Attitudes of rural people in central Ethiopia toward epilepsy

Sot Scr Med Vol 32, No 2, pp 203-209, 1991 0277-9536’91 S3 00 + 0 00

Pnnted m Great Bntam All nghts resewed Copynght c 1991 Pcrgamon Press plc

ATTITUDES OF RURAL PEOPLE IN CENTRAL ETHIOPIA TOWARD EPILEPSY

RJZDDA TEKLE-HAIMANOT,‘* MEKONNEN ABEBE,’ LARS FORSSREN,’ AYELE GEBRE-MARIAM,’ JAN HEIJBEL,~ G~STA HOLMGRRN~ and JAN EKSTED?

‘Department of Internal Medicme, Addls Ababa Umverslty, ZDepartment of Neurology, UmeP Umveraty, jDepartment of Paedratncs, Addls Ababa University, P 0 Box 1176, Addls Ababa, Ethlopla, ‘Department of Paedlatncs, Umei University and ‘Department of Chmcal Genetics, UmeH Umverslty.

S-901 87 Ume& Sweden

Abstract-In the famung community of the sub-dtstnct of Meskan and Mareko In central Ethlopla, where the prevalence of epilepsy IS known to be 5 2/1000, a door-to-door survey was undertaken m 1546 sampled households to find out pubhc attitudes to epilepsy Nearly 64% of the respondents were m the age group of 14-50 years, and 58 6% were women The majonty (86%) were ilbterate, and 94% had Incomes of a subsistence level, 89% had heard or witnessed seizures Tradltlonal views on the association ofevil splnts and superstttton was prevalent By 45% of the interviewees, the disease was beheved to be contagrous through physxal contacts during an attack Although there was sympathetic concern m the commumty for the person suffermg from epilepsy, negative attitudes were strong on matnmomal assoclatlons. sharmg of accommodation and physxal contacts Hrlth affected persons, particularly when there were obvious signs and frequent attacks by setzures The study demonstrates that the rural community has very poor knowledge of the causes and nature of epilepsy, and this has resulted m social depnvatlons and at times, reJectIon of the sufferers

Key words-epilepsy, knowledge, attitudes, ‘evd spmt’, Afnca

INTRODUCTION

In African communmes there are widespread beliefs that epilepsy IS due to possession or bewnchment by evil spu-ns or the devil, and m some of the cultures the spint 1s beheved to be those of ancestors [l-6] There are also behefs that the transmtsslon of the disease is by physical contact, such as by sahva [7-91. In central Uganda, epilepsy is attnbuted to the presence of a hzard m the brain, and epilepttc falls occur whenever the lizard moves [lo] Therefore, attitudes toward eptlepsy and the person with epl- lepsy m mdlgenous Afnca are mvanably unfavourable, because they reflect the mythical behefs about the disease

As m Afnca at large, excludmg mfecttons of the central nervous system, epilepsy IS the most common neurological disorder m Ethiopia [1 I] Besides tts high prevalence, epilepsy, hke leprosy, carnes a strong social stigma, and those afflicted by n can become ostracized by the society While Giel has reported on the social consequences of the disease in Ethtopla [ 121, there has been no detailed study of pubhc attitudes to tt This study addresses itself to this question.

MATERIALS AND METHODS

Between 1986 and 1988 an epldemtologlcal study of neurological disorders was carned out m the rural sub-distnct of Meskan and Mareko (population 18 1,883) covering an area of 1500 km* m the Shoa Admunstrative Region of central Ethiopia The town

*Address correspondence to Redda Tekle-Halmanot, P 0 Box 4147. Addls Ababa, Ethiopia

of Butajtra IS the admmlstrattve centre of the sub- distnct At the time of the survey, the sub-dlstnct comprtsed 6 urban dwellers* assoctatlons and 82 peasant assoctattons There was a total of about 40,000 households in the sub-district, with an average family size of 4.5 members

A 30% random sample of the peasant associattons was taken and all the urban dwellers’ associations were surveyed The study thus included 25 of the 82 peasant associations and all the three towns withm the sub-district, involving 60,820 mhabrtants m 13,460 households. Eighty-me per cent of the m- habitants were from the Gurage ethnic group, while the rest were from the Kembata, Oromo, Amhara and Tigre ethmc groups

Followmg the Ethiopian Agrarian Reform Procla- mation of 1975, farmers were orgamted mto peasant associauons while the inhabitants of the towns and cities were brought under the urban dwellers’ assoct- auons Thus, when the study was started, 17 of the 25 peasant associations selected for the survey were villagized into nucleated settlements and 4 more got vtllaglzed dunng the study penod The remammg 4 villages, all m the highlands, were St111 not vtllagtzed at the end of the survey because of then heavy dependence on the onset (Enset ventncosum) diet The enset, IS a false banana which takes about 5 years to mature for consumption The staple diet of the Gurage people, kocho, ts produced from the core of the underpart of the plant

In the survey, tramed lay health-workers were employed as enumerators to admmister specially designed questlonnalres to detect neurological symp- toms and signs and used m a commumty-based study m the same area (1 I]

203

204 REDDA TEKLE-HAIMANOT et al

Concomitant with this exercise, the lay health workers were also tramed to interview adults, mamly heads of households, on their opmlons of common neurological disorders that may carry slgmficant negative and unfavourable attitudes m the community These disorders were mental retardation, physl- cal handicap, leprosy and epilepsy. In order to avold confusion, every fourth household of all the ran- domly selected villages m the study area was mter- vlewed on each of the disorders This resulted m the mcluslon of 1546 households for the epilepsy attltudl- nal survey

The enumerators were secondary school graduates who came from the villages (8) and the town of Butajlra (5) There were 11 males and 2 females with ages ranging from 26 to 3 1 years Ten belonged to the Gurage and one each of the Amhara, Kembata and Oromo ethnic groups All were able to speak at least one of the Gurage dialects

The questionnaire used for the study IS shown m the Appendix The questions were made as simple and stratghtforward as possible and translated mto Amhanc, the Ethiopian official language To avold bias and get as much mformatlon as posnble, the questions were constructed to encourage open answers In order to ensure a umformlty of response during the door-to-door mtervlews, the enumerators were instructed how to translate the questlons mto the language of the respondent m a standardized manner Before the admmlstratlon of the questlon- nalre, the alms and purpose of the study was clearly explained to the respondents There was a 94% participation m the interviews.

The chl-square test (with Yates’ correction) was used for test of independence between two vanables

RESULTS

Different names were used for epilepsy m the community The most common were azurit, zewur, tchot, eldoa and enquhyet m the different Gurage dialects Gegebdo and tchote were used in the Kembata and Oromo languages respectively All the terms refer to the ‘spmnmg’ effect and/or the accom- panying fall of the disease, as perceived by the respondents In the Trgre language it IS called as heman barla (the slave’s Illness) Yemitil beshlta (the falling sickness), as It 1s commonly known m the

Table I Charactensttcs of reswndents

Charactenstxs No %

AIF (yr)

Sex

Rebgton

Mdrttal status

Level of education

occupation

14-25 26-35 36-45 46+

Male Female

Chnstlan Moslem

Mamed Wtdow/wtdower Smgle Divorced

llhterate Read and wnte Grade 2-8 Grade 9 and above

206 14 2 377 26 0 338 23 3 531 36 5

606 41 6 850 58 4

674 46 3 781 53 7

1147 78 8 162 II 2 76 52 70 48

I240 85 2 120 82 75 52 21 14

I267 87 0 75 51 37 25 29 20 27 19 I3 09

Farmer Housewfe Merchant Labourer Dependent Student Government employee 9 06

official language, Amhanc, was used by only 10% of the respondents

As summarized m Table 1, 63 5% of the respondents were m the age range of 1445 years Their major occupation was farming (86 7%), and the men were often m the fields when the lay heath-workers made their door-to-door vlslts Thus, there were more females (58 4%) among the respondents There were slightly more Muslims (53.7%) than Chnstlans The majority of the respondents (78 8%) were mart-red, with children; 85% were llhterate (those who could not read or wnte), and those that were literate obtained their skill from church and regular schools as well as through partlclpatlon m the literacy cam- palgn Only 1 4% had secondary school education The vast myonty, 94% had incomes at subsistence level (U S. 120 dollar per annum) and only 1% could be classified as well-to-do

As shown rn Table 2, 89% of those interviewed stated that they had heard or read about epilepsy, 86% had witnessed a seizure attack during their hfetlme, 14% admitted that they had a family member with epilepsy.

Table 2 Pubhc response to attltudmal questtons

Answer

Response Yes No Don’t know Questton number (%) (%) (%)

Have heard or read about ep~lcpsy~ you 1441 89 0 II 0 - Have seen someone wth seizure attack? you 1338 86 2 13 8 - Do have a family member wth epdepsy? you I332 I4 3 85 1 - Is ep~lcpsy heredrtary’ 1274 49 95 I -

Is epdepsy contagrous? 1269 446 53 4 20 Is epllcpsy a form of msantty? 1265 I9 98 I - Would employ an epileptic you I254 25 0 75 0 -

Are you wlhng to work wth an cplleptlc’ I257 52 7 46 I I2 Would house a wth epdepsy under pressure? you person 1260 67 2 32 2 06 Do you thmk a person wth epdepsy should be hldden from publtc? I262 I8 98 2 -

Would you allow an cplleptic to use pobhc transport? I262 90 I 91 08 Would shake hands wth an eprleptlcq you I262 90 8 92 - Would have a wth cpllepsy as a mend? you person I259 40 6 58 3 -

Do you object to your own child assonatmg wtth persons wth eptlepsy’J I254 65 I 33 9 -

Atutudes of rural people an central Ethlopla toward eprlepsy 205

Tdble 3 Questmn would you allow someone from your famtlY to marry a person wtth eptlcpsy’

Result (I 257 responses)

Yes Wtll not tolerate (reason not spectficd) No. the eptleptx IS unable to earn a hvtng No, contagtous No. gcnettcally unadvtsable Don’t know

%

26 0 33 6 23 3 II 8 39 I4

Only 5% consldered epilepsy hereditary, and a very small number of the mtervtewed (2%) thought rt to be a form of msamty When asked If eptlepsy was contagious, 45% of those that responded answered m the affirmative Of these, 98% considered contact durmg a convulstve attack to be the most important method of transmrsston Any type of contact with a person having epilepsy without a convulstve attack played only a minor role m the transmtssron of the disease to a healthy person, according to the respondents

When asked tf they would employ a person wtth epilepsy, 75% responded that they would not How- ever, 52 7% were wlllmg to work with a person suffering from eptlepsy Srxty-seven per cent stated that they would give restdenttal accommodatton only If they were under pressure to do so

Agreement to the use of public transport by a person with epilepsy was gtven by 90%, and a nearly equal percentage were wtlhng to shake hands wrth someone havmg the disease, 41% were willing to be friends wtth persons with eptlepsy, although only 4 6% of the respondents had a person wrth epilepsy as a frtend at the time of the survey When asked tf they would allow then own children to play wrth another child having epilepsy, 65% responded that they would not obJect However, we were told by about 50% of the respondents that they would instruct then children to run away from then play- mate If he/she was to develop a convulsrve attack

Only 26% were wtlhng to allow someone wtth epilepsy to marry a member of then family Behef that the person with eprlepsy was incapable of bemg gainfully employed and generatmg an mcome to support a famtly was stated by 17%, while 11 8% gave the contagious nature of the disease as a reason for dtsallowmg marriage with an epllepttc (Table 3)

Nearly 52% of the response regardmg knowledge on the cause of eptlepsy belonged to the category ‘don’t know’ Of the affirmatrve answers, the favoured opmion was evil spurts (30%) Etght per cent believe that epilepsy was a curse or pumsh- ment from God Very few of those mtervrewed thought of natural causes such as accidents and mfecttons (Table 4)

Trble 4 Questton do you thtnk you know the cause of epdepsy~

Result ( 1270 responses) %

Don’t know 51 6 Ewl sptnt 30 0 Pumshmcnt/curv from God 80 Physlcrl contact wth d convulsmg person 50 Born wnh n 50 Febrde dlsedse 02 Accident 01 Ltghtenmg 01

Table 5 Questton do you know what to do for someone havmg a convulswe dttack/fit?

Result (I265 responses) o;o

Don’t know 88 5 Protect/guard patlent 57 Chve herbal medxtne 27 Gwe holy water 09 Hanged man s rope 09 Conventional medlcrne 09 Strike match near nose 04

Among the respondents, 89% did not know what care to gave to a person with eptlepsy during a setzure attack About 6% stated that they would guard and protect the person having the convulston from hurt- mg himself Interestmgly, 12 persons (0 9%) gave the mformatron that tying a hanged man’s rope whtch had been used for sutcrde had a therapeuttc effect during an attack Herbal medicines and wearing rehgtous charms on the body were also mentioned as possrble treatment by 2 7% Modern drugs were the least favoured form of treatment (Table 5)

When asked tf they would consider a person wtth eptlepttc fits well controlled cured from his Illness, 66 7% answered in the affirmattve, whtle 28 8% stated that the dtsorder was incurable

Regarding the questton of how soctety should care for the eprlepts, only 54 4% had opmtons About 34% responded that society should gave alms to the sufferers, 16 4% thought that medtcmes should be provided Very few people saw the role of government m canng for the persons with eprlepsy Two respondents beheved that arnmal sacrtfice to evtl sptnts was necessary (Table 6)

The attttudmal findmgs m this study were srmtlar between men and women, and between followers of either the Chnsttan or Muslim fanh Older respondents (above the age of 50 years) had stgmficantly more negative attnudes to epilepsy and person with epilepsy than the respondents under 40 years of age Surpnsmgly, those respondents who had family members with epilepsy drd not stgmficantly differ m their attitudes to the majonty who did not have affected family members

When the effects of education was analysed, tt was found that there were no stattsttcally stgmficant differences However, the number of those wtth secondary educatton was too small to draw reasonable conclusions

Analysts of the data comparing rural to urban respondents (Table 7) revealed that both groups had similar attitudes on mhentance of eptlepsy and mar- nage to a person wtth eptlepsy What was surpnsmg, though, was the significantly htgher percentage of urban respondents who thought epilepsy to be contagious and were unwrlhng to allow then children to

Table 6 Questton how should soctety take care of persons wtth epdepsy’J

Result ( I2 I4 responses) %

Don’t know 45 6 Gwe alms 34 2 Medtcme IO be prowded 164 LCI own famdy help 16 Government to take care I5 Pray for them 05 Gwe wcrlfices to the spwts 02

206 REDDA TEKLE-HAIMANOT et al

Table 7 Attitudes toward eptlepsy among urban and rural mhabt- 1ants

QUeStIOn Urban Rural P value

Causes of epdepsy Don’t know 85 7 79 9 Evtl spwt 124 176 0 II Other 19 25

lnherltance Inhertted 50 49 0 86 Not mhented 95 0 95 1

Contagiousness Yes 40 4 30 0 001 No 57 1 68 0 Don t know 25 18

Attitudes to marriage Poslllve 25 0 26 0 0 94 Negatwe 71 2 12 9 Don’t know 38 II

To work wtth eplleptlc Postt1ve 70 2 539 <OOOl Negattve 25 5 45 5 Don’t know 43 06

Allow own child to play wth eptlepttc Yes 50 9 67 7 0001 No 45 4 32 7 Don t know 37 06

Employ eptleptlc Yes 23 0 25 3 0 60 No 77 0 74 7

Suggested treatment TradItIonal 37 01 Holy water 19 02 Conventtonal 88 06 <OOOl Don’t know 85 6 99 I

play wtth persons with epilepsy On the other hand they were more postttvely mchned to work wtth a person havmg the disease As wtth educated respondents more of the urban inhabitants were willing to use modern medtcme for the management of the dtsease

DISCUSSION

People m rural commumttes m Afnca percetve epilepsy as a feared and dreaded disease because of tts alleged assoctation with evil sptrtts and witchcraft. As a result of these traditional behefs and supersti- tions, the person with eptlepsy m Africa suffers from soctal deprtvatton and premdice In Ethtopta, as m other Afrtcan countries, the person wtth epilepsy faces sertous social stigmatization and may even be ostracized by society

Many who have read the very descrtpttve reports of Giel on the eptleptic outcast m Ethtopta [I21 have been led to beheve that all or most Ethioptans wtth epilepsy are outcast and banished to their fate m churchyards and cemeteries This survey mdtcates that the attitude ptcture towards epilepsy m rural Ethiopia is not as pronouncedly negative as de- scribed The spectai situation where rejectton does occur ts when an eptlepttc has uncontrolled seizures resultmg m severe burn deformities and/or profound mental retardation [13] In thts respect, the situation m Ethiopia 1s not different from that m other African countrtes For Instance, writing about Tanganyrka m 1959, Smart [4] has clearly tdenttfied the “demented and anti-social groups of eptleptics” that constituted 12% of admissions to mental hospttals

As evtdenced by this study there IS also a ‘ttme- hmtted’ form of reJectton durmg setzure attacks Thts 1s exemplified by the fact that 50% of the respondents m thts study admitted that they would Instruct thetr chtldren to run away from playmates who develop seizure attacks whtch points to the behef of respondents on the contagtous nature of the dtsorder

The response of the mtervtewees from the rural commumty during our recent survey has succeeded m regtstermg the prevalent behefs on and attttudes toward epilepsy Concermng the background of the commumty studted, it should be noted that the charactensttcs that were most relevant to our attttud- ma1 study were the high tlhteracy rate of 85%, and the prevalence of epilepsy m the commumty (5 2/1000), where the maJonty of those suffermg from eptlepsy were not receivmg anttconvulsant treatment Because of the close soctal contacts and mteracttons wtthm the communrty, the majortty of the respondents to the door-to-door mtervtews had wttnessed seizure attacks, but were not aware of the causes of the dtsease

Although epilepsy was stall feared and dreaded m the rural community studied, we were impressed by the fact that the respondents showed reasonable understandmg and tolerance to the person with eptlepsy, parttcularly tf the sufferer dtd not exhtbtt aggressive tendenctes and dtd not have other stgns of affectton by the dtsease There was a parttcular sympathy for children wtth the dtsease, both from parents and the general pubhc It IS mterestmg that more people (65%) were wtlhng to allow then chtldren to play wtth peers having eptlepsy, compared to the experience of Dada and Odeku [14] m Nigeria, where 84-93% of respondents m two studies opposed such an assoctatton

In addttton, 98% of the respondents m this study dtd not believe that the person wtth epilepsy should be concealed from the public, and only 2% thought the disease to be a form of msamty The great maIortty of the respondents stated that they would allow the person with epilepsy to use pubhc transport, and were also wtlhng to shake hands with those known to have eptlepsy About half were also wtllmg to work with such a person

On the other hand, the lack of knowledge about epilepsy m the populatton studied came out clearly m this study The myonty did not know what to do for a person with eptlepsy durmg a convulsive attack Some of those who had opuuons suggested mdige- nous approaches aimed at neutrahzmg or appeasmg supernatural causes based on mythical views of evil spirits and bewttchments

Inasmuch as obvtously negattve attitudes were concerned, almost half of the respondents thought eptlepsy to be contagtous This would explam why many Ethiopians wtth epilepsy present with severe bums, because onlookers are afraid to pull them out of domestic fires Stmilar views on the transmittabthty of eptlepsy by direct physical contact with the person with epilepsy or his secretions have been reported from Tanzama [7], Uganda[8] and Nigerta [9]

There was also a strong stand on matrimomal associatton with a person havmg the disease 74% disapproved of it Respondents gave accounts of cases where husbands divorced thetr wives, or waves

Attitudes of rural people in central Ethiopia toward epilepsy 207

ran away, on discovering that the other partner was suffermg from eptlepsy

Respondents were found to be negattvely mchned to giving restdenttal accommodation to the person wtth eptlepsy Surprismgly, only 30% of those respondents havmg a relative with epilepsy expressed their wtlhngness to accommodate a person with eptlepsy In addition, nearly 60% of the mterviewees were reluctant to have a person with epilepsy as a frtend

As m other parts of Africa [2, 151, we knew that m Ethtopta native medicmes m the form of herbal remedies, holy water or charms to wear, given by faith healers or spiritual healers, were commonly used m the commumty we studied for the alleged purposes of treatment, preventton and cure of epilepsy How- ever, this was not evidenced m this study We think thts may be due to a tendency of respondents to htde the mformation, least they are blamed as old- fashioned and superstitious

The vtew of the rural respondents to soctety’s responstbihty to the care of the eptleptic was mterestmg They saw giving alms an important contnbutton, to the epilepttc and very few expected the government to play an acttve role, although 16 4% thought the provision of medicme for the affected was required for the care of the person with epilepsy

Dada m 1968 showed that attitudes vaned con- siderably m different parts of Nigeria [16] We may therefore question whether our attitudmal findings m the rural central region of Ethiopia are representattve of vtews m the country as a whole Although there may be some vartations and devtations, we Judge from our experience m other rural areas of Ethiopia that our findmgs are fairly representative of the predominant attitudes on the disease This IS further supported by the fact that, although the community we studied was predommantly of the Gurage ethmc group, other maJor ethmc sectors of the country were also represented m it

Iivanamen et al [ 171 have clearly shown m their study that respondents’ acquarntance with an epilepttc person, educatton level and age were important factors m acquiring and mcorporatmg useful mformatton about epilepsy Caveness et al [18] have also confirmed that the most favourable opuuon about eptlepsy was from the better educated, better employed, young and urban members of the population Among the population we studied, urban people had more negative attitudes toward epilepsy than rural The relative negattve attitudes of the urban respondents may probably be due to their frequent exposure to the very unfortunate persons with uncontrolled seizures exhtbitmg unstghtly burns and demented states. Such mdividuals are often seen in the streets of the towns and the compounds of worship places as beggars

Epilepsy is a maJor public health problem m developmg countries Besides the disease itself, the problems of the epileptic anywhere m the world are compounded by the difficulties commonly encoun- tered m schools and employments These problems are particularly serious m Africa, as shown by the studies of Dada and Odeku [14] and Danesi [ 191 tn Ntgerta In the context of the Ethiopian rural population, thts study points to the need for mtensive

efforts to dissemmate correct mformation about epilepsy through every means possible, together with an improved health care dehvery system which would provide and guarantee adequate and contmuous supply of cheap anticonvulsants wtthm the extstmg basic health servtces

It IS thus fatr to expect that the nation-wide hteracy campatgn which IS vigorously bemg propagated in Ethiopia at the present time wtll contribute sigmfi- cantly to the future national health educational efforts, creating increased awareness and helpmg to eradicate behefs and archatc tradittonal practices which typically predommate the attitudes of the rural population toward epilepsy m Ethiopia In this respect, the present efforts on the part of those that care for persons with epilepsy m the production of health educattonal materials and programmes on the mass media to mform those that suffer from the dtsease and the general public should be sustamed and developed Needless to say, primary health care has to be developed m order to prevent the common causes of epilepsy, such as complicated obstetric conditions and central nervous system mfections

The curriculum of tramrng of medical students, nurses and other health personnel responsible for primary health care IS bemg modified to mclude special onentattons on the diagnosis and close follow up of persons with epilepsy As we observed m this study, the rural population IS quite receptrve and apprectattve of the health education on epilepsy given by our enumerators They also follow very carefully the mstructtons on the anticonvulsant therapy These posttive attitudes of the rural population should be exploited further m the efforts to change the wrong behef and practices pertauung to epilepsy

Acknowledgements-The study was funded by the Swedish Agency for Research Cooperation with Developmg Countries (SAREC) and the Addis Ababa Umverslty We also thank the Ethiopian Science and Technology Commas- slon for Its Invaluable assistance We are particularly m- debted to our lay health-workers who made the interviews with devotion We gratefully acknowledge the enthusiastic and positive participation of the commumty we studled

REFERENCES

Haddock D R W Neurological disorder m Tanzania J trop med Hva 68. 161-166. 1965 Hurst L A, Reef H E and Sachs S B Neuropsychi- atnc disorders in the Bantu S Afi med J X,750-761,

1961

Levy L F , Forbes J 1 and Parlrenyatwa T S Epilepsy m Africans Cent Afr J h4ed 10, 241-249, 1964 Smartt C G F Epilepsy m Tanganylka and Its treatment with premldone (myosohne) E Afr med J 36, 91-98, 1959

Bllhngton W R The problems of the epdeptlc patient in Uganda E Afr med J 45, 563-569, 1968 Cardozo L J and Pate1 M G Epilepsy in Zambia E Afr med J 53, 488-493, 1976 Jrlek-Aall L, Jllek W and Miller J R Chmcal and genetlc aspects of seizure disorders prevalent m an lso- lated African population Epdepna 20, 613422, 1979 Billinghurst J R , German G A and Orley J H The pattern of epilepsy m Uganda Trop Geogr Med 25, 226-232, 1973 Osuntokun B 0 and Odeku E L Epilepsy m lbadan Nlgerra Afr J med Scr 1, 185-200, 1970

208 REDDA TEKLE-HAIMANOT et a/

10

II

I2

13

14

15

Bennett F J Custom and child health m Buganda, V 16 conceptsofdlsease Trop Geogr Med 15,148-lS7,1963 Tekle-Halmanot R, Abebe M , Gebre-Marram A, Forsgren L , Holmgren G , HeiJbel J. and Ekstedt J Commumty-based study of neurologtcal disorders m 17 rural central Ethiopia development of a screening Instrument Ehop med J 28, 123-127, 1990 Glel R The epileptic outcast E Afr med J 45, 27-31, 18 1967 Gel1 R The problem of epilepsy m Ethropla Trop Geogr Med 22, 439-442, 1970 Dada T 0 and Odeku E L Epilepsy m NIgerIan 19 patient, a review of 234 cases W Afr med J 15, 153-163, 1966 Danesl M A Pattent perspectives on epilepsy m a developing country Eprlepsm 25, 184-190, 1984

Dada T 0 Epllepsia m Ntgena A study of the incidence, pathogenesls, chmcal patterns and soc~o- psychologlcal problems of epilepsy Thesis, Bristol. 1968 Itvanamen M , Uutela A and Vllkkumaa I Public awareness and attitudes toward epilepsy m Fmland Epdepsm 21, 413-423, 1980 Caveness W F , Houston Merritt H and Gallup G H A survey of pubhc attitudes toward epilepsy m 1974 wtth an mdlcatlon of trends over the past twenty-five years Eprlepsla 15, 523-536, 1974 Danesl M A, Odusote K A, Roberts 0 0 and Adu E 0 Social problems of adolescent and adult eplleptlcs m a developing country, as seen m Lagos, Nigeria Eprlepsta 22, 689-696, 1981

APPENDIX

Art~rude Quesilonnave

Date Farmers/Urban Assoclatlon House No Interviewer

TO BE ANSWERED BY ONE MEMBER OF THE HOUSEHOLD, PREFERABLY BY THE HEAD OR WlFE

-Name of informant Age

-Marital status Married - Single _ Divorced - Widow -

-Number of children Male - Female - Total -

-Occupation Income per month ___

-Education Ilhterate - Read and write _ Grade _

-Rehglon ChrIstIan _ Moslem _ Other _

ATTITUDES TO EPILEPSY

-Have you ever heard or read about epilepsy? Yes - No -

If yes, where?

Sex

--Is there m your language another name for a person who falls with Jerking in arms and legs and does not respond when spoken to’J

Yes - No - If yes, specify

After giving a full descrlptton of the different types of eptlepsy (Including partial and absence seizures) the enumerator tells the respondent WE REFER TO ALL THESE MANIFESTATIONS AS EPILEPSY AND THAT IS THE TERM WE WILL USE IN THE QUESTIONS TO FOLLOW

-Have you ever seen anyone who was having an eptleptlc seizure?

Yes - No _

-Have you among your relatives anyone with epilepsy?

Yes ~ No -

If yes, specify relation

-Do you know or did you know anyone else with epilepsy?

Yes- No-

-Do you thmk you know the cause of epilepsy?

Yes - No -

If yes, explam

-Do you thmk that epilepsy IS Inherited?

Yes - No -

If yes, m what way3

-Do you think that epilepsy is contaglousq

Yes - No _

If yes. how?

Attitudes of rural people m central Ethlopla toward epilepsy 209

-If yes, 1s epilepsy contagious

during the epileptic attack only _

at all times -

-Do you thmk epilepsy IS a form of insanity’

Yes - No _

-Do you know what to do with a person havmg an epileptic attack?

Yes - No -

If yes, what7

--If you have assisted a person with epilepsy dunng an attack and the attack contmues, do you know what to do next?

Yes - No -

If yes, what7

-Can a person who has had attacks be prevented from having further attacks or be made to have less attacks m the future?

Yes - No -

If yes, how?

-If a person with epilepsy has been treated and hts epileptic attacks have disappeared, will you consider him/her to be an ordmary healthy person?

Yes - No -

If no, why?

--If you had the opportunity, would you employ someone with epilepsy?

Yes - No _

If no, why?

-Are you wllhng to work with a person havmg epilepsy?

Yes - No _

If no. why’

-Would you allow your own child to play with a child havmg epilepsy?

Yes - No -

If no, why7

-What would you do If you are forced to accommodate a person with epdepsy?

-Do you have a friend with epllepsyv

Yes - No -

-WIII you be a friend of someone that has epilepsy?

Yes - No __

If no. why?

-Mdy anyone m your famdy marry someone who has epilepsy7

Yes ~ No _

If no. why?

-Are you afraid of someone who has epilepsy?

Yes __ No __

If yes. why? _

-Should a family havmg a member with epilepsy hide hlmiher from outslder9

Yes _ No -

If yes, why?

-_

-Do you think a person with epilepsy should use pubhc transportatlon3

Yes _ No -

If no. how should he/she travel?

-Would you shake hands with a person known to have epilepsy?

Yes - No -

-How should the society take care of a person with epllepsyv

At the end of the mtervlew health education on epilepsy IS given to the respondent and his/her family by the enumerator

Documents

Attitudes of rural people in central Ethiopia toward epilepsy