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Epileptic Disorders

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Knowledge 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