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Knowledge and attitudes of teachers towards epilepsy in Zimbabwe

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Page 1: Knowledge and attitudes of teachers towards epilepsy in Zimbabwe

Acta Neurol Scand 1997: 96: 133-137 Printed in U K - all rights reserved

Copyright 0 Munksgaard 1997 ACTA NEUROLOGICA

SCANDINAVICA ISSN 0001 -6314

Knowledge and attitudes of teachers towards epilepsy in Zimbabwe

Mielke J, Adamolekun B, Ball D, Mundanda T. Knowledge and attitudes of teachers towards epilepsy in Zimbabwe. Acta Neurol Scand 1997: 96: 133-137. 0 Munksgaard 1997.

Objective - As a preliminary to designing a health education programme on epilepsy for teachers in Zimbabwe, we evaluated the knowledge and attitudes to epilepsy of teachers in Epworth, a poor, high density suburb of Harare, Zimbabwe. Materials and methods - All teachers in Epworth were invited to awareness workshops on epilepsy. A questionnaire on knowledge and attitude of epilepsy was distributed to all consenting participants. Results - 165 teachers (Male : Female 1 : 1.9) responded. Of the respondents 89% had heard or read about epilepsy, while 70.6% had observed an epileptic seizure. Epilepsy was considered hereditary by 34.6%, while 12.6% thought it was a form of insanity. Only 0.6% thought evil spirits were a cause, 22.6% thought that epilepsy was contagious, 82% would allow their child to play with an epileptic child, 76% would marry an epileptic while 55.7% would employ an epileptic. The majority would accommodate an epileptic and teach an epileptic child in class. Conclusions - These positive attitudes

education and may imply that with increasing levels of formal education in the general African population, a more tolerant attitude towards epilepsy

I

' towards epilepsy by teachers may be attributed to their higher level of

I can be expected.

In many parts of Africa, epilepsy is a highly stigmatized disease which is said to be commonly regarded as a manifestation of visitation of the devil, the effect of witchcraft, or the revenge of an aggrieved ancestral spirit (1). The management of epilepsy is therefore commonly assumed to be in the domain of spiritual healers who hold out the attractive promise of a complete cure of epilepsy by magico-spiritual therapies. As a consequence of this, many patients with epilepsy reporting for the first time in a conventional hospital facility may have spent between 1 to 5 years in spiritual therapy before reporting to the hospitals where much more effective therapy may be available (2).

Epilepsy is also reportedly widely believed to be infectious, and transmissible by contact with the patient's saliva (3,4). As a result of this erroneous view, school authorities may expel a child who develops epilepsy for fear of infecting other children. An adult epileptic may lose his job, find it difficult to marry, may be shunned by friends and relatives and may become a vagabond (5).

These very negative attitudes to epilepsy can conceivably be combatted by community-based educational programmes. Teachers in primary and

J. Mielke, B. Adamolekun, D. Ball'. T. Mundanda' Departments of Medicine and 'Pharmacy, University of Zimbabwe, 'Epilepsy Support Foundation, Harare, Zimbabwe

Key words: epilepsy, knowledge; aaitudes; teachers: Zimbabwe, Africa

Or B. Adamolekun. Department of Medicine, University of Zimbabwe, PO. Box A178. Avondale. Harare, Zimbabwe

Accepted for publication April 7. 1997

secondary schools are an important target for any such enlightenment programme on epilepsy, be- cause they come in contact with epileptic children attending schools and, as key informants in society, can have an important role to play in their surveil- lance and management. They can also impart cor- rect information and knowledge about epilepsy to their pupils and to the community, albeit in an informal manner as health education for epilepsy is not a usual part of the school health curriculum.

As a preliminary to designing an extensive health education programme on epilepsy for teachers in Zimbabwe, we evaluated and now report on the knowledge and attitudes to epilepsy of teachers in Epworth, a high density suburb of Harare, Zimbabwe.

Materials and methods

The Epilepsy Support Foundation (ESF) is a regi- stered welfare organization established in 1990 with the objective of assisting people with epilepsy to improve their quality of life. One of its functions is to provide public education about epilepsy through workshops and seminars to selected groups of professionals and health promoters.

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Page 2: Knowledge and attitudes of teachers towards epilepsy in Zimbabwe

Mielke et al.

As part of a nationwide epilepsy awareness campaign organized by the ESF and targeted at teachers in primary and secondary schools, Epworth, a poor, high density suburb of Harare (population 80,000) was selected for a pilot study to determine the knowledge and attitudes of teachers towards epilepsy. We considered the teachers in Epworth district to be representative of the majority of teachers in Zimbabwe, who teach in similar schools in the rural and high density urban areas.

With the consent and cooperation of the Ministry of Education, teachers in the district were invited to awareness workshops on epilepsy. In order to involve all teachers in the district without disrup- ting the school teaching schedules, it was found necessary to conduct 3 separate workshops. At these workshops the aims and purposes of the study were explained to the teachers. A self-administered, open- ended questionnaire (11) on knowledge and attitude of epilepsy was distributed to all consenting partici- pants.

Results

Demographic characteristics

Out of a total of 210 teachers registered with the Epworth educational board, 165 teachers (82.5%) participated in the 3 workshops and responded to the study questionnaires. The response rates for each question varied from 87% to 96%.

Of the respondents 66% were aged 40 years or less (Table l), with the majority being females (male : female 1 : 1.9). Some 37.6% of the teachers were secondary school graduates, while 14% were university graduates. Most of the teachers (54%) were married, while all were Christians by religion. About 90% of the total Zimbabwean population are Christians. Some 66% of the teachers had teaching experience of less than 10 years (Table 1).

Previous knowledge and experience of epilepsy

About 89% of respondents had heard or read about epilepsy, while 70.6% had actually observed an epileptic seizure. None of the teachers had had a formal teaching or lecture on epilepsy. Seven (4.2%) respondents had observed epileptic seizures in their pupils in the class setting. Some 14.5% of respondents admitted to having relatives with epi- lepsy (Table 2).

Etiology of epilepsy

Epilepsy was considered hereditary by 34.6% of respondents, while 12.6% thought it was a form of insanity with 22.6% believing that epilepsy was

134

Table 1. Characteristics of respondents (n= 165)

Characteristics No. %

Age in years 21-30 31-40 41 -50 51 -60

Sex Male Female

Marital status Single Married Divorced Unstated

Religion Christian Other

Educational level '0' levels 'A' levels Diploma Certificate University degree Unstated

Teaching experience (years) 1-10

11 -20 21 -30

> 30

61 48 43 13

59 106

30 89 20 26

165 0

62 28 6

29 23 17

109 30 14 12

37 29 1 26 7.9

35.8 64.2

18.2 54.0 12.1 15.7

100 0

37.6 17.0 3.6

17.6 14.0 10.3

66.0 18.2 8.5 7.3

Table 2

Answer ( % I

Question Response Don't number Yes No know

Have you heard or read about epilepsy? Have you seen someone during a seizure

Do you have a relative with epilepsy? Do you know the cause of epilepsy? Is epilepsy hereditary? Is epilepsy contagious? Is epilepsy a form of insanity? Will you employ an epileptic? Will you work with an epileptic? Will you shake hands with an

Do you have an epileptic friend? Will you be friends with an epileptic? Can you marry an epileptic? Will you allow your child to play with

Are you willing to teach a child with

attack?

epileptic?

an epileptic child?

epilepsy?

161 89.4 10.6 161 707 29.3

161 145 855 159 7 93 153 346 522 131 159 226 71 1 6 3 157 1 2 3 877 157 557 443 157 796 204 157 961 3 9

155 5.8 94.1

153 75.8 24.2 154 82.5 17.5

155 88.3 11.6

155 83.2 16.8

Page 3: Knowledge and attitudes of teachers towards epilepsy in Zimbabwe

Teachers and epilepsy in Zimbabwe

contagious, including 1 respondent whose brother was epileptic. All of these believed that epilepsy could be transmitted by contact with the epileptic patient's saliva or blood during or in-between seizures.

While 93% of respondents did not know any cause of epilepsy (Table 3), 0.6% thought evil spirits were a cause.

Willingness to relate to an epileptic patient

Of the teachers, 79.6% were willing to work with an epileptic patient, while 55.7% would be willing to employ an epileptic patient as a domestic helper.

A proportion (16.8%) of the teachers would be reluctant to teach an epileptic child in their class. The main reason for this reluctance was a professed lack of knowledge about how to cope with the child's seizures if it occurred in the class setting.

Most (82%) of the teachers would allow their own child to play with an epileptic. While 88.3% of respondents did not mind being friends with an epileptic, 5.8% actually had friends that were epi- leptic. About 96% of the teachers would willingly shake hands with a known epileptic patient, includ- ing most of those who thought epilepsy to be contagious.

Of the respondents, 75.8% were willing to marry an epileptic. The main concerns given by those unwilling to marry an epileptic were worries about the risks of transmission of disease to their off- spring and worries about the burden of extra care that the diagnosis entailed.

If asked to accommodate an epileptic, 40.5% would do so unconditionally, while another 32 % would agree after seeking information about epi- lepsy management (Table 4), particularly the man- agement of acute seizures.

Management of seizures

Of the respondents, 24.9% would intervene in a potentially useful manner during a seizure attack (Table 5) , while the majority (71.4%) were uncer- tain about what to do. Most respondents (84%) would refer patients to hospital if seizures con- tinued, while 1.4% would consider referring to traditional healers (Table 6). About half (49.1 %) of the teachers believed that seizures could be reduced, with the majority thinking that drugs could achieve this (Table 7 ) .

Discussion

There are differing opinions in the literature regarding attitudes of educated persons towards epilepsy. Martin (6) reported that some prevalent

Table 3

Causes of epilepsy (response n=158) Don't know Heredity Brain disorder Excessive blood sugar Evil spirits

93% 1.3% 4.4% 0.6% 0.6%

Table 4

What wil l you do if asked to accommodate an epileptic patient? (response n=153) Agree without reservations 40.5% Agree after seeking information about epilepsy management 32% Agree, but never leave alone 11.1% Agree, but isolate patient and all utensils he has used 2 6% Refuse 9.8% Don't know 3.9%

Table 5

Do you know what to do during a seizure attack? (response n=161) No 71.4% Yes 28.6%

Useful intervention 24.9% Dangerous intervention 3.7%

Table 6

What will you do if seizure attack continues? (response n=144) Send to hospital 84.0% Wait 0.7% Consult traditional healers 1.4% Don't know 13.9%

Table 7

Can epileptic seizures be made less? (response n=147) No 39.5% Yes 49 1%

With drugs 45% With prayers 1.4% By avoiding certain foods 2.7%

Don't know 11.6%

myths about epilepsy are believed by teachers more often than the general public. Arangio (7) noted the vulnerability of professionals to preju- dice about epilepsy and the need to combat this through education.

On the other hand, it has been suggested that educated persons such as teachers may be better informed about epilepsy and therefore have a more positive attitude to it (8). Studies from India (9) and Taiwan (10) also showed that better educated people were less likely to be prejudiced against epileptic patients.

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Page 4: Knowledge and attitudes of teachers towards epilepsy in Zimbabwe

Mielke et al.

Our study appears to support the latter view by revealing many positive findings regarding Zimbabwean teachers’ attitude towards epilepsy.

For example, 22.6% of Zimbabwean teachers thought that epilepsy was contagious, compared with 46% of rural Ethiopians (11) and 60% of Tanzanian school pupils (12) in studies using a similar questionnaire.

In addition, 82% of teachers in this study were willing to allow their child to play with an epileptic child, higher than the 68% response to the same question in the survey amongst rural Ethiopians (11). A much higher proportion of teachers (76%) were willing to marry an epileptic patient com- pared with 25% of rural Ethiopians (11) and 19% of Tanzanian school pupils (12).

Similarly, 55.7% of teachers were willing to employ an epileptic, compared with 25% of rural Ethiopians. The majority of teachers were willing to accommodate an epileptic in their homes as well as teach an epileptic child in class. These differ- ences may be due to the higher level of education of respondents in our study.

Although the level of previous knowledge and experience of epilepsy in the teachers was quite high, with 90% having read or heard about epilepsy and 72% having witnessed a seizure; a considerable lack of knowledge on issues such as etiology and medical treatment was found. Thus, 12.6% thought epilepsy was a form of insanity, compared with 1.9% of rural Ethiopians (11) and 9% of Tanzanian school pupils (12).

However, while a surprising 93% could not name a cause for epilepsy, less than 1% of teachers ascribed the cause of epilepsy to evil spirits, com- pared with 30% of rural Ethiopians (11). While all the teachers in the present study were Christians by religion, 46.3% of the rural Ethiopians were Christians while 54% were Muslim. As no dif- ferences in attitudes to epilepsy were observed be- tween the rural Ethiopian Christians and Muslims (11) it is unlikely that the difference in attitudes towards the etiology of epilepsy in this study compared to that in rural Ethiopians was due to differences in religious beliefs.

A similarly low percentage of teachers in Nigeria (3.8%) thought epilepsy was caused by evil spirits, compared with 26% of their pupils with the same belief (13).

The concept that epilepsy is caused by evil spirits (4, 5) , which is central to the negative attitudes of Africans towards epilepsy; now appear to be changing in the African, possibly as a result of increasing levels of mass literacy. This may be partly responsible for the largely more tolerant views of epilepsy being recently reported in Africans (11) and also seen in this study. It may

also explain the finding in this study that only 1.4% of teachers will consider referring epileptic patients to traditional healers.

There was also an uncertainty about what to do in the management of seizures in 71.4% of teachers. Those teachers who were unwilling to associate with epileptic patients at home, work or school appeared to have that attitude mainly because of their inadequate knowledge of the acute manage- ment of seizures if they do occur. A focused health education intervention programme for teachers, emphasizing aspects of etiology and management of epileptic seizures; may therefore improve the confidence of teachers regarding epilepsy and lead to further improvement in teacher attitudes to epilepsy. Similar health education campaigns for teachers in other parts of Zimbabwe will also reinforce these observed positive attitudes towards epilepsy.

In conclusion, the more positive attitudes towards epilepsy by our sample of Zimbabwean teachers may be attributed to their higher level of education. This implies that with increasing levels of formal education in the general African popu- lation, a more tolerant attitude towards epilepsy can be expected.

Acknowledgements

We thank the Ministry of Education, Harare Region, Zimbabwe for giving us permission to work with the teachers. We also thank Plan International, Harare for funding the teachers’ workshops.

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