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Knowledge, attitude and practice with respect to epilepsy among school teachers in Assiut city, Egypt
Epilepsy Research (2010) 92, 191—200
journal homepage: www.elsevier.com/locate/epilepsyres
Knowledge, attitude and practice with respect to epilepsy among school teachers in Assiut city, Egypt Ghaydaa A. Shehata a,∗, Dalia G. Mahran b a b
Department of Neurology and Psychiatry, Assiut University Hospital, PO Box 71516, Assiut, Egypt Department of Public Health and Community Medicine, Faculty of Medicine, Assiut University, Assiut, Egypt
Received 10 July 2010; received in revised form 31 August 2010; accepted 13 September 2010 Available online 13 October 2010
KEYWORDS Knowledge; Practice; Epilepsy; Teachers; Schools; Egypt
Summary Objective: This study was designed to assess knowledge, attitude and practice with respect to epilepsy among secondary school teachers in Assiut city, Egypt. Methods: A cross sectional study was applied among secondary schools in Assiut city, Egypt. A 12-item questionnaire was self administered to 189 teachers, who selected randomly. Results: All teachers had heard about epilepsy. 54% of teachers deal with students with epilepsy as normal students. About one quarter (23.8%) of teachers accepted to give student with fit in the class first aid measures and 12.7% accepted to give the student, who was having a seizure in the class any form of prescribed treatment. Positive attitudes were common among females and single teachers. Conclusion: The current study suggests that, a well directed health educational program about causes and management of epileptic seizures may improve the perception of epilepsy by teachers in Egypt. Teacher-targeted interventions aimed at reducing epilepsy-associated stigma and its sequel in Egyptian students. © 2010 Elsevier B.V. All rights reserved.
Introduction Epilepsy is one of the most common neurological disorders with a worldwide prevalence between 5 and 10 per 1000 with considerable variations between different settings (Sander and Shorvon, 1987; Saraceno, 2002). It has become more apparent that people with epilepsy are socially discriminated against on the ground of widespread
∗
Corresponding author. Tel.: +20 88 2297075; fax: +20 88 2333327. E-mail address: [email protected] (G.A. Shehata).
lack of knowledge, negative public attitudes, and misconceptions about the disease. Knowledge, perceptions and attitudes towards epilepsy have been investigated among patients (Doughty et al., 2003; Long et al., 2000), health service providers (Beran and Read, 1983; Al-Adawi et al., 2001; Gelineau et al., 2008) and general public (Bener et al., 1998; Jacoby et al., 2004; Millogo et al., 2004; Mirnics et al., 2001) in different settings. The social problems encountered by schoolchildren with epilepsy as a result of negative attitudes and beliefs are enormous and also the attitude and knowledge of teachers regarding adulthood epilepsy, in which that is likely to
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192 influence the educational performance of children with the disease (Ojinnaka, 2002). Teachers knowledge about and attitudes towards epilepsy can have a direct impact on students with epilepsy in terms of school performance, social skill development, and post school success in the areas of employment, social skills, and social network development (Hsieh and Chiou, 2001; Bishop and Boag, 2006). In many parts of Africa there is still much superstition about epilepsy (Jilek-Aall et al., 1997). It is linked either with evil spirits or witchcraft activities or in some societies little or no effort is being made to educate people about this disorder (Jilek-Aall et al., 1997). Such as a crosssectional survey, using a self-administered questionnaire, was carried out among rural community primary and secondary schoolteachers in schools randomly selected from three local government areas in Enugu city in Nigeria showed that many schoolteachers still have wrong beliefs, views and attitudes towards epilepsy (Ojinnaka, 2002). However, despite the significant impact of teacher’s knowledge about epilepsy and attitudes towards persons with epilepsy, very little research has been conducted in Egypt in the last two decades either to assess the degree to which teachers have accurate knowledge and information about epilepsy or to gauge teacher’s attitudes towards students with epilepsy. In addition, teachers’ attitude and knowledge regarding students with epilepsy are likely to influence the educational performance of students with the disease. The aim of this study was to examine the knowledge, attitude and practice of teachers in Assiut city in Upper Egypt among secondary school teachers about epilepsy and epileptic students which in turn can provide information on how the teachers can deal with epileptic student during the school days. Furthermore, this kind of study can provide information for better understanding the social effects of epilepsy in students.
Materials and methods Study setting This cross sectional study was carried out in Assiut city. Assiut is the largest town in Upper Egypt and lies about 234 miles south of Cairo. It is an old city which was first settled in pharaonic times, then the capital of the Thirteenth Nome of Upper Egypt and named Syut. Although the city has a considerable strategic value in its position between Upper and Lower Egypt, it somehow managed to stay clear of national importance as a capital. It consists of 11 districts. It has 235 villages surrounded by 911 satellites (Assiut Governorate website). The economic level of Assiut city is similar to all cities in Egypt and it well represents the economic status of Egypt. The estimated number of population in Assiut Governorate in the last census in 2006 was 3,441,597 (last record of Central Agency for Public Mobilization and Statistics (CAPMAS), Cairo — Egypt). It is also the home of the third largest university in Egypt.
G.A. Shehata, D.G. Mahran were selected randomly by using systematic random sample, in which the prevalence of epilepsy is ranged from 5 to 10 per 1000 (Sander and Shorvon, 1987; Saraceno, 2002), we excepted the prevalence of knowledge of epilepsy is the same. Sample size calculation indicated that sample of 138 of teachers will be appropriate with a confidence interval 95% and with accepted error of 5% points above and below. According to the following formula: n = p(1 − p) × (z − d)2 = (0 − 5)(0 − 5)(1.96/0.05)2 = 138. However, we increased the sample size up to 195 to guard against high drop out. We randomly selected one from each 5 teachers of government schools and one from each 3 teachers from private schools (number = 195). Explanation of the aim of the study was done firstly and we asked them to fulfill the questionnaires after their acceptance to participate. We excluded all those with previous or current seizures.
Study questionnaire The study questionnaire consisted of 5 categories: A — personal data about the teacher; B — data about the familiarity with epilepsy; C — data about the knowledge of epilepsy; D — data about attitude and practice towards students with epilepsy; and E — practice of teachers with an epileptic fit in the classroom (Appendix 1). (Socio-demographic data about the participants., data about the familiarity with epilepsy, data of knowledge, attitude and practice (KAP) of epilepsy, data about attitude towards students with epilepsy and teachers’ management of an epileptic fit in the classroom.) The questionnaire consisted of 12-item questionnaire written in Arabic language. It was matched with previous questionnaires that has been used by other international research groups in previous published studies in the Nigeria (Ojinnaka, 2002), USA (Bishop and Boag, 2006), Greece (Kaleyias et al., 2005), and Istanbul — Turkey (Bekiroglu et al., 2004).
Data collection Data were collected by simplified structured self-administered questionnaire that was pilot tested. It was thought that selfadministered questionnaire would offer participants a greater freedom to express their knowledge, attitudes and practicing when compared to personal interview approach. The questionnaire was presented and its purpose was explained by one of the investigators (the authors and 3 well trained psychologists) to all teachers in each participating school and he collected the answered questionnaires, guaranteeing a 100% return rate. Brief explanation about the study was provided before beginning of the study by the researchers themselves.
Ethical issues The protocol of the study was approved by ethical committee of Faculty of Medicine, Assiut University, Egypt. Written approval consent was obtained from the head of Ministry of Education in Assiut city to carry out the study. Also, we had an approval from the higher authority in Ministry of Education to carry out the study in secondary schools. In addition, we made interviews with the head managers and all teachers to explain the aim of the study and the content of the questionnaire.
Statistical analysis Respondents Fifteen secondary schools: 5 (33.3%) private schools and 10 (66.7%) government schools in Assiut city were chosen to be involved in this study. These schools represented from all areas in the city from different social classes. The teachers included in this study
Data were recorded in a preceded questionnaire and data entry was done using the Excel program. Then the computer software package SPSS for Windows (Version 16) was used to do the data analysis. Continuous variables such as age, were expressed as the mean ± standard deviation (SD), whereas categorical variables (gen-
"Egyptian KAP of teachers towards epilepsy". Table 1
193
Demographic characteristics of the respondents. No. of respondents (n = 189)
Age (years) 25—30 31—35 36—40 41—45 46—50 51—55 56 and more Sex Male Female Marital status Married Single Widow School category Government Private
Percentage (%)
15 10 20 71 41 17 15
7.9 5.3 10.65 37.6 21.7 9.0 7.9
111 78
58.7 41.3
168 16 5
88.9 8.5 2.6
137 52
72.5 27.5
Knowledge about epilepsy (Tables 2 and 3) All teachers had heard about epilepsy (100%). However, teachers aged 31—35 years were more likely than other age groups to deal with students with epilepsy as any other students (p = 0.030). While 10.2% of teachers in government schools believed that epilepsy is one form of psychiatric illness. 100% of widows and 51.2% of female teachers had correct knowledge about epilepsy, which is one of brain diseases. 46.7% of teachers aged 56 and more years, 33.3% of male teachers, and 38.5% teachers of private schools considered epilepsy as genetic disease. Meanwhile 58.4% of teachers of government schools thought that every child with epilepsy is mentally retarded.
Data are presented as number and percentages of participants. der) were presented as frequencies (%). The Pearson chi-square test (2 test) was used to examine the association between responses and each demographic variable in a univariate analysis. Significance level was set at p ≤ 0.05.
Results A total of 189 teachers responded to questionnaire out of 195 teachers, yielding a response rate of 96.9%. The demographic characteristics are shown in Table 1. One hundred and four (76.2%) were aged
Table 2
Attitude towards epilepsy (Table 4) One hundred and two (54%) of teachers thought that, students with epilepsy as other students. Fifty-one (27%) believed that students with epilepsy should be educated in schools of other students. To examine the impact of age of teachers, sex, marital status and school category upon positive attitude of teachers towards epilepsy, deal with child normally or with sympathy, believe that the student with epilepsy does not cause a trouble in the class and also the student with epilepsy should complete his education in schools for other students either if seizures occurred or controlled with good treatment, n = 62 (32.8%).
Teachers responses to questions concerning familiarity with epilepsy.
Variables
Category
No. of respondents
Q1
Age
25—30 31—35 36—40 41—45 46—50 51—55 56 and more Male Female Married Single Widow Government Private
15 10 20 71 41 17 15 111 78 168 16 5 137 52
15 10 20 71 41 17 15 111 78 168 16 5 137 52
Sex Marital status
School category
40 years or more, with the male:female ratio of 1.4:1. The majority of respondents were married (88.9%).
(100%) (100%) (100%) (100%) (100%) (100%) (100%) (100%) (100%) (100%) (100%) (100%) (100%) (100%)
p value
Q2
Not computed
1 (6.7) 4 (40%) 4 (20%) 7 (9.9%) 3 (7.3%) 1 (5.9%) 0 12 (10.8%) 8 (10.3%) 2 (12.5%) 18 (10.7%) 0 17 (12.4%) 3 (5.8%)
Not computed Not computed
Not computed
p value 0.030
1.00 0.720
0.289
Q3 1 (6.7%) 5 (50%) 7 (35%) 12 (16.9%) 8 (19.5%) 3 (17.6%) 1 (6.7%) 24 (21.6%) 13 (16.7%) 3 (18.8%) 34 (20.2%) 0 31 (22.6%) 6 (11.5%)
p value 0.053
0.459 0.530
0.062
Values under the question columns represent number and percentages of participants with a ‘‘yes’’ response to the question; Pearson chi-square represents p value. Q1: Have you ever heard or read about the disease called — epilepsy or convulsive seizure? Q2: Have you ever had an epileptic student as a student? Q3: Have you ever witnessed a seizure at school?
194
Table 3
Answers to questions concerning the knowledge about epilepsy.
Variables
Category (n)
Q4a
p
Age
25—30 (n = 15) 31—35 (n = 10) 36—40 (n = 20) 41—45 (n = 71) 46—50 (n = 41) 51—55 (n = 17) 56 and more (n = 15) Male (n = 111) Female (n = 78) Married (n = 168) Single (n = 16) Widow (n = 5) Government (N = 137) Private (n = 52)
1 (6.7%) 2 (20%) 1 (5%) 3 (4.2%) 3 (7.3%) 4 (23.5%) 1 (6.7%) 8 (7.2%) 7 (9.2%) 13 (7.7%) 2 (12.5) 0 14 (10.2%)) 1 (1.9%)
0.157 9 (60%) 5 (50%) 11 (55%) 38 (53.5%) 14 (34.1%) 4 (23.5%) 5 (33.3%) 0.786 43 (38.7%) 43 (55.1%) 0.639 73 (43.5%) 8 (50%) 5 (100%) 0.047 66 (48.2%) 20 (38.5%)
Sex Marital status School category
Q4b
p
Q4c
0.114 0 0 0 1 (1.4%) 0 0 0 0.027 1 (0.9%) 0 0.041 1 (0.6%) 0 0 0.151 1 (0.7%) 0
p
Q4d
p
Q4e
p
0.947
0 0 1 (5%) 1 (1.4%) 1 (2.4%) 0 0 1 (0.9%) 2 (2.6%) 3 (1.8%) 0 0 1 (0.7%) 2 (3.8%)
0.855
3 (20%) 1 (10%) 3 (15%) 9 (12.7%) 17 (41.5%) 4 (23.5%) 7 (46.7%) 37 (33.3%) 7 (9%) 43 (25.6%) 1 (6.2%) 0 24 (17.5%) 20 (38.5%)
0.005 0 2 (20%) 0 9 (12.7%) 2 (4.9%) 0 2 (13.3%) 0.000 7 (6.3%) 8 (10.3%) 0.099 13 (7.7%) 2 (12.5%) 0 0.003 12 (8.8%) 3 (5.8%)
Not computed Not computed Not computed
0.570 Not computed 0.184
Q4f
p
Q4g
0.134 2 (13.3%) 0 4 (20%) 10 (14.1%) 4 (9.8%) 5 (29.4%) 0 0.414 14 (12.6%) 11 (14.1 0.639 22 (13.1%) 3 (18.8%) 0 0.366 19 (13.9%) 6 (11.5%)
p
Q5
0.176 10 (66%) 8 (80%) 13 (65.0%) 38 (53.5%) 17 (41.5%) 8 (47.1%) 6 (40%) 0.829 54 (48.6%) 46 (59.0%) 0.552 88 (52.4%) 11 (68.8%) 1 (20%) 0.812 80 (58.4%) 20 (38.5%)
p 0.194
0.184 0.149
0.015
Values under the question columns represent number and percentages of participants with a ‘‘yes’’ response to the question. Q4: What do you think is the cause of epilepsy?; a — psychiatric illness; b — brain disease; c — blood disease; d — contagious disease; e — genetic disease; f — i do not know ; g — more than one reasonable responses as infection, tumors, etc. Q5: Do you think a student with epilepsy is usually associated with mental retardation?
G.A. Shehata, D.G. Mahran
"Egyptian KAP of teachers towards epilepsy". Table 4
195
Teachers responses to questions concerning attitude towards students with epilepsy.
Attitude
Response (%) n = 189
Deal with a student with epilepsy as any other student Feel sympathy to student with epilepsy and as any student with chronic illness Feel negative towards student with epilepsy and neglect him completely Do not know how to deal with a student with epilepsy No, a student with epilepsy in the class, does not make a problem Yes, a student with epilepsy in the class makes a problem, because he or she disrupts the education process in the class Yes, a student with epilepsy in the class makes a problem, because he or she makes the teacher anxious Yes, a student with epilepsy in the class make a problem, because he or she has bad psychic effects upon the other students A student with epilepsy in the class makes a problem, has bad effect on the school A student with epilepsy in the class makes a problem, because of the objections from other student’s parents if there were a student with epilepsy in the class A student with epilepsy in the class makes a problem, because of any combination of previous responses A student with epilepsy should complete his education in schools for normal students, although he or she had a seizure in class sometimes A student with epilepsy should complete his education in schools for normal students, ordering their parents to treat them regularly A student with epilepsy should be transferred to schools for students with special needs, because teachers cannot be responsible if something happens to the student during seizure A student with epilepsy should be transferred to schools for students with special needs, because the presence of a student with epilepsy had bad effect upon other students Presence or transfer student with epilepsy from schools of normal students, teachers did not answer
102 (54) 43 (22.8) 2 (1.1) 42 (22.2) 101 (53.4) 6 (3.2) 18 (9.5) 27 (14.3) 0 1 (0.5)
36 (19) 51 (27) 86 (45.5) 9 (4.8)
9 (4.8)
34 (18)
Values under responses column represent number and percentages of participants, responses to questions 6, 7 and 8.
Teachers’ practice towards an epileptic seizure in the class (Table 5) Out of all respondents, 23.8% (n = 45) of teachers accepted to give students with fit in the class the first aid measures and 12.7% (n = 24) accepted to give the students with seizure in the class, any form of prescribed treatment as suppository which was significantly more apparent among teachers (n = 6; 30%) aged 36—40 years (p = 0.015).
Discussion The knowledge and attitudes of the teachers towards students with epilepsy (among many factors related to epilepsy or other) can adversely influence academic achievement and quality of life of an epileptic student at school (Kaleyias et al., 2005). In a community like Egypt, teachers have a pivotal role with substantial influence on the society. So the main objective of this study was to assess the knowledge, attitude and practice of teachers in secondary schools with respect to epilepsy and to understand their approach to deal with a student with epilepsy. In addition, through the results of this research, we can inform the ministry of education
and encourage them to organize health education programs for all the teachers about epilepsy and how to deal with epileptic students. The response rate (96.9%) of our sample is satisfactory, in which the remaining teachers not included in the study, were occupied by teaching students at classes and many of them teaching in more than one school. Familiarity with epilepsy in our sample (100%) was higher than values reported in studies of schoolteachers (97%) in India (Thacker et al., 2008), score of 70% and 59% of those in the Nigeria (Ojinnaka, 2002; Kaleyias et al., 2005), respectively. In which, the source of their knowledge about the disease was mainly from the public media, movies and parents of students. This very high familiarity with epilepsy in our sample supports the suspected high epilepsy prevalence among school students in this area. In this study, 10.6% of teachers have an epileptic student in their class at some time, most of them are teachers aged 31—35 years, which may be attributed to their high exposure to larger number of students that they were sharing in teaching more. In addition, 19.6% have witnessed a seizure at school. That is lower than values reported in previous studies as 24% in Greek (Kaleyias et al., 2005), and Thailand (Kankirawatana, 1999), 23% in Nigeria (Ojinnaka, 2002) although rates up to
196 Table 5
G.A. Shehata, D.G. Mahran Teachers responses to questions concerning management of an epileptic fit in the classroom.
Variables
Category
No. of respondents (n = 189)
Q9
p value
Q10
p value
Age
25—30 31—35 36—40 41—45 46—50 51—55 56 and more Male Female Married Single Widow Government Private
15 10 20 71 41 17 15 111 78 168 16 5 137 52
6 (40%) 2 (20%) 6 (30%) 15 (21.1%) 9 (22%) 6 (35.3%) 1 (6.7%) 27 (24.3%) 18 (23.1%) 38 (22.6%) 5 (31.2%) 2 (40%) 32 (23.4%) 13 (25%)
0.350
5 (33.3%) 0 6 (30%) 5 (7%) 4 (9.8%) 3 (17.6%) 1 (6.7%) 14 (12.6%) 10 (12.8%) 21 (12.5%) 3 (18.8%) 0 17 (12.4%) 7 (13.5%)
0.015*
Sex Marital status School category
0.864 0.511
0.849
1.000 0.532
0.811
Values under the question columns represent number and percentages of participants with a ‘‘yes’’ response to the question. Q9: Do you think that you can give the student who was having a seizure in the class, the first aid measures? Q10: Do you accept to give the student, who was having a seizure in the class, any form of prescribed treatment like as suppository? * Pearson chi square p value is significant p ≤ 0.05.
41% and 57% have been reported (Kaleyias et al., 2005). This factor of familiarity with epilepsy seems to be important, as it was correlated with a higher degree of confidence in one’s ability to help a seizing student, a more accurate knowledge of the prognosis of epilepsy, and a more positive attitude towards the epileptic student (Kaleyias et al., 2005). Thacker et al. (2008) reported that the awareness about epilepsy is shown to be high in several studies from developing as well as developed countries. In the present study, majority of our school teachers (83.1%) gave reasonable answers to the questions about the causes of epilepsy, such as genetics, brain disease, and any other reasonable answers as trauma, infections and tumor, or complications of blood disease. However, our results are similar to studies done by Birbeck et al. (2006), who reported that most Zambian teachers (>70%) recognized epilepsy as a brain-related disorder and among 568 Indian schoolteachers, in which the majority felt epilepsy as a brain disease and gave reasonable answers to the questions about the causes of epilepsy, such as genetics (10.4%), trauma (8.5%), infections (3.3%) and tumor (3.5%). It was also creditable that only a minority (17.5%) of our teachers considered epilepsy as psychological events (7.9%), as contagious disease (1.6%), and did not know the cause of epilepsy (7.9%). Our results are less than the previous studies as in Turkey (Bekiroglu et al., 2004), 24% of teachers believed that epilepsy is a psychological disorder, 11% of Greek teachers reported they do not know what epilepsy is (Kaleyias et al., 2005) and in 2001, Dantas et al. (2001) assessed knowledge and attitudes towards epilepsy among 300 teachers in Brazil (Dantas et al., 2001) and reported that some teachers still thought that epilepsy was contagious. Regarding the association of epilepsy with mental retardation, 52.9% of our teachers believed that every child with epilepsy is mental retarded, which is similar to the study done by Kaleyias et al. (2005), reported 53% of teachers
think that epilepsy and mental retardation were usually or always coexist. When teachers were asked what their attitude towards the epileptic student was, about three quarters (76.8%) of teachers stated it is the same as to any other student or feel sympathy and deal with him or her as with a chronic health problem, and only 1.1% stated that they would rather avoid an epileptic student. This finding, provided it is sincere, indicates a very high degree of acceptance of epileptic students by their teachers. Despite that, 46.6% of the teachers stated that the epileptic student is a source of ‘‘problems’’ in the classroom. This is not a contradiction, however, because when one looks at the specific problem generated by the epileptic child, the most common was ‘‘increased anxiety and responsibility for the teacher, and bad psychic effects upon the other students’’ which is reasonable and does not indicate rejection by the teacher. On the other hand, 0.5% believed that parents of other students would object to the presence of an epileptic student at school. When asked whether epileptic students should continue their studies at their regular school or be transferred to some ‘‘special’’ school, a high percent (72.5%) responded with a positive response, and 9.6% would like the student to be transferred to another school either because his or her presence is considered as an ‘‘too much of a responsibility for the teacher’’ or ‘‘is negative for other students by any mean as interruption of the educational process’’. Our results regarding attitudes are more positive than other previous studies as 60% Nigerian teachers had negative attitudes (Ojinnaka, 2002) and quite the same of Indian teachers in which 59% had positive attitudes (Thacker et al., 2008). So, Prior knowledge of an epileptic student was associated with positive attitudes (Kaleyias et al., 2005). Other important findings in the study are in the issue of management of students with epilepsy. About 23.8% of the teachers thought that they can give the student
"Egyptian KAP of teachers towards epilepsy". who is having a seizure in the class the first aid measures while only 12.7% (more at age group 46—51 years due to more experiences) accepted to give the student, who is having a seizure in the class, any form of prescribed treatment such as suppository. These findings concerning management of an epileptic fit in the classroom are not a surprising result, since there has been no formal health education on epilepsy in any of the schools and most of the knowledge was acquired from ill-informed neighbors, parents of students and public information. In addition, lack of school medical clinics and deficient first aid measures in most of our schools are important factors. Health education is a very important strategy for overcoming barriers in major public health problems like epilepsy.
Limitation of this study This study was carried in Assiut city only and was not extended to include other cities from Lower Egypt and also did not include rural areas as may be there are different attitudes towards epilepsy according to culture levels.
197 Future researches using a more geographically diverse sample as from Lower Egypt or from rural areas are clearly indicated.
Conclusion The current study suggests that, a well directed health educational program about causes and management of epileptic seizures may improve the perception of epilepsy by teachers in Egypt. Efforts should therefore be directed for the population, using possible avenues such as seminars, school health education programmers and the mass media, especially the radio and televisions, which is an important, source of information in most developing countries.
Disclosure of conflicts of interest None of the authors has any conflict of interest to disclose. We confirm that we have read the Journal’s position on issues involved in ethical publication and affirm that this report is consistent with those guidelines.
198
G.A. Shehata, D.G. Mahran
Appendix A. Knowledge, attitude and practice of epilepsy among school teachers in Assiut city, Egypt A- Personal data about the teacher: -Age:…………….. -Sex : 1- male
2- Female
-Marital status: 1- Single
2- Married
3- Divorced
4-Widow
B- Data about the familiarity with epilepsy Q1: Have you ever heard or read about the disease called ?epilepsy or convulsive seizure?
1- Yes
2-No
Q2: Have you ever had an epileptic student in your class? 1- Yes
2-No
Q3: Have you ever witnessed a seizure at school? 1- Yes
2-No
C- Data about the Knowledge of epilepsy Q4: What do you think is the cause of epilepsy? (More than one answer is allowed) •
Psychiatric illness
•
Brain disease
•
Blood disease
•
Contagious disease
•
Genetic disease
•
Any reasonable answers as brain tumor, infections,--etc
Q5: Do you think that, student with epilepsy is usually associated with mental retardation?
1- Yes
2-No
D - Data about attitude and practice towards students with epilepsy
"Egyptian KAP of teachers towards epilepsy".
199
Q6: How do you deal with a student with epilepsy? •
As any other student
•
Feel sympathy to him and deal with him as any student with chronic illness
•
Feel negative towards him and neglect him completely
•
I do not know
Q7: Do you think that, the student with epilepsy in your class make a problem? 1- Yes
2-No
- If your answer is yes; what kind of problems he or she will do: •
Disrupt the education process in the class
•
Make the teacher is anxious about the responsibility if the seizure occurs during the classroom
•
Had bad psychic effects upon the other students
•
Presence of a student with epilepsy can negatively effect upon the school
•
The objections from other students' parents if there were a student with epilepsy in the class
•
Any other response
Q8: Do you think that a student with epilepsy should complete his education in your school? (Please choose the correct answer): •
Yes, although he or she had a seizure in the class sometimes
•
Yes with ordering to their parents to treat them regularly
•
No and they should transferred to schools with special needs, because: 1. Teachers can not tolerate the responsibility if something happen to the student during seizure 2. Presence of a student with epilepsy had bad effect upon other students
E- Practice of teachers with an epileptic fit in the classroom: Q9: Do you think that you can give the student with a seizure in the class, the first aid measures?
1- Yes
2-No
Q10: Do you accept to give the student, who has a seizure in the class, any form of prescribed treatment such as suppository? 1- Yes
2 -No
200
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G.A. Shehata, D.G. Mahran Jacoby, A., Gorry, J., Gamble, C., Baker, G.A., 2004. Public knowledge, private grief: a study of public attitudes to epilepsy in the United Kingdom and implications for stigma. Epilepsia 45 (11), 1405—1415. Jilek-Aall, L., Jilek, M., Kaaya, J., Mkombachepa, L., Hillary, K., 1997. Psychosocial study of epilepsy in Africa. Soc. Sci. Med. 45 (5), 783—795. Kaleyias, J., Tzoufi, M., Kotsalis, C., Papavasiliou, A., Diamantopoulos, N., 2005. Knowledge and attitude of the Greek educational community toward epilepsy and the epileptic student. Epilepsy Behav. 6 (2), 179—186. Kankirawatana, P., 1999. Epilepsy awareness among school teachers in Thailand. Epilepsia 40 (4), 497—501. Long, L., Reeves, A.L., Moore, J.L., Roach, J., Pickering, C.T., 2000. An assessment of epilepsy patients’ knowledge of their disorder. Epilepsia 41 (6), 727—731. Millogo, A., Ratsimbazafy, V., Nubukpo, P., Barro, S., Zongo, I., Preux, P.M., 2004. Epilepsy and traditional medicine in BoboDioulasso (Burkina Faso). Acta Neurol. Scand. 109 (4), 250— 254. Mirnics, Z., Czikora, G., Zavecz, T., Halasz, P., 2001. Changes in public attitudes toward epilepsy in Hungary: results of surveys conducted in 1994 and 2000. Epilepsia 42 (1), 86— 93. Ojinnaka, N.C., 2002. Teachers’ perception of epilepsy in Nigeria: a community-based study. Seizure 11 (6), 386—391. Sander, J.W., Shorvon, S.D., 1987. Incidence and prevalence studies in epilepsy and their methodological problems: a review. J. Neurol. Neurosurg. Psychiatry 50 (7), 829—839. Saraceno, B., 2002. The WHO World Health Report 2001 on mental health. Epidemiol. Psichiatr. Soc. 11 (2), 83—87. Thacker, A.K., Verma, A.M., Ji, R., Thacker, P., Mishra, P., 2008. Knowledge awareness and attitude about epilepsy among schoolteachers in India. Seizure 17 (8), 684—690.
journal homepage: www.elsevier.com/locate/epilepsyres
Knowledge, attitude and practice with respect to epilepsy among school teachers in Assiut city, Egypt Ghaydaa A. Shehata a,∗, Dalia G. Mahran b a b
Department of Neurology and Psychiatry, Assiut University Hospital, PO Box 71516, Assiut, Egypt Department of Public Health and Community Medicine, Faculty of Medicine, Assiut University, Assiut, Egypt
Received 10 July 2010; received in revised form 31 August 2010; accepted 13 September 2010 Available online 13 October 2010
KEYWORDS Knowledge; Practice; Epilepsy; Teachers; Schools; Egypt
Summary Objective: This study was designed to assess knowledge, attitude and practice with respect to epilepsy among secondary school teachers in Assiut city, Egypt. Methods: A cross sectional study was applied among secondary schools in Assiut city, Egypt. A 12-item questionnaire was self administered to 189 teachers, who selected randomly. Results: All teachers had heard about epilepsy. 54% of teachers deal with students with epilepsy as normal students. About one quarter (23.8%) of teachers accepted to give student with fit in the class first aid measures and 12.7% accepted to give the student, who was having a seizure in the class any form of prescribed treatment. Positive attitudes were common among females and single teachers. Conclusion: The current study suggests that, a well directed health educational program about causes and management of epileptic seizures may improve the perception of epilepsy by teachers in Egypt. Teacher-targeted interventions aimed at reducing epilepsy-associated stigma and its sequel in Egyptian students. © 2010 Elsevier B.V. All rights reserved.
Introduction Epilepsy is one of the most common neurological disorders with a worldwide prevalence between 5 and 10 per 1000 with considerable variations between different settings (Sander and Shorvon, 1987; Saraceno, 2002). It has become more apparent that people with epilepsy are socially discriminated against on the ground of widespread
∗
Corresponding author. Tel.: +20 88 2297075; fax: +20 88 2333327. E-mail address: [email protected] (G.A. Shehata).
lack of knowledge, negative public attitudes, and misconceptions about the disease. Knowledge, perceptions and attitudes towards epilepsy have been investigated among patients (Doughty et al., 2003; Long et al., 2000), health service providers (Beran and Read, 1983; Al-Adawi et al., 2001; Gelineau et al., 2008) and general public (Bener et al., 1998; Jacoby et al., 2004; Millogo et al., 2004; Mirnics et al., 2001) in different settings. The social problems encountered by schoolchildren with epilepsy as a result of negative attitudes and beliefs are enormous and also the attitude and knowledge of teachers regarding adulthood epilepsy, in which that is likely to
0920-1211/$ — see front matter © 2010 Elsevier B.V. All rights reserved. doi:10.1016/j.eplepsyres.2010.09.007
192 influence the educational performance of children with the disease (Ojinnaka, 2002). Teachers knowledge about and attitudes towards epilepsy can have a direct impact on students with epilepsy in terms of school performance, social skill development, and post school success in the areas of employment, social skills, and social network development (Hsieh and Chiou, 2001; Bishop and Boag, 2006). In many parts of Africa there is still much superstition about epilepsy (Jilek-Aall et al., 1997). It is linked either with evil spirits or witchcraft activities or in some societies little or no effort is being made to educate people about this disorder (Jilek-Aall et al., 1997). Such as a crosssectional survey, using a self-administered questionnaire, was carried out among rural community primary and secondary schoolteachers in schools randomly selected from three local government areas in Enugu city in Nigeria showed that many schoolteachers still have wrong beliefs, views and attitudes towards epilepsy (Ojinnaka, 2002). However, despite the significant impact of teacher’s knowledge about epilepsy and attitudes towards persons with epilepsy, very little research has been conducted in Egypt in the last two decades either to assess the degree to which teachers have accurate knowledge and information about epilepsy or to gauge teacher’s attitudes towards students with epilepsy. In addition, teachers’ attitude and knowledge regarding students with epilepsy are likely to influence the educational performance of students with the disease. The aim of this study was to examine the knowledge, attitude and practice of teachers in Assiut city in Upper Egypt among secondary school teachers about epilepsy and epileptic students which in turn can provide information on how the teachers can deal with epileptic student during the school days. Furthermore, this kind of study can provide information for better understanding the social effects of epilepsy in students.
Materials and methods Study setting This cross sectional study was carried out in Assiut city. Assiut is the largest town in Upper Egypt and lies about 234 miles south of Cairo. It is an old city which was first settled in pharaonic times, then the capital of the Thirteenth Nome of Upper Egypt and named Syut. Although the city has a considerable strategic value in its position between Upper and Lower Egypt, it somehow managed to stay clear of national importance as a capital. It consists of 11 districts. It has 235 villages surrounded by 911 satellites (Assiut Governorate website). The economic level of Assiut city is similar to all cities in Egypt and it well represents the economic status of Egypt. The estimated number of population in Assiut Governorate in the last census in 2006 was 3,441,597 (last record of Central Agency for Public Mobilization and Statistics (CAPMAS), Cairo — Egypt). It is also the home of the third largest university in Egypt.
G.A. Shehata, D.G. Mahran were selected randomly by using systematic random sample, in which the prevalence of epilepsy is ranged from 5 to 10 per 1000 (Sander and Shorvon, 1987; Saraceno, 2002), we excepted the prevalence of knowledge of epilepsy is the same. Sample size calculation indicated that sample of 138 of teachers will be appropriate with a confidence interval 95% and with accepted error of 5% points above and below. According to the following formula: n = p(1 − p) × (z − d)2 = (0 − 5)(0 − 5)(1.96/0.05)2 = 138. However, we increased the sample size up to 195 to guard against high drop out. We randomly selected one from each 5 teachers of government schools and one from each 3 teachers from private schools (number = 195). Explanation of the aim of the study was done firstly and we asked them to fulfill the questionnaires after their acceptance to participate. We excluded all those with previous or current seizures.
Study questionnaire The study questionnaire consisted of 5 categories: A — personal data about the teacher; B — data about the familiarity with epilepsy; C — data about the knowledge of epilepsy; D — data about attitude and practice towards students with epilepsy; and E — practice of teachers with an epileptic fit in the classroom (Appendix 1). (Socio-demographic data about the participants., data about the familiarity with epilepsy, data of knowledge, attitude and practice (KAP) of epilepsy, data about attitude towards students with epilepsy and teachers’ management of an epileptic fit in the classroom.) The questionnaire consisted of 12-item questionnaire written in Arabic language. It was matched with previous questionnaires that has been used by other international research groups in previous published studies in the Nigeria (Ojinnaka, 2002), USA (Bishop and Boag, 2006), Greece (Kaleyias et al., 2005), and Istanbul — Turkey (Bekiroglu et al., 2004).
Data collection Data were collected by simplified structured self-administered questionnaire that was pilot tested. It was thought that selfadministered questionnaire would offer participants a greater freedom to express their knowledge, attitudes and practicing when compared to personal interview approach. The questionnaire was presented and its purpose was explained by one of the investigators (the authors and 3 well trained psychologists) to all teachers in each participating school and he collected the answered questionnaires, guaranteeing a 100% return rate. Brief explanation about the study was provided before beginning of the study by the researchers themselves.
Ethical issues The protocol of the study was approved by ethical committee of Faculty of Medicine, Assiut University, Egypt. Written approval consent was obtained from the head of Ministry of Education in Assiut city to carry out the study. Also, we had an approval from the higher authority in Ministry of Education to carry out the study in secondary schools. In addition, we made interviews with the head managers and all teachers to explain the aim of the study and the content of the questionnaire.
Statistical analysis Respondents Fifteen secondary schools: 5 (33.3%) private schools and 10 (66.7%) government schools in Assiut city were chosen to be involved in this study. These schools represented from all areas in the city from different social classes. The teachers included in this study
Data were recorded in a preceded questionnaire and data entry was done using the Excel program. Then the computer software package SPSS for Windows (Version 16) was used to do the data analysis. Continuous variables such as age, were expressed as the mean ± standard deviation (SD), whereas categorical variables (gen-
"Egyptian KAP of teachers towards epilepsy". Table 1
193
Demographic characteristics of the respondents. No. of respondents (n = 189)
Age (years) 25—30 31—35 36—40 41—45 46—50 51—55 56 and more Sex Male Female Marital status Married Single Widow School category Government Private
Percentage (%)
15 10 20 71 41 17 15
7.9 5.3 10.65 37.6 21.7 9.0 7.9
111 78
58.7 41.3
168 16 5
88.9 8.5 2.6
137 52
72.5 27.5
Knowledge about epilepsy (Tables 2 and 3) All teachers had heard about epilepsy (100%). However, teachers aged 31—35 years were more likely than other age groups to deal with students with epilepsy as any other students (p = 0.030). While 10.2% of teachers in government schools believed that epilepsy is one form of psychiatric illness. 100% of widows and 51.2% of female teachers had correct knowledge about epilepsy, which is one of brain diseases. 46.7% of teachers aged 56 and more years, 33.3% of male teachers, and 38.5% teachers of private schools considered epilepsy as genetic disease. Meanwhile 58.4% of teachers of government schools thought that every child with epilepsy is mentally retarded.
Data are presented as number and percentages of participants. der) were presented as frequencies (%). The Pearson chi-square test (2 test) was used to examine the association between responses and each demographic variable in a univariate analysis. Significance level was set at p ≤ 0.05.
Results A total of 189 teachers responded to questionnaire out of 195 teachers, yielding a response rate of 96.9%. The demographic characteristics are shown in Table 1. One hundred and four (76.2%) were aged
Table 2
Attitude towards epilepsy (Table 4) One hundred and two (54%) of teachers thought that, students with epilepsy as other students. Fifty-one (27%) believed that students with epilepsy should be educated in schools of other students. To examine the impact of age of teachers, sex, marital status and school category upon positive attitude of teachers towards epilepsy, deal with child normally or with sympathy, believe that the student with epilepsy does not cause a trouble in the class and also the student with epilepsy should complete his education in schools for other students either if seizures occurred or controlled with good treatment, n = 62 (32.8%).
Teachers responses to questions concerning familiarity with epilepsy.
Variables
Category
No. of respondents
Q1
Age
25—30 31—35 36—40 41—45 46—50 51—55 56 and more Male Female Married Single Widow Government Private
15 10 20 71 41 17 15 111 78 168 16 5 137 52
15 10 20 71 41 17 15 111 78 168 16 5 137 52
Sex Marital status
School category
40 years or more, with the male:female ratio of 1.4:1. The majority of respondents were married (88.9%).
(100%) (100%) (100%) (100%) (100%) (100%) (100%) (100%) (100%) (100%) (100%) (100%) (100%) (100%)
p value
Q2
Not computed
1 (6.7) 4 (40%) 4 (20%) 7 (9.9%) 3 (7.3%) 1 (5.9%) 0 12 (10.8%) 8 (10.3%) 2 (12.5%) 18 (10.7%) 0 17 (12.4%) 3 (5.8%)
Not computed Not computed
Not computed
p value 0.030
1.00 0.720
0.289
Q3 1 (6.7%) 5 (50%) 7 (35%) 12 (16.9%) 8 (19.5%) 3 (17.6%) 1 (6.7%) 24 (21.6%) 13 (16.7%) 3 (18.8%) 34 (20.2%) 0 31 (22.6%) 6 (11.5%)
p value 0.053
0.459 0.530
0.062
Values under the question columns represent number and percentages of participants with a ‘‘yes’’ response to the question; Pearson chi-square represents p value. Q1: Have you ever heard or read about the disease called — epilepsy or convulsive seizure? Q2: Have you ever had an epileptic student as a student? Q3: Have you ever witnessed a seizure at school?
194
Table 3
Answers to questions concerning the knowledge about epilepsy.
Variables
Category (n)
Q4a
p
Age
25—30 (n = 15) 31—35 (n = 10) 36—40 (n = 20) 41—45 (n = 71) 46—50 (n = 41) 51—55 (n = 17) 56 and more (n = 15) Male (n = 111) Female (n = 78) Married (n = 168) Single (n = 16) Widow (n = 5) Government (N = 137) Private (n = 52)
1 (6.7%) 2 (20%) 1 (5%) 3 (4.2%) 3 (7.3%) 4 (23.5%) 1 (6.7%) 8 (7.2%) 7 (9.2%) 13 (7.7%) 2 (12.5) 0 14 (10.2%)) 1 (1.9%)
0.157 9 (60%) 5 (50%) 11 (55%) 38 (53.5%) 14 (34.1%) 4 (23.5%) 5 (33.3%) 0.786 43 (38.7%) 43 (55.1%) 0.639 73 (43.5%) 8 (50%) 5 (100%) 0.047 66 (48.2%) 20 (38.5%)
Sex Marital status School category
Q4b
p
Q4c
0.114 0 0 0 1 (1.4%) 0 0 0 0.027 1 (0.9%) 0 0.041 1 (0.6%) 0 0 0.151 1 (0.7%) 0
p
Q4d
p
Q4e
p
0.947
0 0 1 (5%) 1 (1.4%) 1 (2.4%) 0 0 1 (0.9%) 2 (2.6%) 3 (1.8%) 0 0 1 (0.7%) 2 (3.8%)
0.855
3 (20%) 1 (10%) 3 (15%) 9 (12.7%) 17 (41.5%) 4 (23.5%) 7 (46.7%) 37 (33.3%) 7 (9%) 43 (25.6%) 1 (6.2%) 0 24 (17.5%) 20 (38.5%)
0.005 0 2 (20%) 0 9 (12.7%) 2 (4.9%) 0 2 (13.3%) 0.000 7 (6.3%) 8 (10.3%) 0.099 13 (7.7%) 2 (12.5%) 0 0.003 12 (8.8%) 3 (5.8%)
Not computed Not computed Not computed
0.570 Not computed 0.184
Q4f
p
Q4g
0.134 2 (13.3%) 0 4 (20%) 10 (14.1%) 4 (9.8%) 5 (29.4%) 0 0.414 14 (12.6%) 11 (14.1 0.639 22 (13.1%) 3 (18.8%) 0 0.366 19 (13.9%) 6 (11.5%)
p
Q5
0.176 10 (66%) 8 (80%) 13 (65.0%) 38 (53.5%) 17 (41.5%) 8 (47.1%) 6 (40%) 0.829 54 (48.6%) 46 (59.0%) 0.552 88 (52.4%) 11 (68.8%) 1 (20%) 0.812 80 (58.4%) 20 (38.5%)
p 0.194
0.184 0.149
0.015
Values under the question columns represent number and percentages of participants with a ‘‘yes’’ response to the question. Q4: What do you think is the cause of epilepsy?; a — psychiatric illness; b — brain disease; c — blood disease; d — contagious disease; e — genetic disease; f — i do not know ; g — more than one reasonable responses as infection, tumors, etc. Q5: Do you think a student with epilepsy is usually associated with mental retardation?
G.A. Shehata, D.G. Mahran
"Egyptian KAP of teachers towards epilepsy". Table 4
195
Teachers responses to questions concerning attitude towards students with epilepsy.
Attitude
Response (%) n = 189
Deal with a student with epilepsy as any other student Feel sympathy to student with epilepsy and as any student with chronic illness Feel negative towards student with epilepsy and neglect him completely Do not know how to deal with a student with epilepsy No, a student with epilepsy in the class, does not make a problem Yes, a student with epilepsy in the class makes a problem, because he or she disrupts the education process in the class Yes, a student with epilepsy in the class makes a problem, because he or she makes the teacher anxious Yes, a student with epilepsy in the class make a problem, because he or she has bad psychic effects upon the other students A student with epilepsy in the class makes a problem, has bad effect on the school A student with epilepsy in the class makes a problem, because of the objections from other student’s parents if there were a student with epilepsy in the class A student with epilepsy in the class makes a problem, because of any combination of previous responses A student with epilepsy should complete his education in schools for normal students, although he or she had a seizure in class sometimes A student with epilepsy should complete his education in schools for normal students, ordering their parents to treat them regularly A student with epilepsy should be transferred to schools for students with special needs, because teachers cannot be responsible if something happens to the student during seizure A student with epilepsy should be transferred to schools for students with special needs, because the presence of a student with epilepsy had bad effect upon other students Presence or transfer student with epilepsy from schools of normal students, teachers did not answer
102 (54) 43 (22.8) 2 (1.1) 42 (22.2) 101 (53.4) 6 (3.2) 18 (9.5) 27 (14.3) 0 1 (0.5)
36 (19) 51 (27) 86 (45.5) 9 (4.8)
9 (4.8)
34 (18)
Values under responses column represent number and percentages of participants, responses to questions 6, 7 and 8.
Teachers’ practice towards an epileptic seizure in the class (Table 5) Out of all respondents, 23.8% (n = 45) of teachers accepted to give students with fit in the class the first aid measures and 12.7% (n = 24) accepted to give the students with seizure in the class, any form of prescribed treatment as suppository which was significantly more apparent among teachers (n = 6; 30%) aged 36—40 years (p = 0.015).
Discussion The knowledge and attitudes of the teachers towards students with epilepsy (among many factors related to epilepsy or other) can adversely influence academic achievement and quality of life of an epileptic student at school (Kaleyias et al., 2005). In a community like Egypt, teachers have a pivotal role with substantial influence on the society. So the main objective of this study was to assess the knowledge, attitude and practice of teachers in secondary schools with respect to epilepsy and to understand their approach to deal with a student with epilepsy. In addition, through the results of this research, we can inform the ministry of education
and encourage them to organize health education programs for all the teachers about epilepsy and how to deal with epileptic students. The response rate (96.9%) of our sample is satisfactory, in which the remaining teachers not included in the study, were occupied by teaching students at classes and many of them teaching in more than one school. Familiarity with epilepsy in our sample (100%) was higher than values reported in studies of schoolteachers (97%) in India (Thacker et al., 2008), score of 70% and 59% of those in the Nigeria (Ojinnaka, 2002; Kaleyias et al., 2005), respectively. In which, the source of their knowledge about the disease was mainly from the public media, movies and parents of students. This very high familiarity with epilepsy in our sample supports the suspected high epilepsy prevalence among school students in this area. In this study, 10.6% of teachers have an epileptic student in their class at some time, most of them are teachers aged 31—35 years, which may be attributed to their high exposure to larger number of students that they were sharing in teaching more. In addition, 19.6% have witnessed a seizure at school. That is lower than values reported in previous studies as 24% in Greek (Kaleyias et al., 2005), and Thailand (Kankirawatana, 1999), 23% in Nigeria (Ojinnaka, 2002) although rates up to
196 Table 5
G.A. Shehata, D.G. Mahran Teachers responses to questions concerning management of an epileptic fit in the classroom.
Variables
Category
No. of respondents (n = 189)
Q9
p value
Q10
p value
Age
25—30 31—35 36—40 41—45 46—50 51—55 56 and more Male Female Married Single Widow Government Private
15 10 20 71 41 17 15 111 78 168 16 5 137 52
6 (40%) 2 (20%) 6 (30%) 15 (21.1%) 9 (22%) 6 (35.3%) 1 (6.7%) 27 (24.3%) 18 (23.1%) 38 (22.6%) 5 (31.2%) 2 (40%) 32 (23.4%) 13 (25%)
0.350
5 (33.3%) 0 6 (30%) 5 (7%) 4 (9.8%) 3 (17.6%) 1 (6.7%) 14 (12.6%) 10 (12.8%) 21 (12.5%) 3 (18.8%) 0 17 (12.4%) 7 (13.5%)
0.015*
Sex Marital status School category
0.864 0.511
0.849
1.000 0.532
0.811
Values under the question columns represent number and percentages of participants with a ‘‘yes’’ response to the question. Q9: Do you think that you can give the student who was having a seizure in the class, the first aid measures? Q10: Do you accept to give the student, who was having a seizure in the class, any form of prescribed treatment like as suppository? * Pearson chi square p value is significant p ≤ 0.05.
41% and 57% have been reported (Kaleyias et al., 2005). This factor of familiarity with epilepsy seems to be important, as it was correlated with a higher degree of confidence in one’s ability to help a seizing student, a more accurate knowledge of the prognosis of epilepsy, and a more positive attitude towards the epileptic student (Kaleyias et al., 2005). Thacker et al. (2008) reported that the awareness about epilepsy is shown to be high in several studies from developing as well as developed countries. In the present study, majority of our school teachers (83.1%) gave reasonable answers to the questions about the causes of epilepsy, such as genetics, brain disease, and any other reasonable answers as trauma, infections and tumor, or complications of blood disease. However, our results are similar to studies done by Birbeck et al. (2006), who reported that most Zambian teachers (>70%) recognized epilepsy as a brain-related disorder and among 568 Indian schoolteachers, in which the majority felt epilepsy as a brain disease and gave reasonable answers to the questions about the causes of epilepsy, such as genetics (10.4%), trauma (8.5%), infections (3.3%) and tumor (3.5%). It was also creditable that only a minority (17.5%) of our teachers considered epilepsy as psychological events (7.9%), as contagious disease (1.6%), and did not know the cause of epilepsy (7.9%). Our results are less than the previous studies as in Turkey (Bekiroglu et al., 2004), 24% of teachers believed that epilepsy is a psychological disorder, 11% of Greek teachers reported they do not know what epilepsy is (Kaleyias et al., 2005) and in 2001, Dantas et al. (2001) assessed knowledge and attitudes towards epilepsy among 300 teachers in Brazil (Dantas et al., 2001) and reported that some teachers still thought that epilepsy was contagious. Regarding the association of epilepsy with mental retardation, 52.9% of our teachers believed that every child with epilepsy is mental retarded, which is similar to the study done by Kaleyias et al. (2005), reported 53% of teachers
think that epilepsy and mental retardation were usually or always coexist. When teachers were asked what their attitude towards the epileptic student was, about three quarters (76.8%) of teachers stated it is the same as to any other student or feel sympathy and deal with him or her as with a chronic health problem, and only 1.1% stated that they would rather avoid an epileptic student. This finding, provided it is sincere, indicates a very high degree of acceptance of epileptic students by their teachers. Despite that, 46.6% of the teachers stated that the epileptic student is a source of ‘‘problems’’ in the classroom. This is not a contradiction, however, because when one looks at the specific problem generated by the epileptic child, the most common was ‘‘increased anxiety and responsibility for the teacher, and bad psychic effects upon the other students’’ which is reasonable and does not indicate rejection by the teacher. On the other hand, 0.5% believed that parents of other students would object to the presence of an epileptic student at school. When asked whether epileptic students should continue their studies at their regular school or be transferred to some ‘‘special’’ school, a high percent (72.5%) responded with a positive response, and 9.6% would like the student to be transferred to another school either because his or her presence is considered as an ‘‘too much of a responsibility for the teacher’’ or ‘‘is negative for other students by any mean as interruption of the educational process’’. Our results regarding attitudes are more positive than other previous studies as 60% Nigerian teachers had negative attitudes (Ojinnaka, 2002) and quite the same of Indian teachers in which 59% had positive attitudes (Thacker et al., 2008). So, Prior knowledge of an epileptic student was associated with positive attitudes (Kaleyias et al., 2005). Other important findings in the study are in the issue of management of students with epilepsy. About 23.8% of the teachers thought that they can give the student
"Egyptian KAP of teachers towards epilepsy". who is having a seizure in the class the first aid measures while only 12.7% (more at age group 46—51 years due to more experiences) accepted to give the student, who is having a seizure in the class, any form of prescribed treatment such as suppository. These findings concerning management of an epileptic fit in the classroom are not a surprising result, since there has been no formal health education on epilepsy in any of the schools and most of the knowledge was acquired from ill-informed neighbors, parents of students and public information. In addition, lack of school medical clinics and deficient first aid measures in most of our schools are important factors. Health education is a very important strategy for overcoming barriers in major public health problems like epilepsy.
Limitation of this study This study was carried in Assiut city only and was not extended to include other cities from Lower Egypt and also did not include rural areas as may be there are different attitudes towards epilepsy according to culture levels.
197 Future researches using a more geographically diverse sample as from Lower Egypt or from rural areas are clearly indicated.
Conclusion The current study suggests that, a well directed health educational program about causes and management of epileptic seizures may improve the perception of epilepsy by teachers in Egypt. Efforts should therefore be directed for the population, using possible avenues such as seminars, school health education programmers and the mass media, especially the radio and televisions, which is an important, source of information in most developing countries.
Disclosure of conflicts of interest None of the authors has any conflict of interest to disclose. We confirm that we have read the Journal’s position on issues involved in ethical publication and affirm that this report is consistent with those guidelines.
198
G.A. Shehata, D.G. Mahran
Appendix A. Knowledge, attitude and practice of epilepsy among school teachers in Assiut city, Egypt A- Personal data about the teacher: -Age:…………….. -Sex : 1- male
2- Female
-Marital status: 1- Single
2- Married
3- Divorced
4-Widow
B- Data about the familiarity with epilepsy Q1: Have you ever heard or read about the disease called ?epilepsy or convulsive seizure?
1- Yes
2-No
Q2: Have you ever had an epileptic student in your class? 1- Yes
2-No
Q3: Have you ever witnessed a seizure at school? 1- Yes
2-No
C- Data about the Knowledge of epilepsy Q4: What do you think is the cause of epilepsy? (More than one answer is allowed) •
Psychiatric illness
•
Brain disease
•
Blood disease
•
Contagious disease
•
Genetic disease
•
Any reasonable answers as brain tumor, infections,--etc
Q5: Do you think that, student with epilepsy is usually associated with mental retardation?
1- Yes
2-No
D - Data about attitude and practice towards students with epilepsy
"Egyptian KAP of teachers towards epilepsy".
199
Q6: How do you deal with a student with epilepsy? •
As any other student
•
Feel sympathy to him and deal with him as any student with chronic illness
•
Feel negative towards him and neglect him completely
•
I do not know
Q7: Do you think that, the student with epilepsy in your class make a problem? 1- Yes
2-No
- If your answer is yes; what kind of problems he or she will do: •
Disrupt the education process in the class
•
Make the teacher is anxious about the responsibility if the seizure occurs during the classroom
•
Had bad psychic effects upon the other students
•
Presence of a student with epilepsy can negatively effect upon the school
•
The objections from other students' parents if there were a student with epilepsy in the class
•
Any other response
Q8: Do you think that a student with epilepsy should complete his education in your school? (Please choose the correct answer): •
Yes, although he or she had a seizure in the class sometimes
•
Yes with ordering to their parents to treat them regularly
•
No and they should transferred to schools with special needs, because: 1. Teachers can not tolerate the responsibility if something happen to the student during seizure 2. Presence of a student with epilepsy had bad effect upon other students
E- Practice of teachers with an epileptic fit in the classroom: Q9: Do you think that you can give the student with a seizure in the class, the first aid measures?
1- Yes
2-No
Q10: Do you accept to give the student, who has a seizure in the class, any form of prescribed treatment such as suppository? 1- Yes
2 -No
200
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