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Negussie AS, Dehan MF, Mekonnen SA, Zelleke TG. Knowledge, attitudes, and practices of caregivers with children diagnosed with epilepsy attending a pediatric outpatient clinic: a descriptive, cross-sectional, questionnaire-based study in Addis Ababa, Ethiopia. BMC Neurol 2024; 24:252. [PMID: 39039504 PMCID: PMC11265119 DOI: 10.1186/s12883-024-03766-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 07/15/2024] [Indexed: 07/24/2024] Open
Abstract
BACKGROUND Caregivers' knowledge and attitudes influence help-seeking behavior and treatment decisions of patients with epilepsy, which in turn significantly impacts epilepsy care. In Ethiopia, epilepsy is often misunderstood, associated with misconceptions and accompanied by persistent negative attitudes. The objective of this study is to assess the knowledge, attitude, and practice of caregivers of children with epilepsy. METHODS We conducted a hospital-based survey at the Yekatit 12 Hospital Pediatric Neurology Clinic, Addis Ababa, Ethiopia, between May and July 2022. We invited caregivers of children with epilepsy taking one or more daily anti-seizure medications to participate. Caregivers were invited to complete a structured questionnaire with guidance from a trained nurse to estimate knowledge and attitudes towards epilepsy and its treatment. Knowledge and attitudes were categorized as "good" and "favorable" (correct answers to ≥ 50% of questions) or "bad" and "unfavorable" (< 50% correct answers), respectively. Attitudes towards standard care versus non-standard (e.g., spiritual) care were also estimated. RESULTS A total of 120 caregivers completed the questionnaire. Many caregivers were familiar with the term 'epilepsy', with more than half (51.7%) having heard or read about it previously. The reported causes of epilepsy varied, with birth injury being the most common cause (44 out of 120 caregivers). Notably, there was association between the caregiver's gender and their knowledge score, with a p-value = 0.05. Caregivers exposed to information about epilepsy through hearing or reading demonstrated significantly higher levels of knowledge, with a p-value < 0.001. Additionally, knowing someone with epilepsy other than the index child was significantly associated with higher knowledge scores (p-value < 0.001). The study also revealed negative attitudes toward epilepsy: for example, 56.7% of surveyed caregivers believed it is unlikely that a child with epilepsy has normal cognitive abilities and 39.1% believed they should never be allowed to attend regular school. Additionally, a high proportion of caregivers (70%) sought alternative treatments (e.g., spiritual help) alongside standard medical care. CONCLUSIONS A significant knowledge gap was identified among caregivers, revealing prevalent misconceptions and negative attitudes. Improving epilepsy awareness, attitudes, and practices among caregivers will potentially contribute to overall improved quality of life for children with epilepsy.
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Affiliation(s)
| | - Mansour Fayz Dehan
- School of Medicine and Health Sciences, George Washington University, Washington, DC, USA
| | | | - Tesfaye Getaneh Zelleke
- School of Medicine and Health Sciences, George Washington University, Washington, DC, USA
- Children's National Medical Center, Washington, DC, USA
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Samia P, Hassell J, Hudson J, Ahmed A, Shah J, Hammond C, Kija E, Auvin S, Wilmshurst J. Epilepsy research in Africa: A scoping review by the ILAE Pediatric Commission Research Advocacy Task Force. Epilepsia 2022; 63:2225-2241. [PMID: 35729725 DOI: 10.1111/epi.17321] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Revised: 06/04/2022] [Accepted: 06/06/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Despite the high prevalence of epilepsy in Africa, evaluation of epilepsy research trends on the continent is lacking. Without establishing effective research, improvement in care for people with epilepsy cannot be effectively strategized or targeted. METHODS A scoping review of the peer-reviewed literature on epilepsy from Africa (1989-2019) was conducted. The aim was to understand from this what areas are well researched versus underresearched based on published epilepsy topics. RESULTS A total of 1227 publications were identified and assessed. A significant increase in publications occurred over the 30 years assessed. African author leadership was evident in most reports. Nine countries had >50 publications identified; the remaining 45 countries had <50 or no publications. Research studies were typically of lower quality (case series and observational studies). Research themes were more focused on clinical epilepsy (descriptive observational studies) and social aspects (qualitative surveys). However, there were a number of unique and strong themes, specifically for neurocysticercosis and nodding syndrome, where strong research collaborations were evident, basic science understandings were explored, and interventional models were established. SIGNIFICANCE Despite Africa being the continent with the most countries, it is lacking in the quantity, quality, and for some areas, relevance of research on epilepsy. Targeted approaches are needed to upskill the strength of research undertaken with more basic science, interventional, and randomized controlled studies. Themes of research need to promote those with unique African content but also to align with current international research areas that have impact on care delivery, such as epilepsy surgery and epilepsy genetics. For this to be possible, it is important to strengthen research hubs with collaborations that empower Africa to own its epilepsy research journey.
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Affiliation(s)
- Pauline Samia
- Department of Paediatrics and Child Health, Medical College, Aga Khan University, Nairobi, Kenya.,Brain and Mind institute, Aga Khan University, Nairobi, Kenya.,Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Jane Hassell
- Department of Paediatric Neurology, Great Ormond Street Hospital for Children, London, UK.,Gertrude's Garden Children's Hospital, Nairobi, Kenya
| | - Jessica Hudson
- Department of Paediatrics, Oxford University Hospitals, Oxford, UK
| | - Azim Ahmed
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jasmit Shah
- Brain and Mind institute, Aga Khan University, Nairobi, Kenya.,Department of Internal Medicine, Aga Khan University, Nairobi, Kenya
| | - Charles Hammond
- Department of Child Health, Komfo Anokye Teaching Hospital, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Edward Kija
- Department of Paediatrics and Child Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Stéphane Auvin
- Department of Pediatric Neurology, Public Hospital Network of Paris, Robert Debré Hospital, Neuro Diderot, National Institute of Health and Medical Research, University of Paris, Paris, France.,University Institute of France, Paris, France
| | - Jo Wilmshurst
- Department of Paediatric Neurology, Red Cross War Memorial Children's Hospital, Cape Town, South Africa.,Neuroscience Institute, University of Cape Town, Cape Town, South Africa
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Austin JK, Birbeck G, Parko K, Kwon CS, Fernandes PT, Braga P, Fiest KM, Ali A, Cross JH, de Boer H, Dua T, Haut SR, Jacoby A, Lorenzetti DL, Mifsud J, Moshé SL, Tripathi M, Wiebe S, Jette N. Epilepsy-related stigma and attitudes: Systematic review of screening instruments and interventions - Report by the International League Against Epilepsy Task Force on Stigma in Epilepsy. Epilepsia 2022; 63:598-628. [PMID: 34985766 DOI: 10.1111/epi.17133] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 11/09/2021] [Accepted: 11/10/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE This is a systematic review aimed at summarizing the evidence related to instruments that have been developed to measure stigma or attitudes toward epilepsy and on stigma-reducing interventions. METHODS This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) standards. A broad literature search (1985-2019) was performed in 13 databases. Articles were included if they described the development and testing of psychometric properties of an epilepsy-related stigma or attitude scale or stigma-reducing interventions. Two reviewers independently screened abstracts, reviewed full-text articles, and extracted data. Basic descriptive statistics are reported. RESULTS We identified 4234 abstracts, of which 893 were reviewed as full-text articles. Of these, 38 met inclusion criteria for an instrument development study and 30 as a stigma-reduction intervention study. Most instruments were initially developed using well-established methods and were tested in relatively large samples. Most intervention studies involved educational programs for adults with pre- and post-evaluations of attitudes toward people with epilepsy. Intervention studies often failed to use standardized instruments to quantify stigmatizing attitudes, were generally underpowered, and often found no evidence of benefit or the benefit was not sustained. Six intervention studies with stigma as the primary outcome had fewer design flaws and showed benefit. Very few or no instruments were validated for regional languages or culture, and there were very few interventions tested in some regions. SIGNIFICANCE Investigators in regions without instruments should consider translating and further developing existing instruments rather than initiating the development of new instruments. Very few stigma-reduction intervention studies for epilepsy have been conducted, study methodology in general was poor, and standardized instruments were rarely used to measure outcomes. To accelerate the development of effective epilepsy stigma-reduction interventions, a paradigm shift from disease-specific, siloed trials to collaborative, cross-disciplinary platforms based upon unified theories of stigma transcending individual conditions will be needed.
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Affiliation(s)
- Joan K Austin
- Indiana University School of Nursing, Indianapolis, Indiana, USA
| | - Gretchen Birbeck
- Epilepsy Division, University of Rochester, Rochester, New York, USA.,Epilepsy Care Team, Chikankata Hospital, Mazabuka, Zambia
| | - Karen Parko
- Department of Neurology, University of California at San Francisco, San Francisco, California, USA.,Epilepsy Center, San Francisco VA Medical Center, San Francisco, California, USA
| | - Churl-Su Kwon
- Departments of Neurosurgery and Neurology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Paula T Fernandes
- Department of Sport Science, Faculty of Physical Education, UNICAMP, Campinas, Brazil
| | - Patricia Braga
- Institute of Neurology, Facultad de Medicina, Universidad de la República, Montevideo, Uruguay
| | - Kirsten M Fiest
- Department of Critical Care Medicine and Department of Community Health Sciences, Hotchkiss Brain Institute, O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada
| | - Amza Ali
- Kingston Public Hospital and University of the West Indies, Kingston, Jamaica
| | - J Helen Cross
- Developmental Neurosciences Programme, UCL-Great Ormond Street Institute of Child Health, London, UK
| | | | - Tarun Dua
- Department of Mental Health and Substance Abuse, World Health Organization, Geneva, Switzerland
| | - Sheryl R Haut
- Saul R. Korey Department of Neurology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York, USA
| | - Ann Jacoby
- Department of Public Health and Policy, University of Liverpool, Liverpool, UK
| | - Diane L Lorenzetti
- Department of Community Health Sciences, University of Calgary and Heath Sciences Library, University of Calgary, Calgary, Alberta, Canada
| | - Janet Mifsud
- Department of Clinical Pharmacology and Therapeutics, Faculty of Medicine and Surgery, University of Malta, Msida, Malta
| | - Solomon L Moshé
- Department of Pediatrics and Dominick P. Purpura Department of Neuroscience, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Manjari Tripathi
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Samuel Wiebe
- Department of Clinical Neurosciences and Department of Community Health Sciences, Hotchkiss Brain Institute, O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada
| | - Nathalie Jette
- Departments of Neurology and Population Health Sciences & Policy, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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Determination of health fatalism and the factors affecting health fatalism in patients with epilepsy in the North of Turkey. Epilepsy Behav 2021; 115:107641. [PMID: 33341394 DOI: 10.1016/j.yebeh.2020.107641] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Revised: 11/08/2020] [Accepted: 11/16/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVE In individuals with epilepsy, health fatalism can affect their perceptions of health and their responses to solutions offered, both positively and negatively. This study aimed to investigate health fatalism in people with epilepsy in Turkey and the factors that influence their health fatalism. METHOD This descriptive and cross-sectional study was conducted between December 2019 and April 2020 with 100 epilepsy patients who were referred to a neurology outpatient clinic in the North of Turkey. The data for the study were collected using a descriptive information form and the Health Fatalism Scale (HES). RESULTS The total mean score on the Health Fatalism Scale for the study participants was found to be 56,16 ± 15,71. Significant association was found between health fatalism and educational status (p < 0,05), polytherapy (p < 0,05), and frequency of seizures (p < 0,001). CONCLUSION In this study, individuals with epilepsy expressed high levels of fatalism in their health beliefs. It was found that illiterate individuals with epilepsy held more fatalistic beliefs. In addition, it was found that participants who used polytherapy and those who had frequent seizures also had higher levels of fatalistic health beliefs.
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Elliot VL, Morgan D, Kosteniuk J, Froehlich Chow A, Bayly M. Health-related stigma of noncommunicable neurological disease in rural adult populations: A scoping review. HEALTH & SOCIAL CARE IN THE COMMUNITY 2019; 27:e158-e188. [PMID: 30548727 PMCID: PMC6619253 DOI: 10.1111/hsc.12694] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Revised: 10/25/2018] [Accepted: 11/12/2018] [Indexed: 06/09/2023]
Abstract
Stigma is a widely recognised public health issue. Many people with neurological disease and their families experience stigmatisation, adding to their burden of illness. Rural populations are typically small, lack anonymity, and often have a higher proportion of older adults with inadequate access to specialised services and resources. Although generally isolated, rural areas can offer benefits such as a sense of familiarity and interconnectedness. The purpose of this scoping review was to map the existing evidence on stigma associated with non-communicable neurological disease in rural adult populations and identify key findings and gaps in the literature. Our literature search of peer-reviewed English language articles published from 1 January 1992 to 22 June 2017 was conducted across five databases yielding 8,209 results. After duplicate removal, pairs of reviewers independently screened 6,436 studies according to inclusion criteria developed a priori; 36 articles were identified for inclusion in this review. Study characteristics were described and illustrated by frequency distribution, findings were grouped thematically, and each of the five types of stigma were identified (social, self, health professional, associative, structural). Four factors influencing stigma (knowledge, familiarity, beliefs, and rurality) and four overarching stigma-related themes (concealment; exclusion; disempowerment, discrimination, and unequal opportunities; and issues related to healthcare systems and providers) emerged. In urban-rural comparison studies, rural residents were generally less knowledgeable about the neurological disease and more stigmatised. The impact of other factors (i.e., gender, age, and education) on stigma varied and are stated where associations were reported. Three main gaps were identified including: low attention to stigma related to neurological diseases other than epilepsy, limited cross-cultural comparisons of stigma related to neurological disease, and inclusion of gender as a variable in the analysis of stigma-related outcomes in only half of the reviewed studies. Further research is recommended.
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Affiliation(s)
- Valerie L. Elliot
- Canadian Centre for Health and Safety in AgricultureUniversity of SaskatchewanSaskatoonSaskatchewanCanada
| | - Debra Morgan
- Canadian Centre for Health and Safety in AgricultureUniversity of SaskatchewanSaskatoonSaskatchewanCanada
| | - Julie Kosteniuk
- Canadian Centre for Health and Safety in AgricultureUniversity of SaskatchewanSaskatoonSaskatchewanCanada
| | - Amanda Froehlich Chow
- Canadian Centre for Health and Safety in AgricultureUniversity of SaskatchewanSaskatoonSaskatchewanCanada
| | - Melanie Bayly
- Canadian Centre for Health and Safety in AgricultureUniversity of SaskatchewanSaskatoonSaskatchewanCanada
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6
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Singh G, Selai C, Islam S, Chaudhary P, Sander JW. Marriage in epilepsy: The impact of the question in knowledge, attitude, and practice surveys. Epilepsy Behav 2018; 85:164-172. [PMID: 29957343 DOI: 10.1016/j.yebeh.2018.06.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Revised: 05/30/2018] [Accepted: 06/01/2018] [Indexed: 12/21/2022]
Abstract
BACKGROUND Knowledge, attitudes, and practice (KAP) questionnaire-based surveys have captured negative attitudes towards marriage involving people with epilepsy (PWE). The attitudes may vary according to the nature of the question posed, whether personal or generic, in addition to many other covariates. METHODS We carried out meta-proportion and -regression analyses of epilepsy-related KAP surveys published between 1970 and 2016 in the medical literature analysis retrieval system online (MEDLINE) database. RESULTS The pooled estimate of the proportion of those responding positively to the marriage question was 0.45 (95% confidence interval (95%CI): 0.35 to 0.54; I2res = 99.89%). The pooled proportion of positive responders to a personal question (0.40; 95%CI: 0.35 to 0.46) was significantly lower than those responding positively to a generic question (0.64; 95%CI: 0.57 to 0.70) (P = 0.001). When modeled individually in regression analyses, only the continent of origin of the survey (P = 0.001; tau2: 0.06; I2res: 99.8%; adjusted R2: 11.4%) and subject population type (P = 0.02; tau2: 0.07; I2res: 99.9%; adjusted R2: 4.2%) were associated with the pooled estimate of positive responders to the question on marriage. CONCLUSIONS Personal questions probing the possibility of marriage of self or family members to someone with epilepsy bring about negative attitudes more often than generic questions inquiring the marriage-worthiness of PWE.
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Affiliation(s)
- Gagandeep Singh
- Department of Neurology, Dayanand Medical College, Ludhiana, India; NIHR University College London Hospitals Biomedical Research Centre, UCL Institute of Neurology, Queen Square, London WC1N 3BG, UK
| | - Caroline Selai
- Education Unit, NIHR University College London Hospitals Biomedical Research Centre, UCL Institute of Neurology, Queen Square, London WC1N 3BG, UK
| | - Saiful Islam
- Education Unit, NIHR University College London Hospitals Biomedical Research Centre, UCL Institute of Neurology, Queen Square, London WC1N 3BG, UK
| | | | - Josemir W Sander
- NIHR University College London Hospitals Biomedical Research Centre, UCL Institute of Neurology, Queen Square, London WC1N 3BG, UK; Chalfont Centre for Epilepsy, Chalfont St Peter, Bucks SL9 0RJ, UK; Stichting Epilepsie Instellingen Nederland (SEIN), Achterweg 5, Heemstede 2103SW, Netherlands.
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7
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Kaddumukasa M, Kaddumukasa MN, Buwembo W, Munabi IG, Blixen C, Lhatoo S, Sewankambo N, Katabira E, Sajatovic M. Epilepsy misconceptions and stigma reduction interventions in sub-Saharan Africa, a systematic review. Epilepsy Behav 2018; 85:21-27. [PMID: 29906697 PMCID: PMC6355646 DOI: 10.1016/j.yebeh.2018.04.014] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Revised: 03/14/2018] [Accepted: 04/20/2018] [Indexed: 01/21/2023]
Abstract
OBJECTIVE This systematic review identified papers that described epilepsy misconceptions or stigma in sub-Saharan Africa (SSA) and research interventions focused on reducing these misconceptions. MATERIALS AND METHODS Publications in the English language from January 2000 to October 2017 that described original research conducted in SSA on misconceptions about epilepsy were utilized. RESULTS Twenty-three publications were identified. Studies were from Nigeria (N = 4), Cameroon (N = 4), Uganda (N = 3), Zambia (N = 2), Ethiopia (N = 2), Tanzania (N = 2), Kenya (N = 2), Ghana, Zimbabwe, Benin, and Mali (N = 1 each). The studies included assessments of misconceptions among healthcare providers and medical students (N = 3), high school students (N = 2), teachers (N = 2), the general public (N = 10), people with epilepsy (N = 7), and traditional healers (N = 1). Only two studies had stigma-focused interventions. Majority of the studies reported limitations to socialization with people with epilepsy and various beliefs associated with epilepsy. CONCLUSIONS Epilepsy misconceptions, stigmatizing cultural beliefs, and perceptions were widely prevalent in SSA, and there are a few studies targeting epilepsy stigma. Existing stigma-reduction educational approaches may be impractical for general population implementation. Scalable approaches to reduce stigma are urgently needed within SSA.
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Affiliation(s)
- Mark Kaddumukasa
- Department of Medicine, School of Medicine, College of Health Sciences, Makerere University, P.O. Box 7072, Kampala, Uganda.
| | - Martin N Kaddumukasa
- Department of Medicine, School of Medicine, College of Health Sciences, Makerere University. P.O. Box 7072, Kampala, Uganda
| | - William Buwembo
- School of Biomedical Sciences, Makerere University, P.O. Box 7072, Kampala, Uganda
| | - Ian. G. Munabi
- School of Biomedical Sciences, Makerere University, P.O. Box 7072, Kampala, Uganda
| | - Carol Blixen
- Neurological and Behavioral Outcomes Center, University Hospitals Cleveland Medical Center & Case Western Reserve University School of Medicine, 11100 Euclid Avenue, Cleveland, OH 44106, USA..
| | - Samden Lhatoo
- Epilepsy Center, UH Case Medical Center, 11100 Euclid Avenue, Cleveland, OH, 44106, USA.
| | - Nelson Sewankambo
- Department of Medicine, School of Medicine, College of Health Sciences, Makerere University. P.O. Box 7072, Kampala, Uganda
| | - Elly Katabira
- Department of Medicine, School of Medicine, College of Health Sciences, Makerere University. P.O. Box 7072, Kampala, Uganda
| | - Martha Sajatovic
- Neurological and Behavioral Outcomes Center, University Hospitals Cleveland Medical Center & Case Western Reserve University School of Medicine, 11100 Euclid Avenue, Cleveland, OH 44106, USA..
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Lee SA, Choi EJ, Jeon JY, Paek JH. Attitudes toward epilepsy and perceptions of epilepsy-related stigma in Korean evangelical Christians. Epilepsy Behav 2017; 74:99-103. [PMID: 28732262 DOI: 10.1016/j.yebeh.2017.06.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Revised: 06/07/2017] [Accepted: 06/11/2017] [Indexed: 11/25/2022]
Abstract
PURPOSE The scriptural description of Jesus driving out an evil spirit from a boy with epilepsy supported the idea of the spiritual nature of epilepsy for centuries. Korea has a shorter history of Christianity than the Western world. We determined whether there are differences in attitudes toward epilepsy and perception of epilepsy-related stigma between people with and without belief in evangelical Christianity in Korea. METHODS Data were collected from evangelical churches and theological colleges. People without religious beliefs were enrolled as a control group through convenience sampling. The Public Attitudes Toward Epilepsy (PATE) scale and the modified Stigma Scale for epilepsy were used. Familiarity with and knowledge of epilepsy were also assessed. Evangelical Christians were categorized as professional or nonprofessional depending on whether they had received professional education in Christian theology. RESULTS A total of 227 evangelical Christians and 139 controls were included. The scores on the Stigma Scale and in the two PATE domains were significantly lower in the professional Christian group than in the controls or the nonprofessional group (p<0.05) but did not differ between the nonprofessional group and controls. After controlling for confounders, only the professional group was independently associated with lower scores on the Stigma Scale and in the PATE personal domain (p<0.05). The remaining associations lost their significance. CONCLUSIONS We found no differences in attitudes toward epilepsy and perception of stigma between people with and without belief in evangelical Christianity in Korea.
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Affiliation(s)
- Sang-Ahm Lee
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
| | - Eun-Ju Choi
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Ji-Ye Jeon
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Joon-Hyun Paek
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
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Zhao T, Gao Y, Zhu X, Wang N, Chen Y, Zhang J, He G, Feng Y, Xu J, Han X, Zhang J. Awareness, attitudes toward epilepsy, and first aid knowledge of seizures of hospital staff in Henan, China. Epilepsy Behav 2017; 74:144-148. [PMID: 28738284 DOI: 10.1016/j.yebeh.2017.06.026] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Revised: 06/19/2017] [Accepted: 06/20/2017] [Indexed: 12/15/2022]
Abstract
AIM The aim of this study was to evaluate awareness of, attitudes toward, and first aid knowledge of seizures of hospital staff in Henan, China. METHOD Two hundred nineteen hospital staff, including doctors, nurses, medical technicians, logisticians, and executives working at tertiary hospitals in Henan, China, completed the survey from March to September in 2016. The data comprised the demographic data section, awareness of epilepsy section, attitude toward epilepsy section, and first aid knowledge of seizure attack section. RESULTS The participants obtained a mean score of 7.48±1.705 on the awareness of epilepsy section, and a mean score of 5.32±1.165 on the first aid knowledge of seizure attacks section. There were significant correlations between educational level (r=0.187, P=0.006), occupation (r=-0.244, P=0.000), and attitudes toward patients with epilepsy (r=0.351, P=0.000) with the awareness of epilepsy. There were significant correlations between age (r=0.170, P=0.014), educational status (r=0.139, P=0.040), and professional titles (r=0.197, P=0.004) with the first aid knowledge of seizures. CONCLUSION The study showed that hospital staff had a moderate level of knowledge regarding epilepsy, and they generally displayed a positive attitude. It was also determined that as the awareness of epilepsy increased, they displayed more positive attitudes toward patients with epilepsy. The study also suggests that specialists working on epilepsy should provide more lectures and educational sessions to improve the knowledge of and attitude toward epilepsy and first aid knowledge of seizures among hospital staff.
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Affiliation(s)
- Ting Zhao
- Department of Neurology, Henan Provincial People's Hospital, People's Hospital, Henan University, Zhengzhou 450003, China
| | - Yajuan Gao
- Department of Clinical Medicine, Zhengzhou University, Zhengzhou 450000, China
| | - Xuerui Zhu
- Department of Neurology, Henan Provincial People's Hospital, People's Hospital, Henan University, Zhengzhou 450003, China
| | - Na Wang
- Department of Neurology, Henan Provincial People's Hospital, People's Hospital, Henan University, Zhengzhou 450003, China
| | - Yanan Chen
- Department of Neurology, Henan Provincial People's Hospital, People's Hospital, Henan University, Zhengzhou 450003, China
| | - Jiahui Zhang
- Department of Neurology, Henan Provincial People's Hospital, People's Hospital, Henan University, Zhengzhou 450003, China
| | - Guinv He
- Department of Neurology, Henan Provincial People's Hospital, People's Hospital, Henan University, Zhengzhou 450003, China
| | - Yan Feng
- Department of Neurology, Henan Provincial People's Hospital, People's Hospital, Henan University, Zhengzhou 450003, China
| | - Jun Xu
- Department of Neurology, Henan Provincial People's Hospital, People's Hospital, Henan University, Zhengzhou 450003, China
| | - Xiong Han
- Department of Neurology, Henan Provincial People's Hospital, People's Hospital, Henan University, Zhengzhou 450003, China.
| | - Jiewen Zhang
- Department of Neurology, Henan Provincial People's Hospital, People's Hospital, Henan University, Zhengzhou 450003, China
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10
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Clinical nurses' knowledge and attitudes toward patients with epilepsy. Epilepsy Behav 2016; 61:206-209. [PMID: 27372960 DOI: 10.1016/j.yebeh.2016.05.009] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Revised: 04/09/2016] [Accepted: 05/06/2016] [Indexed: 11/21/2022]
Abstract
BACKGROUND Insufficient knowledge and negative attitudes of clinical nurses regarding epilepsy may affect the quality of health care for patients with epilepsy. AIM The aim of this study was to evaluate knowledge and attitudes of nurses working at a university hospital located in eastern Turkey regarding epilepsy. METHOD The descriptive study was conducted with 85 nurses working at the internal medicine clinics at Yakutiye Research Hospital in Erzurum, Turkey in March 2014. The data comprised the personal information form, epilepsy knowledge scale, and epilepsy attitude scale. RESULTS Clinical nurses obtained a mean score of 12.62±2.77 on the epilepsy knowledge scale and 55.43±6.59 on the epilepsy attitude scale. There was a significant difference between the educational status of nurses and mean scores on the epilepsy knowledge scale and epilepsy attitude scale (P<0.05). There was a positive, significant correlation between knowledge scores and attitude scores of clinical nurses regarding epilepsy (r=0.227, P<0.05). In addition, more than half of nurses (57.6%) knew that epileptic seizures would not pose a danger to other people. Unfortunately, approximately one-third of clinical nurses (36.5%) believed that epilepsy was incurable. CONCLUSION As a result of the study, it was determined that nurses had a moderate level of knowledge regarding epilepsy, and they generally displayed a positive attitude, but it was not sufficient. In addition, more knowledge was associated with a more positive attitude.
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Atakli D, Dogan Ak P, Guveli BT, Yuksel B. Knowledge of epilepsy among persons with epilepsy in Turkey. Epilepsy Behav 2016; 57:41-45. [PMID: 26921597 DOI: 10.1016/j.yebeh.2016.01.030] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Revised: 01/24/2016] [Accepted: 01/25/2016] [Indexed: 01/28/2023]
Abstract
PURPOSE It has been shown in studies that there are knowledge gaps about epilepsy in both developing and developed countries all around the world. Lack of knowledge exists even among people with epilepsy (PWE), and this may affect their lives negatively. This study aimed to evaluate what PWE in Turkey know about their disease. METHOD A self-completed questionnaire consisting of demographic details, an item about perceived stigmatization, and 24 items about general knowledge of medical and social aspects of epilepsy was developed. Applicants were asked to answer 'true', 'false', or 'do not know' to each statement. The scores of the questionnaire were defined as low (< 15 point), medium (≥ 15-20), and high (≥ 20). RESULTS The mean score on the questionnaire was 15.17 ± 3.74 (range, 4-24). One hundred twenty-five PWE (37.9%) scored low, 170 PWE (51.5%) scored medium, and 35 PWE (10.6%) scored high. The education level and household income were highly correlated with the knowledge level. Higher education level (r: 0.31) and high income (r: 0.25) were correlated with higher mean scores (p < 0.01). Lack of information was present particularly in terms of etiology, management of seizures, and medication during pregnancy. CONCLUSION We documented the knowledge deficit of PWE about their disease, a situation that may lead to suboptimal management and negative attitudes. We concluded that study programs should be organized and more education should be provided to PWE in order to overcome these issues.
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Affiliation(s)
- Dilek Atakli
- Bakirkoy Education and Research Hospital for Psychiatry, Neurology and Neurosurgery, Neurology Department, Istanbul, Turkey; Fatih Sultan Mehmet Education and Research Hospital, Neurology Department, Istanbul, Turkey; Antalya Education and Research Hospital, Neurology Department, Antalya, Turkey
| | - Pelin Dogan Ak
- Bakirkoy Education and Research Hospital for Psychiatry, Neurology and Neurosurgery, Neurology Department, Istanbul, Turkey; Fatih Sultan Mehmet Education and Research Hospital, Neurology Department, Istanbul, Turkey; Antalya Education and Research Hospital, Neurology Department, Antalya, Turkey.
| | - Betul Tekin Guveli
- Bakirkoy Education and Research Hospital for Psychiatry, Neurology and Neurosurgery, Neurology Department, Istanbul, Turkey; Fatih Sultan Mehmet Education and Research Hospital, Neurology Department, Istanbul, Turkey; Antalya Education and Research Hospital, Neurology Department, Antalya, Turkey
| | - Burcu Yuksel
- Bakirkoy Education and Research Hospital for Psychiatry, Neurology and Neurosurgery, Neurology Department, Istanbul, Turkey; Fatih Sultan Mehmet Education and Research Hospital, Neurology Department, Istanbul, Turkey; Antalya Education and Research Hospital, Neurology Department, Antalya, Turkey
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Bigelow J, Berrett S, Kimuli I, Katabira E. Perceptions of epilepsy among first-year medical students at Mulago Hospital in Kampala, Uganda. Epilepsy Behav 2015; 51:28-32. [PMID: 26253598 DOI: 10.1016/j.yebeh.2015.06.020] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2015] [Revised: 06/09/2015] [Accepted: 06/10/2015] [Indexed: 11/19/2022]
Abstract
Epilepsy is associated with stigma throughout the world, which leads to poor treatment of people with epilepsy (PWE). In Uganda, there are more than 75,000 PWE and a large treatment gap. This study evaluated the knowledge, attitudes, and practices regarding epilepsy among first-year medical students at Mulago Hospital. A 22-question survey was developed based on the previous studies of Birbeck et al.'s regarding the stigma of epilepsy in Zambia. This was administered to first-year medical students (96 respondents) at Mulago Hospital in Uganda. More than 80% said that they would not allow their children to marry PWE. Most respondents believed that epilepsy was a mental illness, and many believed that PWE cannot have normal intelligence. Students reported that there was a negative perception and negative treatment of PWE in the community. Some students believed that epilepsy was caused by supernatural causes and was contagious. These misperceptions must be identified and corrected among medical students and other healthcare providers to allow for fair treatment of PWE; this should be incorporated into medical school curriculums in Uganda.
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Affiliation(s)
- Jeffrey Bigelow
- Yale-New Haven Hospital, 20 York Street, New Haven, CT 06510, USA.
| | | | - Ivan Kimuli
- Makerere University School of Medicine, Mulago Hospital, Kawempe, Kampala, Uganda.
| | - Elly Katabira
- Makerere University School of Medicine, Mulago Hospital, Kawempe, Kampala, Uganda.
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Pupillo E, Vitelli E, Messina P, Beghi E. Knowledge and attitudes towards epilepsy in Zambia: a questionnaire survey. Epilepsy Behav 2014; 34:42-6. [PMID: 24681384 DOI: 10.1016/j.yebeh.2014.02.025] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2013] [Revised: 02/19/2014] [Accepted: 02/22/2014] [Indexed: 11/19/2022]
Abstract
Misconception and stigma towards epilepsy have a profound impact on this disease in Africa. An unselected sample of Zambian people was interviewed to investigate their knowledge and attitudes towards epilepsy. Proper/improper answers were scored, and a composite score was developed with negative values for unsatisfactory awareness and high stigma levels. The sample comprised 231 people residing in urban (107) or in rural (124) areas. The median and interquartile range of scores for epilepsy awareness and stigma were, respectively, -1 (-3; +1) and +1 (-1; +6). Poor education was the only significant predictor of unsatisfactory awareness (p=0.0131), while education and residency were significantly associated with stigma (p<0.0001 and p=0.0004). Rural people were mostly in the highest stigma level (44.2%) and urban people in the lowest stigma level (60.4%). Misconception and negative attitudes towards epilepsy among Zambian people reflect poor education and rural residency.
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Affiliation(s)
- Elisabetta Pupillo
- Departement of Neurosciences, IRCSS - Istituto di Ricerche Farmacologiche "Mario Negri", Milano, Italy
| | | | - Paolo Messina
- Departement of Neurosciences, IRCSS - Istituto di Ricerche Farmacologiche "Mario Negri", Milano, Italy
| | - Ettore Beghi
- Departement of Neurosciences, IRCSS - Istituto di Ricerche Farmacologiche "Mario Negri", Milano, Italy.
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Otte WM, Nhaga AA, Tchuda DL, Abna B, van der Maas F. Cultural beliefs among people with epilepsy or physical impairment in Guinea-Bissau: Differences and similarities. Epilepsy Behav 2013; 29:504-7. [PMID: 24094843 DOI: 10.1016/j.yebeh.2013.09.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2013] [Revised: 09/02/2013] [Accepted: 09/04/2013] [Indexed: 10/26/2022]
Abstract
People living with a disability in sub-Saharan Africa have poorer health outcomes, lower educational successes, less economic participation, and higher levels of poverty than people without disability. Disability-inclusive development promotes the involvement of people with disabilities in programs that reduce these inequalities. This requires a good understanding of how individuals with disability perceive their condition. In this study, we identified cultural beliefs among 31 individuals with epilepsy or physical impairment, known to a community-based rehabilitation service in Guinea-Bissau, using face-to-face interviews. We related these beliefs to religious background and type of disability. We found poor knowledge of and attitudes towards disability among persons with epilepsy and physical impairment. Cultural beliefs were significantly shaped by religious background. Islamic respondents were more positive about their disability as compared to Christians and traditional believers. A better understanding of cultural beliefs among people with disabilities may help to launch and adapt disability-inclusive community-based rehabilitation services.
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Affiliation(s)
- Willem M Otte
- Community-based Rehabilitation Effata, Waddinxveen, The Netherlands; Department of Pediatric Neurology, Rudolf Magnus Institute of Neuroscience, University Medical Center Utrecht, The Netherlands; Biomedical MR Imaging and Spectroscopy Group, Image Sciences Institute, University Medical Center Utrecht, The Netherlands.
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Elafros MA, Sakubita-Simasiku C, Atadzhanov M, Haworth A, Chomba E, Birbeck GL. Stigma and psychiatric morbidity among mothers of children with epilepsy in Zambia. Int Health 2013; 5:288-94. [PMID: 24214528 DOI: 10.1093/inthealth/iht028] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Epilepsy-associated stigma contributes substantially to the social, medical, and economic burden of disease for people with epilepsy (PWE), but little is known about its impact on caregivers of PWE. METHODS To better understand stigma experienced by caregivers of PWE, factors that influence caregiver stigma, and the effect of stigma on a caregiver's psychologic well being, we interviewed 100 caregivers of children with epilepsy in Zambia. Questions assessed maternal knowledge, attitudes, and practices related to epilepsy, maternal stigma, mother's proxy report of child stigma, and maternal psychiatric morbidity. RESULTS Of 100 mothers, 39 (39%) indicated that their child was stigmatized because of his or her epilepsy. Maternal proxy report of child stigma was highly correlated with maternal stigma (OR: 5.4, p=0.04), seizure frequency (p=0.03) and seizure severity (p=0.01). One in five of 100 mothers (20%) reported feeling stigmatized because of their child's epilepsy. Higher maternal stigma was associated with lower familial and community support (ORs: 65.2 and 34.7, respectively; both p<0.0001) as well as higher psychiatric morbidity (OR: 1.2; p=0.002). Formal education and epilepsy knowledge were associated with decreased maternal stigma (ORs: 0.8 and 0.7, respectively; both p<0.001). CONCLUSIONS One in five mothers of PWE feel stigmatized because of their child's epilepsy. As maternal stigma is associated with psychiatric morbidity, educating caregivers about epilepsy and screening for anxiety and depression are warranted.
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Affiliation(s)
- Melissa A Elafros
- Michigan State University, International Neurologic & Psychiatric Epidemiology Program (INPEP), East Lansing, Michigan, USA
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Understanding of and attitudes towards people with epilepsy among community-based rehabilitation volunteers in Guinea-Bissau. Epilepsy Behav 2013; 28:196-200. [PMID: 23770632 DOI: 10.1016/j.yebeh.2013.05.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2013] [Revised: 04/17/2013] [Accepted: 05/10/2013] [Indexed: 11/22/2022]
Abstract
BACKGROUND Community-based epilepsy care programs improve access to epilepsy treatment in resource-poor settings. Community volunteers are important to these services. Most studies on familiarity with, understanding of, and attitudes towards people with epilepsy (PWE), however, ignore these volunteers. METHODS We explored these issues among 15 community volunteers involved in a community-based rehabilitation child epilepsy service recently initiated in Guinea-Bissau using face-to-face interviews. RESULTS We found that the volunteers had a reasonable understanding of epilepsy, moderate attitudes towards PWE, and a good understanding of difficulties PWE encounter in society. CONCLUSION Evaluation of understanding and attitudes of community volunteers may be useful to improve low-cost community-based epilepsy programs. A correct understanding of epilepsy among community volunteers may increase effective treatment of and support to children with epilepsy through community-based epilepsy programs.
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Mbuba CK, Abubakar A, Hartley S, Odermatt P, Newton CR, Carter JA. Development and validation of the Kilifi Epilepsy Beliefs and Attitude Scale. Epilepsy Behav 2012; 24:480-7. [PMID: 22795174 PMCID: PMC3532597 DOI: 10.1016/j.yebeh.2012.06.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2012] [Revised: 05/31/2012] [Accepted: 06/03/2012] [Indexed: 11/23/2022]
Abstract
Epilepsy remains misunderstood, particularly in resource poor countries (RPC). We developed and validated a tool to assess beliefs and attitudes about epilepsy among people with epilepsy (PWE) in Kilifi, Kenya. The 50-item scale was developed through a literature review and qualitative study findings, and its reliability and validity were assessed with 673 PWE. A final scale of 34 items had Cronbach's alpha scores for the five subscales: causes of epilepsy (α=0.71); biomedical treatment of epilepsy (α=0.70); cultural treatment of epilepsy (α=0.75); risk and safety concerns about epilepsy (α=0.56); and negative attitudes about epilepsy (α=0.76) and entire scale (α=0.70). Test-retest reliability was acceptable for all the subscales. The Kilifi Epilepsy Beliefs and Attitude Scale is a reliable and valid tool that measures beliefs and attitudes about epilepsy. It may be useful in other RPC or as a tool to assess the effectiveness of interventions to improve knowledge, beliefs, and attitudes about epilepsy.
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Affiliation(s)
- Caroline K Mbuba
- KEMRI/Wellcome Trust Research Programme, Centre for Geographic Medicine Research (Coast), Kilifi, Kenya
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Bella T, Omigbodun O, Atilola O. Towards School Mental Health in Nigeria: Baseline Knowledge and Attitudes of Elementary School Teachers. ACTA ACUST UNITED AC 2011. [DOI: 10.1080/1754730x.2011.9715636] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Atadzhanov M, Haworth A, Chomba EN, Mbewe EK, Birbeck GL. Epilepsy-associated stigma in Zambia: what factors predict greater felt stigma in a highly stigmatized population? Epilepsy Behav 2010; 19:414-8. [PMID: 20851056 PMCID: PMC3005974 DOI: 10.1016/j.yebeh.2010.08.017] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2010] [Revised: 08/12/2010] [Accepted: 08/13/2010] [Indexed: 10/19/2022]
Abstract
Epilepsy-associated stigma in Africa has been described largely in terms of enacted stigma or discrimination. We conducted a study of 169 adults with epilepsy attending epilepsy clinics in Zambia's Lusaka or Southern province using a three-item instrument (maximum score = 3). Potential determinants of felt stigma including age, gender, education, wealth, disclosure status (meaning whether or how their community members knew of their condition), seizure type (generalized vs partial), seizure frequency, the presence of visible epilepsy-associated stigmata, personal contagion beliefs, and community contagion beliefs. The median stigma score was 2.5, suggesting some ceiling effect in the instrument. People with epilepsy who believed their condition to be contagious, who thought their community believed epilepsy to be contagious, and whose condition had been revealed to their community against their wishes reported more felt stigma. Community and clinic-based educational campaigns to dispel contagion beliefs are needed.
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Chomba E, Haworth A, Atadzhanov M, Mbewe E, Birbeck GL. The socioeconomic status of children with epilepsy in Zambia: implications for long-term health and well-being. Epilepsy Behav 2008; 13:620-3. [PMID: 18602496 PMCID: PMC2586063 DOI: 10.1016/j.yebeh.2008.06.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2008] [Revised: 06/13/2008] [Accepted: 06/17/2008] [Indexed: 11/27/2022]
Abstract
Epilepsy is a highly stigmatized disorder in Zambia. Studies indicate that adults with epilepsy in many regions have significantly lower socioeconomic status (SES) than their peers. We conducted a case-control study of Zambian children with epilepsy (CWE) to assess their SES. Ninety-eight pairs of children were recruited (n=196); their mean age was 10.8 years, and 59.7% were male. The comparison group's medical conditions included asthma (54.0%), rheumatic heart disease (26.6%), type 1 diabetes (14.2%), and hypertension (5.2%). Compared with children with nonstigmatized chronic medical conditions, CWE have fewer educational opportunities, more environmental hazards, and poorer food quality and security (all P's<0.05). This deprivation may be related to lost maternal income for mothers who deferred employment so they could remain at home to care for their children. This early deprivation has long-term implications for health and well-being. Health care workers and child advocates need to be aware of the circumstances facing CWE in this region.
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Affiliation(s)
- Elwyn Chomba
- University of Zambia (UNZA) School of Medicine, Department of Pediatrics & Child Health, # Nationalist Rd, University Teaching Hospital, Lusaka, ZAMBIA, Tele +260-1-254655, Fax +260-1-291607, email
| | - Alan Haworth
- UNZA School of Medicine, Department of Psychiatry & Chainama College of Health Sciences, PO Box 30066, Lusaka, ZAMBIA, Tele +260-97-308078, Fax +260-1-226143, Email
| | - Masharip Atadzhanov
- UNZA School of Medicine, Department of Medicine, PO Box 50110, Lusaka, ZAMBIA, Tele +260-97-775662, Fax +260-1-250753, Email
| | - Edward Mbewe
- Chainama College of Health Sciences, PO Box 33991, Lusaka, ZAMBIA, Tele +260-96-743668, Email
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Abstract
This article discusses the concept of illness-related stigma and its relevance to consideration of the psychosocial impact of epilepsy. It provides an overview of the recent literature on epilepsy-related stigma as it relates to the stigma experience of people with epilepsy themselves and to the beliefs and attitudes held by other key target groups. The limitations of these and previous studies are considered, and some advances in knowledge arising from them are highlighted. Finally, some suggestions are made about possible areas for further investigation.
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Rhodes PJ, Small N, Ismail H, Wright JP. The use of biomedicine, complementary and alternative medicine, and ethnomedicine for the treatment of epilepsy among people of South Asian origin in the UK. Altern Ther Health Med 2008; 8:7. [PMID: 18366698 PMCID: PMC2329602 DOI: 10.1186/1472-6882-8-7] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2007] [Accepted: 03/20/2008] [Indexed: 11/30/2022]
Abstract
Background Studies have shown that a significant proportion of people with epilepsy use complementary and alternative medicine (CAM). CAM use is known to vary between different ethnic groups and cultural contexts; however, little attention has been devoted to inter-ethnic differences within the UK population. We studied the use of biomedicine, complementary and alternative medicine, and ethnomedicine in a sample of people with epilepsy of South Asian origin living in the north of England. Methods Interviews were conducted with 30 people of South Asian origin and 16 carers drawn from a sampling frame of patients over 18 years old with epilepsy, compiled from epilepsy registers and hospital databases. All interviews were tape-recorded, translated if required and transcribed. A framework approach was adopted to analyse the data. Results All those interviewed were taking conventional anti-epileptic drugs. Most had also sought help from traditional South Asian practitioners, but only two people had tried conventional CAM. Decisions to consult a traditional healer were taken by families rather than by individuals with epilepsy. Those who made the decision to consult a traditional healer were usually older family members and their motivations and perceptions of safety and efficacy often differed from those of the recipients of the treatment. No-one had discussed the use of traditional therapies with their doctor. The patterns observed in the UK mirrored those reported among people with epilepsy in India and Pakistan. Conclusion The health care-seeking behaviour of study participants, although mainly confined within the ethnomedicine sector, shared much in common with that of people who use global CAM. The appeal of traditional therapies lay in their religious and moral legitimacy within the South Asian community, especially to the older generation who were disproportionately influential in the determination of treatment choices. As a second generation made up of people of Pakistani origin born in the UK reach the age when they are the influential decision makers in their families, resort to traditional therapies may decline. People had long experience of navigating plural systems of health care and avoided potential conflict by maintaining strict separation between different sectors. Health care practitioners need to approach these issues with sensitivity and to regard traditional healers as potential allies, rather than competitors or quacks.
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Tuan NA, Cuong LQ, Allebeck P, Chuc NTK, Tomson T. Knowledge attitudes and practice toward epilepsy among adults in BaVi, Vietnam: first report from the population-based EPIBAVI study. Epilepsia 2007; 48:1914-9. [PMID: 17634066 DOI: 10.1111/j.1528-1167.2007.01174.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PURPOSE We conducted a survey to assess knowledge, attitudes, and practice toward epilepsy in a population-based study in a rural district of Vietnam. METHODS We utilized an established knowledge-attitudes-practice questionnaire. This was applied by trained surveyors in face-to-face interviews of 2005 randomly selected adult residents (19-71 years of age) of the BaVi district, 60 km west of Hanoi. RESULTS Of the respondents, 67.0% had heard about epilepsy, 52.1% had known someone with seizures, and 49.3% had witnessed seizures. In total, 36.3% would object to their children playing with someone with seizures and 82.0% to their children marrying someone with epilepsy. Only 32.6% thought that epilepsy patients should be employed in a job as other people, while 10% thought that epilepsy was a form of insanity. Familiarity with epilepsy, having heard of epilepsy, known someone with epilepsy, or having seen seizures was associated with less negative attitudes. About half of the respondents (50.4%) thought epilepsy was caused by a brain disease and 80.1% would suggest consultation of a medical doctor for epilepsy. CONCLUSIONS Knowledge of epilepsy among Vietnamese people is still limited compared to some Western countries and the attitudes more negative. Our findings indicated more negative attitudes than in another recent survey from Vietnam. This may be due to differences in sociodemographic characteristics and educational level of the study populations. The discrepancies demonstrate the importance of selection of study population and the need for caution in generalizing from results of surveys.
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Affiliation(s)
- Nguyen Anh Tuan
- Department of Neurology, Hanoi Medical University, Hanoi, Vietnam.
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Mbewe E, Haworth A, Atadzhanov M, Chomba E, Birbeck GL. Epilepsy-related knowledge, attitudes, and practices among Zambian police officers. Epilepsy Behav 2007; 10:456-62. [PMID: 17363333 PMCID: PMC2749646 DOI: 10.1016/j.yebeh.2006.12.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2006] [Revised: 12/26/2006] [Accepted: 12/28/2006] [Indexed: 11/23/2022]
Abstract
OBJECTIVE In Zambia, where emergency medical services are very limited, the police are frequently called to the scene for unaccompanied people experiencing seizures or exhibiting disturbed behaviors during a seizure. Police officers receive no formal medical training to manage such encounters. We developed and administered a police-specific survey to assess knowledge, attitudes, and practices (KAP) regarding epilepsy among police officers in Zambia. METHODS In 2004, a 28-item KAP questionnaire that included queries specific to police encounters with seizures and epilepsy was developed and delivered to a random sample of 200 police officers stationed in Lusaka. Descriptive data were reviewed and open text questions postcoded and categorized. RESULTS The response rate was 87.5% (n=175). Police were familiar with epilepsy, with 85% having witnessed a seizure. Although 77.1% recognized epilepsy as a brain disorder, almost 20% blamed spirit possession, 13.9% associated epilepsy with witchcraft, and more than half the respondents believed epilepsy is contagious. When asked how they would treat someone brought in for disturbing the peace during a seizure, most police provided supportive or neutral responses, but 8% reported taking harmful actions (arrest, detain, handcuff, restrain), and 14.3% indicated that people with epilepsy in police custody require quarantine. CONCLUSIONS A significant number of police officers in Zambia lack critical knowledge regarding epilepsy and self-report detrimental actions toward people with seizures. In regions of the developing world where the police provide emergency medical services, police officers need to be a target for educational and social intervention programs.
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Affiliation(s)
- Edward Mbewe
- Chainama Hills College Hospital, PO Box 30043, Lusaka, Zambia.
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Chomba EN, Haworth A, Atadzhanov M, Mbewe E, Birbeck GL. Zambian health care workers' knowledge, attitudes, beliefs, and practices regarding epilepsy. Epilepsy Behav 2007; 10:111-9. [PMID: 17055341 PMCID: PMC2938019 DOI: 10.1016/j.yebeh.2006.08.012] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2006] [Revised: 07/31/2006] [Accepted: 08/20/2006] [Indexed: 10/24/2022]
Abstract
OBJECTIVE Zambia suffers from a physician shortage, leaving the provision of care for those with epilepsy to nonphysician health care workers who may not be adequately trained for this task. These individuals are also important community opinion leaders. Our goal in this study was to determine the knowledge, attitudes, beliefs, and practices of these health care workers with respect to epilepsy. METHODS Health care workers in urban and rural districts of Zambia completed a self-administered, 48-item questionnaire containing items addressing demographics, personal experience with epilepsy, social tolerance, willingness to provide care, epilepsy care knowledge, and estimates of others' attitudes. Analyses were conducted to assess characteristics associated with more epilepsy care knowledge and social tolerance. RESULTS The response rate was 92% (n=276). Those who had received both didactic and bedside training (P=0.02) and more recent graduates (P=0.007) had greater knowledge. Greater knowledge was associated with more social tolerance (P=0.005), but having a family member with epilepsy was not (P=0.61). Health care workers were generally willing to provide care to this patient population, but approximately 25% would not allow their child to marry someone with epilepsy and 20% thought people with epilepsy should not marry or hold employment. Respondents reported that people with epilepsy are feared and/or rejected by both their families (75%) and their community (88.8%). CONCLUSIONS Knowledge gaps exist particularly in acute management and recognition of partial epilepsy. More recent graduates were more knowledgeable, suggesting that curriculum changes instituted in 2000 may be improving care. Health care workers expressed both personal and professional reservations about people with epilepsy marrying. In addition to improving diagnosis and treatment skills, educational programs must address underlying attitudes that may worsen existing stigmatizing trends.
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Affiliation(s)
- Elwyn N Chomba
- Department of Pediatrics and Child Health, University of Zambia School of Medicine, Nationalist Road, Lusaka, Zambia.
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Birbeck G, Chomba E, Atadzhanov M, Mbewe E, Haworth A. The social and economic impact of epilepsy in Zambia: a cross-sectional study. Lancet Neurol 2007; 6:39-44. [PMID: 17166800 PMCID: PMC2938018 DOI: 10.1016/s1474-4422(06)70629-9] [Citation(s) in RCA: 105] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Among the 40 million people with epilepsy worldwide, 80% reside in low-income regions where human and technological resources for care are extremely limited. Qualitative and experiential reports indicate that people with epilepsy in Africa are also disadvantaged socially and economically, but few quantitative systematic data are available. We sought to assess the social and economic effect of living with epilepsy in sub-Saharan Africa. METHODS We did a cross-sectional study of people with epilepsy concurrently matched for age, sex, and site of care to individuals with a non-stigmatised chronic medical condition. Verbally administered questionnaires provided comparison data for demographic characteristics, education, employment status, housing and environment quality, food security, healthcare use, personal safety, and perceived stigma. FINDINGS People with epilepsy had higher mean perceived stigma scores (1.8 vs 0.4; p<0.0001), poorer employment status (p=0.0001), and less education (7.1 vs 9.4 years; p<0.0001) than did the comparison group. People with epilepsy also had less education than their nearest-age same sex sibling (7.1 vs 9.1 years; p<0.0001), whereas the comparison group did not (9.4 vs 9.6 years; p=0.42). Housing and environmental quality were poorer for people with epilepsy, who had little access to water, were unlikely to have electricity in their home (19%vs 51%; p<0.0001), and who had greater food insecurity than did the control group. During pregnancy, women with epilepsy were more likely to deliver at home rather than in a hospital or clinic (40%vs 15%; p=0.0007). Personal safety for people with epilepsy was also more problematic; rape rates were 20% among women with epilepsy vs 3% in the control group (p=0.004). INTERPRETATION People with epilepsy in Zambia have substantially poorer social and economic status than do their peers with non-stigmatised chronic medical conditions. Suboptimum housing quality differentially exposes these individuals to the risk of burns and drowning during a seizure. Vulnerability to physical violence is extreme, especially for women with epilepsy.
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Affiliation(s)
- Gretchen Birbeck
- Michigan State University's International Neurologic and Psychiatric Epidemiology Program, East Lansing, MI 48824-1313, USA.
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Birbeck GL, Chomba E, Atadzhanov M, Mbewe E, Haworth A. Zambian teachers: what do they know about epilepsy and how can we work with them to decrease stigma? Epilepsy Behav 2006; 9:275-80. [PMID: 16877045 DOI: 10.1016/j.yebeh.2006.06.005] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2006] [Revised: 05/31/2006] [Accepted: 06/05/2006] [Indexed: 11/21/2022]
Abstract
PURPOSE Teachers play a central role in determining access to education and may mediate epilepsy-associated stigma. We developed and administered a teacher-specific survey to assess teachers' knowledge, attitudes, behaviors, and practices (KABPs) regarding epilepsy in Zambia and social and demographic determinants of KABPs. METHODS In 2004, we surveyed 171 teachers in urban and rural regions using a 46-item questionnaire. Knowledge and tolerance composite scores were developed and analyses completed to identify demographic and social determinants of KABPs and evaluate whether generic tolerance questions were associated with stigmatizing practices. RESULTS The response rate was 93% (n=159). Knowledge regarding epilepsy ranged broadly. Misattribution was evident for etiology (spirit possession 17.3%; contagion 28.2%; witchcraft 16.8%), and individuals with poorer knowledge were more likely to recommend traditional healers (p=0.0004) rather than physicians for epilepsy care. Higher knowledge was associated with higher tolerance (p=0.01). Tolerance was highest among urban residents (p=0.002) and individuals with personal familiarity/experience with epilepsy. More tolerant teachers were less likely to report stigmatizing practices, such as ejecting children with seizures from school. CONCLUSIONS Teacher-targeted interventions aimed at reducing epilepsy-associated stigma and its sequelae in Zambia should include both an educational component and a social component in which teachers are exposed to a person or persons with the condition. Education programs led by person(s) with epilepsy may be ideal.
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Affiliation(s)
- Gretchen L Birbeck
- Michigan State University's International Neurologic and Psychiatric Epidemiology Program (INPEP), East Lansing, MI, USA.
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