Journal of Neurological Research and Therapy
ISSN: 2470-5020
Current Issue
Volume No: 2 Issue No: 4
share this page

Research Article | Open Access
  • Available online freely | Peer Reviewed
  • Epilepsy: Knowledge and Attitudes of Primary School Teachers in the City of Bouake/Ivory Coast

    Akani AF 1     Karidioula HA 1     Bony KE 1       Gnazégbo A 1     Kouamé-Assouan A-E 1     Tanoh AC 2     Diallo LL 3     Sylla A 1     Koffi YT 1    

    1Department of Neurology, University Teaching Hospital, Alassane Ouattara University, Bouake Ivory Coast.

    2Department of Neurology, University Teaching Hospital of Cocody, Felix Houphouet Boigny University / Abidjan Ivory Coast.

    3Department of Neurology, Teaching Hospital of Conakry, Guinea University of Conakry.

    Abstract

    We report the results of a two-month descriptive observational survey to assess the knowledge about epilepsy among primary school teachers in Bouake in Ivory Coast. This study included 310 teachers who were randomly chosen from three Primary School Inspections (PSI). Almost all the teachers who were included had shown inaccurate information about epilepsy. 46.45% of the respondents thought that epilepsy was contagious and 47.74% recommanded to avoid contacting with salivary secretions of the patient during seizure. For 16.45% of them, persons living with epilepsy (PWE) could be not married and 19.7% believed that PWE could not have children due to the risk of transmission. This study highlights the urgent need of awareness campaigns among primary school teachers.

    Received 16 Mar 2018; Accepted 24 Sep 2018; Published 27 Sep 2018;

    Academic Editor:Dr. Sidharth Mehan, Associate Professor, Department of Pharmacology, Rajendra Institute of Technology & Sciences (Rits).

    Checked for plagiarism: Yes

    Review by: Single-blind

    Copyright©  2018 Akani AF, et al.

    License
    Creative Commons License    This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

    Competing interests

    The authors have declared that no competing interests exist.

    Citation:

    Akani AF, Karidioula HA, Bony KE, Gnazégbo A, Kouamé-Assouan A-E et al. (2018) Epilepsy: Knowledge and Attitudes of Primary School Teachers in the City of Bouake/Ivory Coast. Journal of Neurological Research And Therapy - 2(4):1-8.
    Download as RIS, BibTeX, Text (Include abstract )
    DOI10.14302/issn.2470-5020.jnrt-18-2032

    Introduction

    Epilepsy is a common neurological disorder with multiple and often curable causes 1. Epilepsy affects approximately 50 million people worldwide making it the most common neurological disorder globally 2. Most people living with epilepsy (PWE) live in low and middle income countries 3. The prevalence of epilepsy in Africa is greater than 10‰ 4. In Sub-Saharan Africa (SSA), the prevalence of active convulsive epilepsy is high and range from 2.2 to 58 per 1000 affecting and estimared 4.4 million people 5.

    In Ivory Coast, the prevalence of epilepsy has been estimated at 7‰ by Kouassi and al. 6. The PWE are still too often stigmatized because of the lack of knowledge about this disease and supernatural beliefs in the population 7. In Ivory Coast, several studies have demonstrated focused on the sociocultural aspects of the epilepsy in different population groups. Assi and al. carried out a study in a population of students in Abidjan 8. Boa and al. assessed the knowledges and beliefs on epilepsy in next of kin of PWE hospitalised in neurology 9. Akani and al. conduced a study on the knowledges of medical traditional health practitionners on epilepsy 10.

    Increased attention is currently scope to the quality of life, that is to say to the psychological and social problems faced by PWE, including access to education. Doumbia and al. have found 35.2‰ epilepsy in the preparatory course (C.P.1) students in their study carried out in one commune of abidjan in Ivory Coast 11. Schools should offer some useful information and assistance in health issues, such as epilepsy. Therefore, teachers should have sufficient knowledge for this purpose. Our study aims at assessing the level of knowledge of primary school teacher in the city of Bouake in Ivory Coast.

    Material and Methods

    That was a two-month descriptive observational study in the city of Bouake. Bouake, the second largest city, is located at the central part of Ivory Coast about , 355 km of Abidjan wich is the economic capital. The study was carried out based on the anonymous questionnaire on the socio-demographic characteristics, knowledge, beliefs and practical attitudes of respondents regarding to the epilepsy. It included both open and closed questions. The questionnaire was distributed to the respondents during the break and retrieved at the end of the same day for each school identified. It was validated after two pre-tests with two different groups of teachers from Bouake. This study was done in 3 Primary School Inspections (PSI) wich were randomly choosen among 5 PSI of the city in Bouake. We founded the maximum size of the sample with EPI Info 7.2 software. As a result , 310 teachers were recruited from 10 primary schools.

    Results

    Most of the respondents were men (73.87%) and the average age was 43.08 years. Muslims were predominant (46.45%), followed by christians (33.87%) and animists (19.68%). 59.03% of the respondents had a high school level and (40.97%) had university level. Table 1 show the demographic characteristics of the respondents.

    Table 1. Demographic characteristics of the respondents (N=310)
    Characteristics Frequency (n) Percentage (%)
    Gender Male 229 73,87
    Female 81 26,13
    Marital status Married 183 59,00
    Single 121 39,00
    Divorced 3 1,00
    Widowed 3 1,00
    Level of education Secondary 183 59,03
    University 127 40,97
    Religion Muslim 144 46,45
    Christian 105 33,87
    Animist 61 19,68
    Had a student living with epilepsy in their classes yes 21 6,77
    No 289 93,23

    Knowledge about epilepsy (Table 2)

    Origin of Epilepsy

    84.84% of respondents had little knowledge about epilepsy. However 62.58% thought that epilepsy was a brain disorder of medical origin wich may lead to madness within 32.9% of respondents While 17.4% of respondents believed that it was a spiritual illness caused by devil or God). 11.9% of respondents considered it as an hereditary disease (Table 2).

    Table 2. Knowledge about epilepsy
    Variable Frequency Percentage (%)
    Awareness on epilepsy No 42 13,55
    Little 263 84,84
    Good 5 1,61
    Origin of epilepsy Brain disorder 194 62,58
    Lead to madness 102 32,9
    Spiritual illness (evil or God) 54 17,4
    Inherited desease 37 11,9
    Ancesters desease 2 0,65
    Clinical signs Foamy drooling 247 79,68
    Loss of consciousness 168 54,2
    Stiffness 165 53,23
    Muscle twitching 150 48,39
    Loss of urine 57 18,39
    Tongue bite 35 11,30
    Favouring factors Head trauma 78 25,2
    Alcohol 24 7,74
    Insomnia 21 6,77
    Infections 20 6,45
    Contagiousness of epilepsy Yes 144 46,45
    No 166 53,55
    Way of contagion Body fluid (drool) 125 40,32
    Contact with patient in seizure 109 35,16
    Eat in the same plates 10 3,23
    Share same clothes 1 0,32

    Clinical Signs

    61.9% of teachers knew the generalized tonic-clonic seizure. For most of respondents (79.68%), the foamy drooling was a clinical sign of epileptic seizures. A loss of consciousness was reported in 54.2% of respondents, stiffness and muscle twitching were in 53.23% and 48.39% cases, respectively. The urinary incontinence and the tongue biting occured in 18.39% and 11.3% respectively. None of the respondents reported the the « absence » seizure. 6.77% of teachers had an epileptic patient in their classrooms.

    Favouring Factors

    Respondents had little knowledge about contributing factors of the epileptic seizures. The head traumatism was the main favouring factor among 25.2% of respondents, while alcohol, insomnia and infections were considered as causes in 7.74%, 6.77% and 6.45% of participants respectively.

    Perception of Epilepsy

    46.45% of the respondents believed in the contagiousness of epilepsy 40.32% by body fluids (drool), and 35.16% in contact with the seizure patient. 85.87% of the respondents regarded epilepsy as curable disease.

    Attitudes Toward Epilepsy

    Among the teachers, 35.16% recommended avoiding the contact with the patient during seizures and 47.74% insisted on the avoidance of the foaming drool. Actions such as "pouring water or powder on the subject" and "praying during the crisis" were mentioned in 10% and 10.96% cases, respectively. However, 25.16% of the teachers suggested to prevent the patient from falling during seizures and 37.74% mentioned to take him immediately to the hospital.

    Epilepsy and Daily Life

    99.35% of the respondents admitted that PWE should not be excluded from school, and thus, they should continue their normal education. 56% of participants considered that the PWE should not hold a position of responsibility in the community or working setting asvillage chief orcompany manager. The occupational setting of PWE should not be informed of their condition in 51.94% cases. Moreover, the PWE go to nightclub, eat with, play video games have children and get married in 65.48%, 46.13%, 37.5%, 19.70% and 16.45% cases of respondents, respectively. According to 50,32% of teachers, the PWE could drive a vehicle and 3.87% of whom would be in agreement with driving a public transport vehicle. 34.19% of teachers supposed that the PWE should not be buried in the same cemeteries with the others. Table 3 shows the beliefs on epilepsy.

    Table 3. Beliefs on epilepsy
    Variable Frequency Percentage (%)
    Attitude toward PWE in seizure Avoidness of the foaming drool 148 47,74
    Take immediately to hospital 117 37,74
    Avoid contact with the patiente in seizure 109 35,16
    Prevent from falling during seizure 78 25,16
    Praying during seizure 34 10,96
    Pouring water or powder 31 10
    Epilepsy and daily life PWE could continue normal education Yes 308 99,35
    No 2 0,65
    PWE should go to nightclub Yes 107 34,52
    No 203 65,48
    PWE could hold a position of responsibility Yes 136 44
    No 174 56
    The professionnal community of PWE should be informe of its state Yes 149 48.06
    No 161 51.94
    PWE should eat on the same plate as the others Yes 167 53,87
    No 143 46,13
    PWE Could drive a vehicle Yes 156 50,32
    No 154 49,68
    PWE Could drive a public transport vehicle Yes 12 3,87
    No 298 96,13
    PWE should play video games Yes 194 62,6
    No 116 37,4
    PWE should have children Yes 249 80,30
    No 61 19,70
    PWE should get married Yes 259 83,55
    No 51 16,45
    PWE should be buried in the same cimeteries as the others Yes 204 65,81
    No 106 34,19

    Expectations of Teachers

    Our study revealed that all teachers needed thorough information about epilepsy. The information tools used were distribution of flyers (44.5%), audiovisual media (32.26%), availability of scientific papers (16.77%). The majority of respondents suggested that PWE should join associations of patients, friends and parents of patients (96.15%). This membership would help to better understand the epilepsy (63,87%), raise awareness (56,45%), access to the treatment (27,74%) and improve the management of epilepsy (43.55%).

    Discussion

    This study has been done in a young and high educatied population. We found that the majority of primary school teachers, who have completed higher education, indicated that they were not enough informed about the epilepsy. This finding was also reported by Maïga (58.7% of the teachers) in Mali 7, Kiwanuka in Uganda 3 and Owolabi in a study conduced in a school teachers population in Nigeria 12. Despite this fact, they knew that epilepsy was a brain disorder from a medical origin. In contrast , some teacher considered it as a supernatural disease due the deep-rooted beliefs in population. This finding agrees with the studies in Abidjan 8, in Benin 1, in Nigeria 12, 13, in Ouganda 3, in Zimbabwe 14 and in Brazil 15.The confusion between epilepsy and mental illness remains, since 32.9% of the respondents admitted that the epilepsy was related to madness.

    Many teachers have recognized the spectacular tonic-clonic seizure, associated with stiffness, convulsion, loss of consciousness, tongue biting and urinary incontinence. The tonic-clonic seizure, generally known as the "great evil" seizure, considered as the major symptome of the epilepsy, wich is well describe by our participants 8. This finding agrees with other reports 12, 16. None of the respondents knew the absence seizure. It rarely helps to diagnose the epilepsy since it highly unseen 10. This finding reported by Owolabi has great implication for in-school recognition of non convulsive seizure 12. The « absence » seizure mostly occurs in school-aged children, with poor school performance implications. Hereby, it is relevant for teachers to be aware of this disease so that they will contribute to diagnose it early. Futher more, they should aware of the factors favouring the occurrence of seizures. The concept of contagiousness still remains. 79.68% of teachers identified the foamy drooling as clinical sign of epilepsy, and 39.14% believed that epilepsy could be spread by touching with the patient during the seizure. This fact was also identified by Owolabi 12 and increases the attitudes of fear and rejection of the patient 10, 12. The conceptions including "avoid touching PWE in seizure" and "avoid his drool" are strongly indicated by the teachers despite their high education level and explain the high rate of accidents occurring within PWE during seizures 8.

    The daily life of PWE is characterized by these misconceptions and thus, leading to social, professional, and family prohibitions as also described by Assi and al 8. All teachers have admitted that thePWE can maintain normal schooling. Objectively, education of epileptic children, can be hindered by several problems, including psychomotor disorder, fear of discrimination, fear of falling in the crowd, and family guilt 17. 56% of teachers have revelead that the PWE should not have a position of responsibility. Assi and al. have made the same observation in a student population in Abidjan in Ivory Coast and have linke dit it with the suddenness and disabling nature of epileptic seizures 8. The professional environment of PWE should not be informed according to 51.94% of the teachers because of the fear of exclusion or dismissal 8. Therefore the awareness of the occupational community may help to take actions during seizures or to obtain a job adaptation 8.

    The lack of knowledge about epilepsy will perpetuate the misconceptions. In addition, the PWE must not only have leisure, such as disco and video games but also eat on the same plates as other members of the family. This fact is a major factor of exclusion in traditional African settings7, 8, 18. In some cultures, the epilepsy is still considered as a reason to prohibit or cancel a weddingamong16.45% of our study respondents 19 due to the risk of transmission to offspring. All respondents would like to get more information about epilepsy through flyers or audiovisual media. The Ivoirian Association against Epilepsy (A.I.L.E) should implement a social marketing strategy on epilepsy awareness flyers and to increase the sensibility campaign for teachers in Bouake so that they would eliminate the misconceptions about epilepsy. This awareness activity could be done in collaboration with the association "stop epilepsie", an Ivorian association of PWE and PWE family.

    Limitations

    This study has some limitations which should be considered in the interpretation of our findings. Explanations were provided to the participant on some questions and this might have affected their responses. The study took place over two months and some teachers interviewed could have given information to their colleagues or read documents. This might have affected theirs spontaneous responses. Despite these limitations, the benefit of this study is that it provide responses that can be considered as baseline for the A.I.L.E social marketing strategy, and considered as base line for comparison with the next studies.

    Conclusion

    Primary school teachers play a vital role in educational and psychosocial development of student as an important part of their life is spent at school. The epilepsy is still, an unknown neurological disorder due to several misconceptions and the lack of knowledge in view of this study. Primary school teachers have erroneous knowledge about epilepsy Hereby, this study should carefully suggest to enhance the understanding or perception of this disease among the populations, particularly in primary school teachers under the management of the Ivoirian Association against Epilepsy (A.I.L.E).

    References

    1.Adoukonou T, Tognon-Tchegnonsi F, Gnonlonfou D, Djidonou A, Sego-sounon D et al. (2015) aspects socio-culturels de l’épilepsie dans une communauté rurale au nord du Bénin en2011.Bull.Soc.Pathol.Exot.108:. 133-8.
    2. (2018) WHO. Epilepsy fact sheet: World Health Organisation. Available at http://www.who.int/news-room/facts-heets/detail/epilepsy.
    3.Kiwanuka Frank.Carolyne Anyango Olyet. (2018)Knowledge, attitude, and beliefs on epilepsy among adults. in EruteSouth,Liradistrict,Uganda.EpilepsiaOpen, 3(2) : 264-269. DOI : 10.1002/epi4.12223 .
    4.Avode D G, Houinato D S, Tevoedjre M, Adjien C, Adoukonou T et al. (2003) Epilepsie en milieu scolaire à Cotonou (Benin). , Afr J Neurol Sci;22 2.
    5.Paul A, Adeloye D, George-Carey R, Ivana K, Grant L et al. (2012) An estimate of the prevalence of epilepsy in sub-saharan Africa : a systematic analysis. , J Glob Health; 2, 1-13.
    6.Kouassi B, Koffi J K, Diarra J A. (1988) Prévalence de l’épilepsie en milieu rural ivoirien: étude pilote. , Pub Méd Afr; 89, 25-30.
    7.Maiga Y, Diarra M, Ct Kuate, Kayentao K, Dicko F et al. (2015) L’épilepsie en milieu scolaire: Enquête chez les enseignants de la ville de Kati au Mali et revue de la littérature. , Afr J Neurol Sci 34-1.
    8.Assi B, Aka-Anghui Diarra E, Kouamé-Assouan A E, Akani F, Doumbia M et al. (2009) Épilepsie: enquête sur les aspects socioculturels et attitudes, menée dans une population de 300 étudiants vivant sur un campus universitaire à Abidjan (Côte d’Ivoire). Epilepsies. 21(3), 296-306.
    9.Boa Y F, Doumbia-Ouattara M, Kl Kouassi, Diakite I, Amon-Tanoh M et al. (2015) Approche socio-culturelle de l’épilepsie en Côte d’Ivoire. , Afr J Neurol Sci 33(2), 10-6.
    10.François A A, B K Elisee, T A Christian, K H Armel, Any G et al. (2014) Tradipraticiens et épilepsies en Côte d’ivoire. Rev Neurol. 170, 508-511.
    11.Mariam Doumbia-Ouattara. (2013) Kouame-Assouan Ange- Eric , Aka-Diarra Evelyne, Kouassi Kouame Leonard, Diakite Ismaila, Sonan-Douayoua Therese.Epilepsie en milieu scolaire en côte d’ivoire. Données d’une enquête réalisée dans la commune de yopougon à Abidjan. , Afr J Neurol Sci 32(2), 30-5.
    12.Lukman Femi Owolabi, Naziru Muhammad Shehu.Shakirah Desola Owolabi. Epilepsy and education in developing countries/ a survey of school teachers’ knowledges about epilepsy and their attitude towards students with epilepsy in Northwestern Nigeria. Available online at :. http://www.panafrican-med-journal.com/content/article/18/225/full/
    13.Kabir M, Iliyasu Z, Abubakar I S, Kabir Z S, Farinyaro A U. (2005) Knowledge, attitude and beliefs about epilepsy among adults in a northern nigerian urban community. Annals of African Medecine. Pubmed Google scholar 4(3), 107-112.
    14.Gedefa M, Wolde T, Solomon G. (2012) Knowledge, attitudes and practices with respect to epilepsy among a Preparatory School Students. in Mekelle city, Ethiopia. International journal of Collaborative Research on Internal Medicine and Public health ;4(3) : Pubmed Google scholar 203-215.
    15.Asdrubal F, Alisson R T, Felipe R, Maira C V, Marcelo R R et al. (2007) awareness, attitudes and perceptions on epilepsy in southern Brazil. Pubmed Google scholar , Arq.Neuro-Psiquiatr 65(4), 1181-1185.
    16.Njamnshi A K, Tabah E N, Bissek A Z, Yepnjo F N. (2010) Knowledge, attitudes and practices with respect to epilepsy among student nurses and laboratory assistant in the south west region of Cameroon. Epilepsy Behav ; 17(3) : 381-388. Pubmed Google scholar.
    17.Ip Ndiaye, Ndiaye M, Tap D. (1983) Sociocultural aspects of epilepsy in Africa. , Prog Clin Biol Res 124, 345-51.
    18.Millogo A, Siranyan A S. (2004) Knowledge of epilepsy and attitudes towards the condition among school teachers in Bobo-Dioulasso (Burkina Faso). Epileptic Disord. 6, 21-6.
    19.OMS Épilepsie. (2001) conséquences sociales et aspects économiques. Aide-mémoire no 166. Révisé en février.