Knowledge , Attitudes and Practices of Schoolchildren Towards Epilepsy in Bindura District, Zimbabwe: Implications for school health promotion

1
Knowledge , Attitudes and Practices of
Schoolchildren Towards Epilepsy in Bindura
District, Zimbabwe Implications for school
health promotion

• Ignicious Murambidzi
• James January

2
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)

3
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)

4
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)

5
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.

6
Rationale

• The study sought to contribute to the knowledge
  base on communitys 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

7
Study purpose

• Aim - obtain baseline data on the knowledge,
  attitudes and practices of schoolchildren with
  respect to epilepsy
• Objectives
• To assess school childrens 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.

8
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

9
Results

Sex 229 females 282 males
Age 127 (12-14 yrs) 262 (15-17yrs) 124 (18yrs)
Mean age 16 years (sd 2) Mean age 16 years (sd 2) Mean age 16 years (sd 2) 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 )
10
Results

• Familiarity 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)

11
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

12
Results

• Practices
• 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,
  p0.002) and school location (urban, p0.039)

13
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.

14
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

15
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

16
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

17
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.

18
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, 414418
• 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
  2002336875.
• 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) 275280

19
References

• de Boer, H.M., Mula., M Sander W.S, 2008, The
  global burden and stigma of epilepsy, Epilepsy
  Behavior 12 540546
• 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.

20
References

• ILAE/IBE/WHO (2003) Global Campaign against
  Epilepsy. Out of the Shadows. Geneva
• Leonardi M, Ustun T. The global burden of
  epilepsy. Epilepsia 200243 (6)215.
• 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 10103.
• MacLeod, JS and Austin, JK., (2003) Stigma in
  the lives of adolescents with epilepsy a review
  of the literature, Epilepsy Behavior 4 (2003)
  112117
• 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 201088260266

21
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,1410611.
• 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

22
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 2005351536
• 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 344351