|Year : 2016 | Volume
| Issue : 2 | Page : 104-110
Public attitudes and knowledge toward epilepsy in ismailia governorate
Ahmed Osama1, Mohammed Abd El Fatah El Smahy2, Mona El sayed MD 3, Sabry Moawad4
1 Professor of Neurology, Neuropsychiatry Department, Suez Canal University, Ismailia, Egypt
2 Lecturer of Neurology, Neuropsychiatry Department, Suez Canal University, Ismailia, Egypt
3 Lecturer of Psychiatry, Neuropsychiatry Department, Suez Canal University, Ismailia, Egypt
4 Resident in the Department of Neuropsychiatry, Mansoura International Hospital, Mansoura, Egypt
|Date of Submission||07-Jun-2016|
|Date of Acceptance||02-Aug-2016|
|Date of Web Publication||2-Nov-2016|
Mona El sayed
Lecturer of Psychiatry, Neuropsychiatry Department, Suez Canal University, Ismailia
Source of Support: None, Conflict of Interest: None
Objective This study was conducted to find out knowledge and attitudes toward epilepsy among a sample of people living in Ismailia governorate in Egypt.
Patients and methods A cross-sectional survey was conducted by using a face-to-face interview; 840 respondents were included, among whom 420 were from an urban area − Sheikh Zayed district − and 420 were from a rural area − Abu-Sultan village. The survey instrument was a 26-item questionnaire in Arabic form that was designed to evaluate knowledge and attitudes with respect to epilepsy.
Results Of the 840 respondents, 91.2% had heard of or read about epilepsy, 24.8% knew someone with epilepsy, and 30.7% had witnessed a seizure. According to the respondents, the main cause of epilepsy was psychological disease (63.7%), followed by evil spirits (Jinn) (49.5%) and a form of insanity (47.4%). Approximately 70% of the respondents (70.7%) agreed that the intelligence of an epileptic patient is below average. About three-quarters of the respondents (74.6%) believed that epilepsy cannot be cured. More than 50% of the respondents believed that an epileptic patient could not get married (57.5%), nor have a child (58.7%). About 80% of the respondents refused to marry an epileptic patient (77.7%) or to marry their child to an epileptic patient (83.0%). Fifty-nine percent of the respondents would not offer a job to a person with epilepsy, and 41.1% refused working with an epileptic patients. The negative attitudes toward an epileptic person were more common among rural, female, less-educated, and elderly respondents.
Conclusion Public perception of epilepsy is lacked and needs attention. The study revealed that practices and knowledge toward epilepsy were limited, especially with respect to epilepsy’s cause, manifestation, and management. Continuing effective educational interventions would be needed to improve the appropriate understanding of epilepsy, and to ameliorate the social discrimination and misconceptions against epilepsy.
Keywords: attitudes, knowledge, epilepsy
|How to cite this article:|
Osama A, El Smahy MA, El sayed M, Moawad S. Public attitudes and knowledge toward epilepsy in ismailia governorate. Egypt J Psychiatr 2016;37:104-10
|How to cite this URL:|
Osama A, El Smahy MA, El sayed M, Moawad S. Public attitudes and knowledge toward epilepsy in ismailia governorate. Egypt J Psychiatr [serial online] 2016 [cited 2023 Sep 21];37:104-10. Available from: https://new.ejpsy.eg.net//text.asp?2016/37/2/104/193016
| Introduction|| |
Nearly 80% of people with epilepsy (PWE) are found in developing countries, where epilepsy remains a major public health problem, not only because of its health implications but also for its social, cultural, psychological, and economic effects (Njamnshi et al., 2010a, 2010b; Yemadje et al., 2011).
It is well known that patients with epilepsy are socially discriminated on the grounds of widespread negative public attitudes and misconceptions. This discrimination against epileptic patients could also be because of the lack of knowledge and understanding about epilepsy (Aydemir, 2011).
Wrong perceptions and beliefs about epilepsy create serious negative social and psychological consequences for PWE, such as fear, humiliation, and limitations in social interactions. One of the greatest challenges facing the optimal management of epilepsy is stigma and discrimination (Daoud et al., 2007; Tuan et al., 2007).
Persons with epilepsy are shunned and discriminated against with regard to education, employment, and marriage, because epilepsy is seen as a highly contagious illness. Assessment of deficiencies in knowledge and attitude among the general community would help press the point and identify the foci for increasing awareness and removing misinformation and false beliefs about epilepsy in a more targeted and effective manner (Ramasundrum et al., 2000).
This discrimination against epileptic patients could also be because of the lack of knowledge and understanding about epilepsy (Olafsson and Hauser, 1999).
| Patients and method|| |
This study is a descriptive cross-sectional household study carried out to assess the awareness, knowledge, and attitudes toward epilepsy of a sample of people living in Ismailia governorate. The study was conducted at two randomly selected geographic areas of Ismailia governorate, including one urban area (Sheikh Zayed district) and a rural area (Abu-Sultan village).
This cross-sectional household survey (door-to-door survey) was applied to urban and rural people living in Ismailia governorate.
The calculated sample size was 840 respondents (420 from urban and 420 from rural areas). They were obtained by random preselection of specific blocks of household identified on local published maps.
The survey instrument is a 29-item questionnaire in Arabic translated form designed to evaluate knowledge and attitudes with respect to epilepsy that had been used in recent studies (Jacoby et al., 2004; Onwuekwe et al., 2009; Aydemir, 2011; Yemadje et al., 2011).
The questionnaire is in two parts: the first part elicited demographic information including name, age, sex, education, occupation, and history of epilepsy or seizures among family members.
The second part elicited knowledge and awareness of existence of epilepsy, attitudes toward epilepsy, employment, social activities, and first-aid measures and management of epilepsy.
An oral consent was taken from all the participants before taking any data or carrying out any investigations. Acceptance of ethical committee of faculty of medicine Suez Canal University was obtained on 5 June 2012.
| Results|| |
A total of 840 respondents were interviewed; 420 (50%) were from Sheikh Zayed district (urban area) and 420 (50%) were from Abu-Sultan village (rural area). They were 485 (57.7%) men and 355 (42.3%) women. Their ages ranged from 18 to 79 years: 377 (44.9%) were less than 40 years and 463 (55.1%) were greater than 40 years, with a mean age of 36±7.25 years. Their levels of education were 231 (27.5%) illiterate/read and write, 358 (42.6%) basic/secondary education, and 251 (29.8%) university/postgraduate education ([Table 1],[Table 2],[Table 3],[Table 4],[Table 5],[Table 6]).
|Table 1 Public attitude toward epileptic patients in Ismailia governorate|
Click here to view
|Table 2 Public knowledge of causes of epilepsy, form of epileptic attacks, and intelligence of epileptic patient in Ismailia governorate|
Click here to view
|Table 3 Public attitude toward management of epileptic patients in Ismailia governorate|
Click here to view
|Table 4 Comparison between the knowledge of illiterate and read and write, basic and secondary educated, and university and postgraduate respondents of the knowledge of causes of epilepsy, form of epileptic attack, and intelligence of epileptic patients in Ismailia governorate|
Click here to view
|Table 5 Comparison between the knowledge of illiterate and read and write, basic and secondary educated, and university and postgraduate respondents of the knowledge of the management of epilepsy in Ismailia governorate|
Click here to view
|Table 6 Comparison between the attitude of illiterate and read and write, basic and secondary educated, and university and postgraduate respondents toward epileptic patients in Ismailia governorate|
Click here to view
| Discussion|| |
Although the majority (91.2%) of respondents had heard about epilepsy, they were found to have little or inadequate knowledge about some aspects of this chronic condition, such as the causes, clinical manifestation, and treatment of epilepsy.
The majority (63.7%) believed that it is a psychological disease, 49.5% believed that it was because of evil spirits (Jinn), and 47.4% mentioned it as an insane disease. These results were more negative when compared with other studies. Only 3% in USA (Canger and Cornaggia, 1985), 8% in Italy (Mecarelli et al., 2011), 1% in Denmark (Jensen and Dam, 1992), and 15% in Hungary (Mirnics et al., 2001) considered epilepsy as an insane disease.
The possible reason behind this misconception could be the education level, as 70% of the respondents in our study were illiterate, and basic and secondary educated.
The study revealed only 38.3% of the respondents believed that the cause of epilepsy was neurological disease, and this concept was among highly educated respondents (84.5%), urban respondents (60%), and those who had family members with epilepsy (72.4%).
Only 36.4% of the respondents knew how to help an epileptic patient during the seizure attack, and only 34% of respondents knew that a person having seizure should be moved to a safe place. Incorrect measures such as presenting eau de cologne or onion for the patient to smell, putting a little of water on his face, and holding the extremities of the patient to end the seizures were favored by 47.1, 47, and 46.7% of the participants, respectively. A significant proportion would act dangerously by putting a spoon/cloth in the patient’s mouth (27.3%) as a first-aid measure. These practices have their roots in cultural beliefs and misconceptions with respect to epilepsy in the society.
These results were more negative compared with other studies conducted in USA (82.1%) (Canger and Cornaggia, 1985), Canada (78.2%) (Fisher et al., 2005), Germany (76.4%) (Canger and Cornaggia, 1985), Iceland (54.3%) (Olafsson and Hauser, 1999), and Croatia (66.3%) (Bagić et al., 2009); they would take the epileptic patient away from danger during the seizure attack.
The study revealed only 52.5% of the respondents would recommend a medical doctor as a source of treatment of epilepsy; this percentage was higher among highly educated (86.1%), urban (77.6%), and male respondents (63.7%), and among respondents with family members with epilepsy (65.8%).
On the other hand, 49.4% of the respondents would recommend Holy Quran, 48.9% would recommend witchcraft–Sheikh, and 26.4% would recommend cupping as sources of treatment for epilepsy. Among them, 93.5% of less-educated respondents of rural areas, as well as women, would recommend witchcraft–Sheikh as a source of treatment.
This perception may be in line with beliefs that epilepsy is due to a spell or evil spirit possession. Such misperception was in agreement with a study conducted in Cameroon (Njamnshi et al., 2010a, 2010b), in which God’s help, magician healer, and medical doctor were recommended for treatments of epilepsy.
Studies conducted in USA (90.2%) (Canger and Cornaggia, 1985), Italy (86.5%) (Mecarelli et al., 2011), Canada (85.4%) (Fisher et al., 2005), Taiwan (66.9%) (Chung et al., 1995), Croatia (67%) (Bagić et al., 2009), Austria (93.1%) (Spatt et al., 2005), Greece (79.1%) (Diamantopoulos et al., 2006), and Denmark (78.4%) (Jensen and Dam, 1992) would recommend a medical doctor as a main source of treatment of epilepsy.
Unfortunately, 77.7% of respondents would object to marry a person with epilepsy, and 83% would object the marriage of their sons/daughters with a person with epilepsy.
The study revealed unfortunately, a high proportion of urban, highly educated, university and postgraduated, younger respondents and even those who had family members with epilepsy also refused their marriage or the marriage of their sons/daughters to an epileptic patient. These negative attitudes are mostly related to wrong beliefs about the causes of epilepsy. These results were more negative compared with other studies conducted in Seoul (37.8%) (Choi-Kwon et al., 2004), USA (18%) (Canger and Cornaggia, 1985), Hungary (32%) (Mirnics et al., 2001), Taiwan (28%) (Chung et al., 1995), Italy (13.5%) (Mecarelli et al., 2011), Canada (22%) (Fisher et al., 2005)), Croatia (19.1%) (Canger and Cornaggia, 1985), and Denmark (22.4%) (Jensen and Dam, 1992); they refused marrying an epileptic person.
Significantly, half (51.9%) of the respondents refused their children to play or share activities with an epileptic person; even a high proportion of highly educated respondents refused their children to play or share activities with an epileptic person. These results were more negative compared with studies conducted in Seoul (18.10%) (Choi-Kwon et al., 2004), USA (6%) (Canger and Cornaggia, 1985), UAE (7%) (Bener et al., 1998), Italy (11%) (Mecarelli et al., 2011), Hungary (15.70%) (Mirnics et al., 2001), Denmark (13%) (Jensen and Dam, 1992), Germany (9.5%) (Canger and Cornaggia, 1985), Taiwan (18%) (Chung et al., 1995), and Greece (34.3%) (Diamantopoulos et al., 2006).
Significantly, more than half (58.1% and 65%) in social and sport respectively of the respondents in our study believed that an epileptic person should not participate in social or sports activities. This misconception was more common in women, illiterate, and rural respondents. Unfortunately, a high proportion of highly educated respondents had the same concept. These results were more negative than other studies conducted in Denmark (8.7, 12.5%) (Jensen and Dam, 1992), France (6.9, 5.3%) (Nubukpo et al., 2003), Germany (11.6, 10.8%) (Canger and Cornaggia, 1985), USA (6.3, 7.2%) (Canger and Cornaggia, 1985), Turkey (17.3, 15.9%) (Aydemir, 2011), and in a Canadian study (11.6, 13.1%) (Fisher et al., 2005), respectively.
Unfortunately, a majority (70.5%) of the respondents believed that an epileptic person could not get a high academic grade like healthy individuals as the person was not intelligent, as 70.7% of them consider an epileptic patient to have below-average IQ. This negative believes differs from studies conducted in other countries: USA, only 9.7% (Canger and Cornaggia, 1985); Canada, 11.1% (Fisher et al., 2005); Germany, 6.9% (Canger and Cornaggia, 1985); and Malaysia, 14.9% (Hasan et al., 2010).
Significantly, more than the half (58.9%) of the respondents would not offer a job to a person with epilepsy, and 41.1% of them refused working with a person with epilepsy.
These results were more negative compared with other studies conducted in Seoul (37.5%) (Choi-Kwon et al., 2004), USA (9%) (Canger and Cornaggia, 1985), and Italy (15%).
Driving (96.0%) and police officer (87.6%) were regarded as the most unsuitable jobs for epileptic persons in this study. Other jobs rated by the respondents include construction and industrial workers (75.8%), physician or scientist (66.2%), and teacher (65.4%). The result is more negative than UK study (Jacoby et al., 2004) that show police office (46%) and armed forces (57%) are the most unsuitable jobs for epileptic patients. However, it might be necessary that the society recognize that some of these occupations can be done by PWE when the disorder is well under control.
| Conclusion|| |
The general Egyptian population in the selected areas had poor knowledge and negative attitudes toward an epileptic person. The majority of the negative attitudes were significantly associated with the misunderstanding of epilepsy.
- Well-organized educational campaigns and media (TV, radio, internet) are needed to improve public perception about epilepsy; efforts to increase public awareness and knowledge are motivated by the expectation that information that reduces the misconceptions and misinformation will improve attitudes and, ultimately, behavior toward PWE and thereby reduce stigma.
- Aggressive and sustained efforts are needed to eradicate this deep-rooted social stigma. It is hoped that the end result would be the provision of a supportive and caring environment in which PWE can live and function better
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Aydemir N (2011). Familiarity with, knowledge of, and attitudes toward epilepsy in Turkey. Epilepsy Behav 20:286–290.
Bagić A, Bagić D, Zivković I (2009). First population study of the general public awareness and perception of epilepsy in Croatia. Epilepsy Behav 15:170–178.
Bener A, Al-Marzooqi FH, Sztriha L (1998). Public awareness and attitudes towards epilepsy in the United Arab Emirates. Seizure 7:219–222.
Canger R, Cornaggia C (1985). Public attitudes toward epilepsy in Italy: results of a survey and comparison with U.S.A. and West German data. Epilepsia 26:221–226.
Choi-Kwon S, Park KA, Lee HJ, Park MS, Lee CH, Cheon SE et al.
(2004). Familiarity with, knowledge of, and attitudes toward epilepsy in residents of Seoul, South Korea. Acta Neurol Scand 110:39–45.
Chung MY, Chang YC, Lai YH, Lai CW (1995). Survey of public awareness, understanding, and attitudes toward epilepsy in Taiwan. Epilepsia 36:488–493.
Daoud A, Al-Safi S, Otoom S, Wahba L, Alkofahi A (2007). Public knowledge and attitudes towards epilepsy in Jordan. Seizure 16:521–526.
Diamantopoulos N, Kaleyias J, Tzoufi M, Kotsalis C (2006). A survey of public awareness, understanding, and attitudes toward epilepsy in Greece. Epilepsia 47:2154–2164.
Fisher RS, van Emde Boas W, Blume W, EIger C, Genton P, Lee P, Engel J (2005). Epileptic seizures and epilepsy: definitions proposed by the International League against Epilepsy (ILAE) and the International Bureau for Epilepsy (IBE). Epilepsia 46:470–472.
Hasan SS, Wei WG, Ahmadi A (2010). Knowledge and attitudes toward epilepsy among Malaysian Chinese. Int J Collab Res Intern Med Public Health 2:361–376.
Jacoby A, Gorry J, Gamble C, Baker GA (2004). Public knowledge, private grief: a study of public attitudes to epilepsy in the United Kingdom and implications for stigma. Epilepsia 45:1405–1415.
Jensen R, Dam M (1992). Public attitudes toward epilepsy in Denmark. Epilepsia 33:459–463.
Mecarelli O, Capovilla G, Romeo A, Rubboli G, Tinuper P, Beghi E (2011). Knowledge and attitudes toward epilepsy among primary and secondary schoolteachers in Italy. Epilepsy Behav 22:285–292.
Mirnics Z, Czikora G, Zavecz T, Halasz P (2001). Changes in public attitude towards epilepsy in Hungary: results of surveys conducted in 1994 and 2000. Epilepsia 42:86–93.
Njamnshi AK, Tabah EN, Bissek AZ (2010a). Knowledge, attitudes and practices with respect to epilepsy among secondary school students in the Kumbo West Health District−North West Region−Cameroon. Epilepsy Behav 18:247–253.
Njamnshi AK, Tabah EN, Bissek AC, Yepnjio FN, Angwafor SA, Dema F et al.
(2010b). Knowledge, attitudes and practices with respect to epilepsy among student nurses and laboratory assistants in the South West Region of Cameroon. Epilepsy Behav 17:381–388.
Nubukpo P, Preux PM, Clement JP, Houinato D, Tuillas M, Aubreton C et al.
(2003). Comparison of sociocultural attitudes towards epilepsy in Limousin (France), in Togo and in Benin (Africa). Med Trop (Mars) 63:143–150.
Olafsson E, Hauser WA (1999). Prevalence of epilepsy in rural Iceland: a population-based study. Epilepsia 40:1529–1534.
Onwuekwe IO, Onodugo OD, Ezeala-Adikaibe B, Aguwa EN, Ejim EC, Ndukuba K et al.
(2009). Pattern and presentation of epilepsy in Nigerian Africans: a study of trends in the southeast. Trans R Soc Trop Med Hyg 103:785–789.
Ramasundrum V, Zabidi AMH, Chong TT (2000). Public awareness, attitudes and understanding towards epilepsy in Kelantan, Malaysia. Neurol J Southeast Asia 5:55–60.
Spatt J, Bauer G, Baumgartner C, Feucht M, Graf M, Mamoli B, Trinka E, Austrian Section of the International League Against Epilepsy (2005). Predictors for negative attitudes toward subjects with epilepsy: a representative survey in the general public in Austria. Epilepsia 46:736–742.
Tuan NA, Cuong le Q, Allebeck P, Chuc NT, Tomson T (2007). Knowledge attitudes and practice toward epilepsy among adults in BaVi, Vietnam: first report from the population-based EPIBAVI study. Epilepsia 48:1914–1919.
Yemadje LP, Houinato D, Quet F, Druet-Cabanac M, Preux PM (2011). Understanding the differences in prevalence of epilepsy in tropical regions. Epilepsia 52:1376–1381.
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6]
|This article has been cited by|
||Public knowledge toward Epilepsy and its determinants in Ethiopia: A systematic review and meta-analysis
| ||Bekahegn Girma, Jemberu Nigussie, Takla Tamir, Etaferaw Bekele |
| ||Epilepsy & Behavior. 2022; : 108764 |
|[Pubmed] | [DOI]|
||Awareness and attitudes toward epilepsy among medical students and interns in Riyadh, Saudi Arabia
| ||Khalid A. Bin Abdulrahman, Majed Ghanem Alharbi, Abdulmajeed Mansour Alzeer |
| ||Primary Health Care Research & Development. 2022; 23 |
|[Pubmed] | [DOI]|
||Knowledge and attitude towards epilepsy among rural residents in southern Ethiopia: a cross-sectional study
| ||Alemayehu Molla,Birhanie Mekuriaw,Endashaw Habtamu,Moges Mareg |
| ||BMC Public Health. 2021; 21(1) |
|[Pubmed] | [DOI]|
||Knowledge and practice of the population toward epilepsy in children in Jeddah, Saudi Arabia
| ||Rahma Bazhair,Adel Alhazmi,Osamah Abualross,Jumanah Alharbi,Ahmed Bahawi,Mahdi Kanjo,Layan Arafah |
| ||International Journal of Medicine in Developing Countries. 2021; : 1195 |
|[Pubmed] | [DOI]|
||Improvement of Public Stigmas and Sociocultural Beliefs towards Epilepsy and Social Identity in the Aseer Region, Saudi Arabia: An Updated Study
| ||Nawal F. Abdel Ghaffar,Reem N. Asiri,Laith N. AL-Eitan,Reem S. Alamri,Reem M. Alshyarba,Faris A. Alrefeidi,Ashwag Asiri,Mansour A. Alghamdi |
| ||Epilepsy & Behavior Reports. 2021; : 100442 |
|[Pubmed] | [DOI]|
||Public perception and attitude towards people living with epilepsy in Nigeria
| ||Tomilola Adewumi,Eniola Oladipo,Abiodun O. Adewuya |
| ||Epilepsy & Behavior. 2020; 106: 107033 |
|[Pubmed] | [DOI]|
||Level of awareness and attitudes toward epilepsy in Qassim, Saudi Arabia: A cross-sectional study
| ||Reema Altowayan,Heetaf Aloqaily,Aqeel Almutairi,Rawan Almassri,Bashaer Alharbi,Ghadah Alsallum,Rahaf Alhabib,Ghaid Alkharaz,Afraa Alateyah,Yousef Alharbi,Elsadig Y. Mohamed |
| ||Epilepsy & Behavior. 2019; 90: 66 |
|[Pubmed] | [DOI]|