Epileptic Disorders
MENUKnowledge of epilepsy and attitudes towards the condition among schoolteachers in Bobo‐Dioulasso (Burkina Faso) Volume 6, issue 1, March 2004
Auteur(s) : Athanase Millogo, Antoine S. Siranyan
Centre Hospitalier National Souro Sanou, Bobo-Dioulasso, Burkina Faso
Received June 19, 2003; Accepted October 3, 2003
Epilepsy is one of the most common neurological diseases of childhood worldwide. Its prevalence is about 15 per 1,000 in the general population of Burkina Faso [1]. Epilepsy still remains a public health problem, with socio-cultural, economical and medical impacts in Africa [2, 3]. Except for one paper dealing with the socio-cultural aspects of epilepsy among secondary school students [4], there is no epidemiological study related to the prevalence of epilepsy either in the general population or in schools in our area. In the Bobo-Dioulasso teaching hospital, epilepsy in childhood represents about 30% of children visiting the neurological department [4]. Sometimes the social discrimination against persons with epilepsy may be more devastating than the disease itself. In general, teachers do not receive any formal instruction on epilepsy during their training. However, they could play an important part in the management and surveillance of children with epilepsy.This study was undertaken to examine teachers’ perception of epilepsy, with regards to their knowledge, attitude and beliefs.
Methods
The study was done in Bobo-Dioulasso, an urban area in the
Western region of Burkina Faso. Bobo-Dioulasso is a city
(population 500,000) located in an agricultural and trading region
and whose economy is based on industry and commercial activities.
The city is considered to be a regional educational pole as there
are several public and private primary and secondary schools and
one public university.
For the academic year 2002-2003, the regional primary teaching
headquarters had 989 primary schoolteachers (534 males
and 455 females), from 79 public and 35 private
primary schools. Two hundred and sixty teachers, chosen at random
from 38 public and 19 private schools, were invited to
participate in the study, by answering a questionnaire which
quantified the knowledge, attitude and practice toward epilepsy
among selected populations. The questionnaire (see Appendix
p. 25) was administered in French by medical students, in
February 2003.
The questions were mainly of the yes/no/don’t know type, but
teachers were also allowed to express their opinions by means of
free answers. For the question about the first aid required when
attending a person during a seizure, we considered that initial
procedures such as protecting the head and staying near the subject
until the end of the seizure, avoiding any harmful situations, were
correct. Inadequate first aid were all those procedures which may
be harmful to the patient, such as pulling the tongue or putting
objects in the mouth.
Results
Socio-demographic characteristics of the sample
The main data related to the schools, teachers’ age, sex and religions are listed in table 1. The responses to the questions about familiarity and attitude toward epilepsy are summarised in table 2. The answers to the question “How would you attend a person during a seizure?” are provided in table 3.
Table 1. Demographic characteristics of the teachers.Public schools | 217 | 83.5% |
---|---|---|
Private schools | 43 | 16.5% |
Teachers’ age (years) | ||
< 30 | 34 | 13% |
30-49 | 204 | 78.5% |
≥ 50 | 22 | 8.4% |
Sex | ||
Male | 121 | 46.5% |
Female | 139 | 53.5% |
Religion | ||
Christians | 178 | 68.4% |
Moslems | 79 | 30.3% |
Others | 3 | 1.2% |
Experience (years) | ||
≤ 6 | 40 | 15.5% |
6-10 | 55 | 21.3% |
≥ 10 | 163 | 63.2% |
Table 2. Responses to questions about familiarity and attitude towards epilepsy.
Question |
Yes | No | I don’t know |
---|---|---|---|
Have you ever read or heard something about epilepsy? | 98.% | 1.2% | |
Do you know someone who has epilepsy? | 77.3% | 22.7% | |
Have you ever seen an epileptic seizure? | 90.8% | 9.2% | |
Do you think epilepsy is a contagious disease? | 11.9% | 73.8% | 14.2% |
Do you think there is discrimination against people who have epilepsy? | 73.1% | 26.9% | |
Do you object to having a pupil with epilepsy in your class? | 15.4% | 84.6% | |
Do you think that a pupil with epilepsy may be as intelligent as others? | 81.2% | 18.8% | |
Do you think all the seizures are characterised by convulsive tremors and loss of consciousness? | 85.8% | 14.2% |
Table 3. How would you attend a person during a seizure?
Question |
Yes | No |
---|---|---|
Pull the tongue | 5% | 95% |
Remove nearby objects | 78.7% | 21.3% |
Protect the head | 60.9% | 39.1% |
Take to a hospital | 42.6% | 57.4% |
Wait for the end of the seizure | 34.5% | 65.5% |
Put an object between the teeth | 27.5% | 72.5% |
Lay the subject down until the end of the seizure | 64% | 36% |
Take the shirt out | 27.9% | 72.1% |
Teachers’ body of knowledge
Almost all of the teachers had heard about epilepsy and had seen
a seizure, while three quarters of them knew someone with
epilepsy.
The most frequently mentioned manifestations of epilepsy were loss
of consciousness, convulsions, foaming at the mouth, amnesia. Among
the 260 teachers, 57% mentioned manifestations related to
“absence”. In 43.2%, teachers related epilepsy to central nervous
system disturbances. Epilepsy was thought to be a contagious
disease by 11.9% and hereditary by 7.7% of the interviewees. The
disease was characterised only by convulsive tremors and loss of
consciousness for 85.8% of the interviewees.
According to teachers, school drop-outs (80.6%), failing and being
held back (83.9%), idiocy (57.2%), and madness (30.7%) were the
most frequently mentioned consequences of epilepsy.
Treatment of epilepsy
Seventy five per cent of the interviewees thought that epilepsy could be treated, while 13.5% thought that it could not be treated. Among those who thought that epilepsy could be cured, 15% thought that epilepsy could be cured only by modern medicine, and 56.5% mentioned that epilepsy could be cured by combination of traditional and modern medicine.
Teachers’ attitudes
At least 40% of the teachers had some knowledge of the initial
first aid to administer during a seizure, such as removing nearby
objects, protecting the head or taking to the hospital. However,
some incorrect ones such as pulling the tongue or putting objects
between the teeth were given.
Fifteen point four per cent objected to epileptic students in
their classes because these students could disturb others. Despite
the fact that most of the teachers believed that this disease is a
natural disease, they also thought that there is discrimination
against people with epilepsy, mainly because 55% thought there was
a risk of contamination. However they did not object to have
epileptic children in their classes.
Teachers’ suggestions
As teachers they had not received any form of health education about epilepsy, the majority of teachers (85.7%) wished to know more about first aid for epilepsy, and would be interested in training for this, and for clinical manifestations and the aetiology of epilepsy.
Discussion
In our study, most of the teachers were familiar with epilepsy
as in other reports (5, 6), although many of them complained about
the extent of their knowledge concerning this disease. In another
study [7], the majority had never been informed about epilepsy and
this finding reflected the great number of equivocal answers
obtained from them. The mythical idea of epilepsy as a contagious
disease [6, 8, 9, 10] comes from the past. Our work and that of
others showed that this idea was still prevelant among certain
teachers [6, 11, 12]. This seems to be one of the most relevant
problems observed.
In Africa, epilepsy is often believed to be contagious, mainly
through saliva and physical contact. This opinion was also noticed
in other studies, especially in Africa [4, 6, 9, 10]. This may be
one of the explanations as to why there are objections to teaching
children with epilepsy. In general, parents object to allowing
their children to have social contact with a person with epilepsy
at school [8, 13, 14]. Some of the teachers objected to having
epileptic children in their classes, although most teachers did
not. In another report, 15% of the respondents preferred to place
all children with epilepsy in a special classroom [15]. This
preference may result from fear of having to deal with a seizure.
Unfortunately, a teacher’s negative attitude towards epilepsy as
seen in a previous study [12] could lead to dismissal of the
student.
Most of the respondents did not report any kind of discrimination
against children with epilepsy. In another survey conducted in
Zimbabwe, the majority of teachers would teach an epileptic child
[6]. But in our study, as in others [6, 9, 16, 17, 18], it was
assumed that epilepsy would affect school performance because of
learning problems.
Unfortunately, many people still believe that epilepsy is a
disease always observed in mentally impaired persons. In our study,
some teachers had doubts about the cognitive potential of students
with epilepsy. Nineteen thought that epileptic students could not
be as intelligent as other students.
Several teachers were misinformed about the clinical
characteristics of the seizures, reflecting the lack of specific
training. In general, most people still believe that only the
generalised tonic-clonic type is really a seizure [4]. This
attitude had already been noticed in a previous study dealing with
knowledge and attitude towards epilepsy among traditional healers
in Bobo-Dioulasso.
We think this is one of the most misleading aspects of the
attitude towards epilepsy, and it points to the necessity of
training. Many of the teachers were not really familiar with the
initial procedures to employ when attending a person during a
seizure. The initial procedures adopted by some teachers who
answered this question would often be inappropriate, although the
answers in general were not entirely unsatisfactory. Some of the
incorrect procedures were related to mythical concepts. In another
study in Thailand, half of the respondents who had experience with
first-aid management of seizures also used improper and potentially
harmful measures [15], and misconceptions regarding first aid are
common [17]. These difficulties were related to poor educational
programs for epilepsy. General public education campaigns for
epilepsy must also be encouraged in order to improve the quality of
life of people with epilepsy [15].
As suggested by many of the teachers, there is the need for wider
public education about epilepsy. With increased levels of specific
education among teachers and the general population, a more
tolerant attitude towards epilepsy can be expected in the hope of
achieving the objectives of the “Out of the Shadow” World
campaign.
Acknowledgements
We thank Mrs Nanette Alvey for the revision of the English version of this paper. n