission. This misconception of
the transmission of epilepsy is nurtured by
anecdotal reports of traditional practices in the
community that contributes significantly to
epilepsy- associated stigma in the student. As
far as the manifestation of epilepsy is
considered; foaming from mouth (69.2%),
convulsions (63.46%), changes in behavior
(19%), and screaming (17.86%) were cited as
manifestations of epilepsy. These were also
the most frequently cited signs of epilepsy in a
study among similar respondents in Cameroon
[11]. Only 14% of participants did not know
any symptoms of epilepsy which was also in
accord with a survey of Cameroonian high
school students [11]. |
| Findings showed that there is still a need for
more widespread dissemination of information
to improve general knowledge about epilepsy.
This is especially true with respect to
management of a seizure. Even though 59% of
students knew that a person having seizure
should be moved to safe place, they had other
misunderstandings regarding management of
epilepsy. The majority of students (81.9%)
would provide match stick smoke, force some
medicine down the patients’ throat (27.2%),
put their head in a toilet hole (11.3%), hold or
tie them down (14%) and significant
proportion would, however, act dangerously
by putting a spoon/cloth in the patient's mouth
(22.8%) as a first aid measure. Another study in Cameroon [11] indicated that putting a
spoon/cloth in the patient's mouth (41.6%),
holding them down (13.4%) and putting their
head in a toilet hole (11.7%), were reported as
a first aid measure. These practices,
particularly providing “match stick smoke”,
have their roots in cultural beliefs and
misconceptions with respect to epilepsy in the
society. The willingness to give some form of
first aid treatment to a patient in crisis
indicates that if these students are well
educated on epilepsy on what to do when
faced with a patient in seizures, they would be
ready to respond appropriately. |
| Participants would recommend a Holy water
(70.33%), medical doctor (64.01%),
traditional healer (44.78%), prayers (32.14%)
and witch-doctor (18.41%) as sources of
treatments for epilepsy. This perception may
be in line with beliefs that epilepsy is due to a
spell or spirit possession. Such misperception
was in agreement with a study done in
Cameroon [16] which God’s help (67.3%) and
physician (64.4%) were recommended for
treatments of epilepsy. In college based study
in Cameroon [7], about 67.4% recommended
physician and 22% suggested prayers.
Another work in Cameroon [11] also
recommended a medical doctor (65.7%) and
prayers (29.7%) as sources of treatments for
epilepsy, while 8.6% would recommend a
traditional healer. These findings indicated
that participants would readily recommend
divine help and a witch-doctor for
managements of epilepsy ties in with their
belief in a supernatural cause. This justifies
the combination of either prayers (Holy water)
or traditional indigenous therapies with
modern treatment. These results emphasize
the need to train medical personnel on
management of epilepsy and to develop a
collaborative approach with traditional healers
and faith based organizations providing care
to PWE [11]. |
Conclusion |
| These findings suggest that knowledge of the
causes of epilepsy is vague among a
considerable proportion of preparatory school
students. In particular, there were an
unexpectedly large proportion of students who
believed that epilepsy is contagious or a form
of insanity and caused by an evil spirit or
punishment for wrong doing. It seems that
majority of the students would provide a
match stick smoke for a person having an
epileptic seizure. The low level of knowledge
and misconceptions found among students
demonstrates that the need for educational
program. |
Ethical approval |
| We confirm that we have
read the Journal’s position on issues involved
in ethical publication and affirm that this
report is consistent with those guidelines. |
Conflict of interest |
| None of the authors has
any conflict of interest to disclose. |
Author contributions |
| Tesfaye Wolde
conceived the study and designed the study;
Mulat Degefa collected and analyzed the data,
Gebremedhin Solomon analyzed the data and
drafted the article. All authors contributed
significantly to improve the scientific content
of the article and approved the final version. |
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