Knowledge , Attitudes and Practices of Schoolchildren

Towards Epilepsy in Bindura District, Zimbabwe: Implications

for school health promotion

Ignicious MurambidziJames January

Introduction • Epilepsy represents a considerable public health

affecting about 50 million people globally with more than 80% living in developing countries (de Boer, Mula & Sander, 2007)

• Treatment gaps for active epilepsy exceeded 75% in most low-income countries and less than 10% in high income countries (Meyer, Dua, Ma, Saxena & Birbeck 2010)

• Different perceptions and understanding of epilepsy, lack of prioritization, poor medical supply chain, lack of knowledge on epilepsy, stigma and discrimination all contribute to treatment gaps (ILAE,IBE, WHO 2003; Scott, Lhatoo & Sander, 2001)

Introduction• Social stigma and discrimination was reported

to be more devastating for persons with epilepsy than the seizures themselves (De Boer, Mula & Sander, 2008)

• Widespread attitudinal and institutional barriers and prejudices against PWE in education, employment, marriage and other socio economic activities (Atadzhanov et al , 2010)

Introduction • KAP studies on epilepsy among teachers

noted that teachers lack basic first aid knowledge on seizure management (Mielke, et al. 1997; Birbeck, et al. 2006; Sanya,et al 2005)

• Studies on adolescents reported little knowledge about epilepsy and seizures, and perceptions that reflected stigma (MacLeod, & Austin,2003; Austin, Shafer, Deering, 2002)

•

Study Rationale• The Demonstration Project on Epilepsy in

Zimbabwe reported high community prevalence of epilepsy of 13.3/1000 and wide treatment gap 93% (ILAE,IBE WHO, 2003)

• Poor understanding of epilepsy, beliefs in supernatural causes, stigma and discrimination notably contributed to the delay in seeking treatment, underutilization of formal health services.

Rationale • The study sought to contribute to the

knowledge base on community’s perception, attitudes, and practices on epilepsy

• Study focused on schoolchildren - reflect their communities’ present and future characteristics.

• look forward to developing culturally sensitive and effective educational materials targeting children as social change agents

Study purposeAim - obtain baseline data on the knowledge,

attitudes and practices of schoolchildren with respect to epilepsy

Objectives• To assess school children’s knowledge of

epilepsy • To describe the attitudes and practices of school

children with respect to epilepsy. • To discuss the implications of the prevailing

knowledge levels, attitudes and practices on the education and management of epilepsy in Zimbabwe.

Methods• A total of 523 school going children from three

secondary schools in Bindura District Mashonaland Central Province, Zimbabwe

• Multi-stage sampling was adopted• The subjects responded to a self administered

questionnaire in either English or Shona (local translation) language.

• 14-item questionnaire was adapted from a study among secondary school children Cameroon, in 2010 (Njamnshi et al, 2010)

• Medical Research Council of Zimbabwe (IRB) reviewed and approved the study

Results

Sex 229 females 282 males

Age 127 (12-14 yrs) 262 (15-17yrs) 124 (18yrs)

Mean age 16 years (sd 2)

Level 202 (F 1-2) 226 (F 3-4) 69 (F 5-6)

Location 174 (Rural) 218 (urban) 131 (CFA )

ResultsFamiliarity with epilepsy• About 87% had heard about epilepsy.• The primary source of information were friends

and school (54.7% and 51.4% respectively). • Up to 63% knew someone with epilepsy while

55.04% had witnessed a seizure.• Participants from rural and commercial farming

areas were likely to know someone with epilepsy or had witnessed a seizure (P = 0.001)

Results Knowledge about epilepsy• There was patchy information on the causes

of epilepsy with 28% correctly identifying epilepsy as a brain disorder

• 26% reported not knowing the causes of epilepsy.

• A number of misconceptions were reported on the causes of epilepsy which included, blood disorder (29%), witchcraft (18%).

• No significant differences between knowledge and age, school location and religion

ResultsPractices• On epilepsy first aid, 47% would call for help, 46%

would take the person away from danger, 34 % would put something soft under the head for protection

• However harmful practices were also common with 17% reporting putting a spoon or cloth in the mouth, 16% pouring cold water and 16% reporting physical restraining

• Correct practices were significantly related to age (18+, p= 0.044 ) education (upper level, p=0.002) and school location (urban, p=0.039)

Results - Attitudes • Most of the participants had positive attitudes

toward persons with epilepsy • Upon knowing someone has epilepsy, 47%

reported that will treat him/ her as before.• 51% reported that they would relate more closely

and learn more about epilepsy.• Respondents reported having no objections to

their children either associating (62%) or marrying (64%) people who sometimes have seizures or fits.

• About 80% believed epilepsy is not a hindrance to education.

Discussion • Participants were familiar with epilepsy, a

result which has also been reported in other African studies (Ndoye, et al. 2005; Njamnshi, et al. 2009)

• This could be attributed to the high prevalence of epilepsy in the region

• Peers (54.7%) and school (51.3%) were the main primary sources of information thus educational interventions targeting peers and school teachers could be more effective

Conclusion • Where, when, and how can children, people

with epilepsy and their families receive information???

• Extensive one-on-one from health care providers have practical challenges (Gilliam et al., 2009;)

• On delivery of information to young people, Lewis et al. (2010) found that this population wanted to receive information in an age-appropriate format and not during clinic visit

Conclusion Way forward• Peer driven programmes can be a powerful

and effective strategy to educate and reduce stigma.

• Engage youths in the development of campaigns to increase efficacy.

• Employ multifaceted approaches, including edutainment, peer education, strengthening school health promotion and media

Study Limitations• Study was conducted in one district out of the

65 districts in the country. Given the diverse socio cultural differences, generalisation of study findings are limited

• The quantitative nature of the study using structured questions with yes or no answers does not permit exploration of the reasons why the respondents hold particular views about epilepsy.

References • Atadzhanov.M, Haworth.A, Chomba.E.N, Mbewe.E.K, &

Birbeck.G.L; (2010), Epilepsy associated stigma in Zambia: What factors predict greater felt stigma in a highly stigmatized population?; Epilepsy & Behavior 19, 414–418

• Austin JK, Shafer PO, Deering JB. ( 2002) Epilepsy familiarity, knowledge, and perceptions of stigma: report from a survey of adolescents in the general population. Epilepsy & Behaviour 2002;3:368–75.

• Birbeck, GL., Chomba E., Atadzhanov M., Mbewe, E., Haworth, A., 2006; Zambian teachers: What do they know about epilepsy and how can we work with them to decrease stigma?, Epilepsy & Behavior 9 (2006) 275–280

References

• de Boer, H.M., Mula., M & Sander W.S, 2008, The global burden and stigma of epilepsy, Epilepsy & Behavior 12 540–546

• Gilliam, F., P. E. Penovich, C. A. Eagan, J. M. Stern, D. M. Labiner, M. Onofrey, G. L. Holmes, E. Mathis, and J. Cramer. 2009. Conversations between community-based neurologists and patients with epilepsy: Results of an observational linguistic study. Epilepsy & Behavior 16(2):315-320.

References • ILAE/IBE/WHO (2003) Global Campaign against Epilepsy.

Out of the Shadows. Geneva• Leonardi M, Ustun T. The global burden of epilepsy. Epilepsia

2002;43 (6):21–5.• Lewis, S. A., J. Noyes, and S. Mackereth. 2010. Knowledge and

information needs of young people with epilepsy and their parents: Mixed-method systematic review. BMC Pediatrics 10:103.

• MacLeod, JS and Austin, JK., (2003) Stigma in the lives of adolescents with epilepsy: a review of the literature, Epilepsy & Behavior 4 (2003) 112–117

• Meyer A., Dua T., Ma J., Saxena S. & Birbeck G., 2010, Global disparities in the epilepsy treatment gap: a systematic review, Bulletin of the World Health Organ 2010;88:260–266

References• Njamnshi A. K. et al, (2010) Knowledge, attitudes and practice

with respect to epilepsy among secondary school students in the Kumbo West Health District - North West Region- Cameroon. Epilepsy & Behavior 18; 247- 253.

• Ndoye NF, et al. (2005) Prevalence of epilepsy its treatment gap and knowledge, attitude and practice of its population in sub-urban Senegal an ILAE/IBE/WHO study. Seizure,14:106–11.

• Mielke.J, Adamolejun. B, Ball.D, Mundanda T (1997) Knowledge and attitudes of teachers towards epilepsy in Zimbabwe, Acta Neurol Scand, 96; (3) :133-4

References • Sanya EO, et al 2005. Perception and attitude to epilepsy

among teachers in primary, secondary and tertiary educational institutions in middle belt Nigeria. Trop Doct 2005;35:153–6

• Scott R.A., Lhatoo S.D., &. Sander J.W.A.S , 2001, The treatment of epilepsy in developing countries: where do we go from here? Bulletin of the World Health Organization, 2001, 79: 344–351