Epilepsy & Behavior 34 (2014) 42–46

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Knowledge and attitudes towards epilepsy in Zambia: A questionnaire survey Elisabetta Pupillo a, Eugenio Vitelli b, Paolo Messina a, Ettore Beghi a,⁎ a b

Departement of Neurosciences, IRCSS — Istituto di Ricerche Farmacologiche “Mario Negri”, Milano, Italy Neurology Department, AO Province of Lodi, Lodi, Italy

a r t i c l e

i n f o

Article history: Received 12 November 2013 Revised 19 February 2014 Accepted 22 February 2014 Available online 28 March 2014 Keywords: Knowledge Attitudes Epilepsy Zambia Rural Urban Care

a b s t r a c t Misconception and stigma towards epilepsy have a profound impact on this disease in Africa. An unselected sample of Zambian people was interviewed to investigate their knowledge and attitudes towards epilepsy. Proper/improper answers were scored, and a composite score was developed with negative values for unsatisfactory awareness and high stigma levels. The sample comprised 231 people residing in urban (107) or in rural (124) areas. The median and interquartile range of scores for epilepsy awareness and stigma were, respectively, −1 (−3; +1) and +1 (−1; +6). Poor education was the only significant predictor of unsatisfactory awareness (p = 0.0131), while education and residency were significantly associated with stigma (p b 0.0001 and p = 0.0004). Rural people were mostly in the highest stigma level (44.2%) and urban people in the lowest stigma level (60.4%). Misconception and negative attitudes towards epilepsy among Zambian people reflect poor education and rural residency. © 2014 Elsevier Inc. All rights reserved.

1. Introduction The care of epilepsy implies not only the correct diagnosis and treatment, but also the management of its main sociocultural consequences (largely, Misconception of the disease and the persistence of stigma) which have a profound impact on patients' quality of life [1–5]. Public knowledge and attitudes towards epilepsy have been repeatedly investigated in developed and developing countries [6–32]. Large gaps have been found in awareness of the causes of the disease, and, even worse, widespread negative attitudes were documented, mainly associated with educational level, age, and sex. Large population surveys in people with epilepsy (PWE) in developing countries involve obvious difficulties; nevertheless, studies have been done even in sub-Saharan Africa [33–43], where socially deprived groups and selected occupational categories could be investigated in particular [44–49]. However, to our knowledge, few studies have compared the opinions and attitudes towards epilepsy of neighboring urban and rural populations. One study that focused on the functional status of PWE in rural versus urban areas found that the burden of the disease was greater in the former [50]. This was explained by hypothesizing a “downward drift” of more impaired PWE towards their families of origin in rural areas, as families in these areas are possibly more willing to care for their disabled ⁎ Corresponding author at: IRCCS — Istituto di Ricerche Farmacologiche “Mario Negri”, Via G. La Masa, 19, 20156 Milano, Italy. Tel.: +39 02 39014542; fax: +39 02 33200231. E-mail address: [email protected] (E. Beghi).

http://dx.doi.org/10.1016/j.yebeh.2014.02.025 1525-5050/© 2014 Elsevier Inc. All rights reserved.

members than their counterparts in urban areas. Whether this attitude coexists with a lack of awareness or with stigma towards epilepsy was not clarified. Our specific purpose was, therefore, to determine which factors have a significant impact on the knowledge and attitudes towards epilepsy in rural versus urban areas in a sub-Saharan country. 2. Purpose The aim of the study was to investigate the knowledge and attitudes towards epilepsy in a sample of Zambian people, some living in two urban aggregates and some in the neighboring rural areas. 3. Materials and methods 3.1. Study population We contacted an unselected sample of people from two different Roman Catholic parishes in the south of Zambia (districts of Chirundu and Siavonga) in the summer of 2009. They came from urban and rural areas. The education imparted to the local population conforms to a UK model and is divided into two periods, primary school (eight years) and secondary school (four years). The contact was made when people spontaneously attended the official parish meetings and services. On these occasions, participants were asked to complete a simple questionnaire, with no exclusion except those who refused to be

E. Pupillo et al. / Epilepsy & Behavior 34 (2014) 42–46

interviewed. Where needed, local bilingual volunteers helped the interviewees understand the questions. No compensation was offered.

43

Table 1 Main characteristics of the sample (231).

3.2. Instruments We reviewed previous reports looking for the instruments used for this purpose, particularly studies in similar settings. Some structured questionnaires used in neighboring areas of Zambia, designed to study the prevalence, awareness, and stigma associated with epilepsy, were considered. On this basis, we developed a new English and Chitonga questionnaire to investigate the knowledge and attitudes of Zambian people about seizures, epilepsy, and PWE.

Age group (years)

Sex

Children (No.)

3.3. The questionnaire The inventory included questions regarding the interviewee's profile (age, sex, marital status, number of children, education, occupation, living in an urban or rural settlement) and his/her knowledge of epilepsy and stigma (see Supplementary material). More specifically, the domains covered by the questions included general knowledge about the disease and its main characteristics (Qs 1–4) and its causes and impact on the individual (Qs 5–9) and society (Qs 10–16). On the basis of questions 5 through 16, we developed a compound score for epilepsy awareness and epilepsy stigma. Each answer was assigned a positive or a negative score. Correct answers were rated with a positive number (+1) and incorrect answers with a negative number (−1). The summary score for “epilepsy awareness” was the sum of the scores for questions 5 through 9. As questions 5–7 permitted multiple answers, the total score ranged between −12 and +6. Based on the summary scores for awareness, two levels were identified: unsatisfactory (≤0) and satisfactory (1–6). The summary score for “epilepsy stigma” was the sum of the scores for questions 10 through 16 (range: − 7 to + 9). Based on the summary score for stigma, three levels were identified: high (≤ 0), medium (1–3), and low (4 +) according to the distribution in tertiles of the total score. 3.4. Statistical analysis Descriptive statistics are presented as counts, percentages, and medians and interquartile range (IQR). Univariate analyses were done using the Kruskal–Wallis test or the Spearman correlation, as appropriate, with awareness and stigma scores as dependent variables. The multivariable analysis of covariance (ANCOVA) model included the variables found to be significant in the univariate tests. To account for nonnormal distribution of the data, the ANCOVA model was applied on ranks. The comparison of rural and urban people was assessed with the logistic model. Results are reported as odds ratio (OR) and 95% confidence interval (95% CI); the multivariable logistic model independently tested the effects of age, sex, education, number of children, marital status, stigma, and awareness scores. All tests are two-tailed with significance set at alpha = 0.05. Data were analyzed using the Statistical Analysis System (SAS Institute, Inc., Cary, NC, U.S.A.) package for PC (version 9.2). 4. Results Overall, 231 unselected Zambian residents answered our survey. Questionnaires were not returned by b5% of those asked to answer. The median age (range) was 32 (13–82) years, and the median (range) number of years of education was 8 (0–20). There was a slight predominance of women (58.6%) and a fairly homogeneous distribution of persons living in urban and rural areas (Table 1). Significant differences were seen for sex (more females from rural areas), number of children (higher in rural areas), years of education (higher in urban areas), and marital status (single prevailing in urban areas). The level of familiarity with fits and seizures differed for rural and urban residents (Table 2), but the percentage of people who claimed they had witnessed

Education (years)

Marital status

a

b18 18–29 30–39 N40 Missing M F Missing 0 1–2 3–5 N5 Missing 0–4 5–8 N8 Missing Single Married Widow Missing

Urban area (107) No. (%)

Rural area (124) No. (%)

14 (13.7) 36 (35.3) 28 (27.5) 24 (23.5) 5 57 (54.8) 47 (45.2) 3 36 (35.6) 19 (18.8) 25 (24.8) 21 (20.8) 6 10 (9.4) 18 (17.0) 78 (73.6) 1 47 (45.2) 43 (41.4) 14 (13.5) 3

20 (17.2) 30 (25.9) 29 (25.0) 37 (31.9) 8 35 (29.7) 83 (70.3) 6 32 (26.2) 17 (13.9) 37 (30.3) 36 (29.5) 2 31 (26.1) 56 (47.1) 32 (26.9) 5 30 (28.0) 60 (56.1) 17 (15.9) 17

p-Value

0.4483a

0.0001

0.0396a

b0.0001a

0.0332

Cochrane–Armitage test for trend.

seizures was similar. Almost all responders said that they had already heard about “epilepsy”, with differences favoring urban residents (p = 0.0309). The median (IQR) scores for epilepsy awareness and stigma were, respectively, − 1 (− 3; +1) and + 1 (− 1; + 6). Awareness about epilepsy was unsatisfactory in 67.5% of interviewees. Univariate analysis indicated age (p = 0.0097), education (p = 0.0505), and residence (p = 0.0513) as possibly related to epilepsy awareness (Table 3). In the multivariable model, only education (p = 0.0131) retained significance. The level of stigma was high in 29.6% of responders and medium in 33.0%. Sex, education, and residence were significantly associated with epilepsy stigma, but only education and residence were significant in the multivariable model (p b 0.0001 and p = 0.0004). Fig. 1 illustrates the distribution of stigma scores for rural and urban residents. When the summary stigma scores were presented in the three severity levels, rural people were mostly in the first (high stigma: 44.2%) and urban people in the last (low/no stigma: 60.4%). 5. Discussion and conclusions This study makes a novel contribution to the existing knowledge by comparing the awareness and attitudes towards epilepsy among urban and rural residents of a region of Southern Zambia. Age and level of education were the main independent predictors of epilepsy awareness in accordance with most previous reports [11,28,29,32,35,45]. Surprisingly, we found a similarly good knowledge about epilepsy in individuals in urban and rural areas. This might be due to the fairly good level of education in both groups (42% and 57% of interviewees from the rural and urban settings, respectively, attended N7 school years). However, the figures might be misleading because upon more focused questioning about the hallmarks of epilepsy, twothirds of the interviewees gave unsatisfactory answers. Interestingly, PWE were subject to greater stigma by rural than urban respondents after correction for age and education; this means that town dwellers seem to tolerate and sympathize with PWE more than rural people. A previous study comparing the disability of PWE among rural Zambians and neighboring urban Zimbabweans [50] found higher rates of disability in the rural cohort, possibly because of a sort of “downward social drift” of more impaired PWE from urban back to rural settings where the family of origin may be more willing to accept severely ill members. These findings are not in contrast with our results: we suggest that disabled patients might be better tolerated

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Table 2 Familiarity with seizures. Questions

Answers

N

Urban people No. (%)

Rural people No. (%)

1. Have you ever heard about anyone suffering from frequent fits?

No Yes Missing No Yes Missing No Yes – Loss of consciousness – Tongue biting – Stiffening/legs or arms shaking – Loss of urine or stool – Confusion – Staring Missing No Yes Missing

41 (18.6) 180 (81.5) 10 31 (13.8) 194 (86.2) 6 30 (13.2) 197 (86.8) 114 (57.9) 132 (67.0) 152 (77.2) 130 (66.0) 110 (55.8) 136 (69.0) 4 15 (6.9) 201 (93.1) 15

9 (8.4) 98 (91.6) – 3 (2.8) 104 (97.2) – 14 (13.1) 93 (86.9) 63 (67.7) 60 (64.5) 77 (82.8) 57 (61.3) 50 (53.8) 58 (62.4) – 3 (2.9%) 101 (97.1%) 3

32 (28.1) 82 (71.9) 10 28 (23.7) 90 (76.3) 6 16 (13.3) 104 (86.7) 51 (49.0) 72 (69.2) 75 (72.1) 73 (70.2) 60 (57.7) 78 (75.0) 4 12 (10.7%) 100 (89.3%) 12

2. Have you ever heard about anyone suffering from fits making him fall, lose consciousness, and burn himself? 3. Have you ever witnessed a seizure? If yes, please check all those things you observed:

4. Have you ever heard about the disease called “epilepsy”?

p-Value 0.0002

b0.0001

0.9559 0.0080 0.4823 0.0747 0.1880 0.5793 0.0555 0.0309

In conclusion, our data seem to confirm that stigma towards PWE in developing countries is mainly due to lower levels of education and to the more disadvantaged setting, as observed comparing rural and urban areas; this latter finding plays an independent role, after correction for education, and is possibly attributable to other factors not investigated in the present study (e.g., inherited beliefs and/or opinions, myths, and misconceptions). Further studies are thus needed to better investigate this specific issue, which we consider important to overcome the misconceptions regarding epilepsy in developing countries.

in the rural communities, possibly on account of a more respectful attitude towards the members of the entire local community. However, they may be confined on the fringes of the community, without any role. This attitude might contribute to the social stigma. The main strength of this study was the evaluation of the knowledge and attitudes towards epilepsy in two different social contexts (urban and rural) in the same area. Another strength is the possibility of ensuring satisfactory understanding of the questions by the interviewees, thanks to a local interpreter. The third strength was the lack of monetary incentives. This study has, however, several weaknesses. First of all, selection bias cannot be excluded because the sample was recruited among people attending a Roman Catholic parish; possibly in this setting, people are more open-minded and more tolerant towards disadvantaged members of the community. However, there was no reason to consider local residents adhering to Catholicism different from those adhering to other confessions or to tribal cultures. Second, answers might be biased by the desire to satisfy the presumed wishes and expectations of the parish members acting as interviewers; however, this bias should play a similar role in both interviewee groups.

Ethics Eligible subjects were engaged in a discussion regarding the informed consent before starting the interview. Verbal and written invitations for participation, along with the study consent form, were delivered to all potential participants. The consent form was read and discussed orally in Chitonga and in English language. The answers to the interview questions were recorded on paper forms. An IRB approval

Table 3 Demographic characteristics of the sample and summary scores for epilepsy awareness/stigma.

Residence Age group (years)

Sex Children (No.)

School (years)

Marital status

Awareness Stigma

Rural Urban b18 18–29 30–39 ≥40 M F 0 1–2 3–5 ≥5 0–4 5–8 ≥8 Single Married Widow bMedian ≥Median bMedian ≥Median

Epilepsy awareness Median (IQR)

p-Value⁎

Adj. p-Value (ANCOVA on ranks)

Epilepsy stigma Median (IQR)

p-Value⁎

Adj. p-Value (ANCOVA on ranks)

−1 (−3; +1) −1 (−3; +1) −3 (−4; −1) −1 (−3; +1) 0 (−2; +1) −1 (−3; +1) −1 (−3; +1) −1 (−3; +1) −3 (−5; 0) 0 (−3; +1) −1 (−2; +1) −1 (−3; +1) −1 (−5; −1) −1 (−3; +1) −1 (−3; +1) −1 (−4; +1) −1 (−3; +1) −1 (−1; +1) Na

0.0513

0.6035

b0.0001

0.0004

0.0097

0.4796

0.1663



0.6954



0.0549

0.7217

0.0051

0.2056

0.0505

0.0131

0.1451







0.0031

0.2270

+1 (−1; +3) +5 (+1; +7) 1 (−1; +3) 3 (+1; +6) 3 (+1; +7) 2 (−2; +7) 3 (+1; +6) 1 (−1; +5) 2 (0; +6) 3 (+1; +7) 1 (−1; +5) 1 (−1; +5) −1 (−4; +1) 1 (−1; +3) 5 (−1; +7) 3 (+1; +6) 2 (0; +7) 1 (0; +3) 1 (−1; 5) 3 (+1; +6) Na

−1 (−4; 1) −1 (−3; 1)

IQR, interquartile range; Na, not applicable. ⁎ Only variables with p b 0.1 were included in the ANCOVA model.

0.3547

b0.0001

b0.0001

0.1520



0.0914

0.0595





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Fig. 1. Distribution of the different levels of stigma among rural and urban residents.

was not required because the study did not imply the collection of individual sanitary information. Acknowledgments The authors are indebted to the local bilingual volunteers who helped the interviewees understand the questions. They also wish to thank Ms. Judy Baggott for English editing and Ms. Susanna Franceschi for secretarial assistance. Conflict of interest statement Dr. Elisabetta Pupillo has received funding from the American ALS Association (ALSA Application ID: 1369) for data management and data monitoring of an observational study protocol. Dr. Eugenio Vitelli declares that there is no conflict of interest. Dr. Paolo Messina has received funding from Sanofi-Aventis (5016), Eisai (6393), Lombardy Region (5341), and the American ALS Association (Application ID: 1369) for the data analysis and data management of RCT and observational study protocol. Dr. Ettore Beghi serves on the editorial advisory boards of Amyotrophic Lateral Sclerosis, Epilepsia, Clinical Neurology & Neurosurgery, and Neuroepidemiology; has received money for board membership from VIROPHARMA and Eisai; and has received funding for travel and speaker honoraria from UCB-Pharma, Sanofi-Aventis, and GSK and for educational presentations from GSK. Appendix A. Supplementary data Supplementary data to this article can be found online at http://dx. doi.org/10.1016/j.yebeh.2014.02.025. References [1] De Boer HM. Epilepsy stigma: moving from a global problem to global solutions. Seizure 2010;19:630–6.

[2] Baker GA, Brooks J, Buck D, Jacoby A. The stigma of epilepsy: a European perspective. Epilepsia 2000;41:98–104. [3] Kumari P, Ram D, Haque Nizamie S, Goyal N. Stigma and quality of life in individuals with epilepsy: a preliminary report. Epilepsy Behav 2009;15:358–61. [4] Jacoby A. Stigma, epilepsy, and quality of life. Epilepsy Behav 2002;3(6S2):10–20. [5] Jacoby A, Austin JK. Social stigma for adults and children with epilepsy. Epilepsia 2007;48(Suppl. 9):6–9. [6] Caveness WF, Gallup Jr GH. A survey of public attitudes toward epilepsy in 1979 with an indication of trends over the past thirty years. Epilepsia 1980;21:509–18. [7] Finke M. Public attitudes toward epilepsy in the Federal Republic of Germany: trends over the past decade. Epilepsia 1980;21:201. [8] Iivanainen M, Uutela A, Vilkkumaa I. Public awareness and attitudes toward epilepsy in Finland. Epilepsia 1980;21:413–23. [9] Canger R, Cornaggia C. Public attitudes toward epilepsy in Italy: results of a survey and comparison with U.S.A. and West German data. Epilepsia 1985;26:221–6. [10] Mecarelli O, Li Voti P, Vanacore N, D'Arcangelo S, Mingoia M, Pulitano P, et al. A questionnaire study on knowledge of and attitudes toward epilepsy in schoolchildren and university students in Rome, Italy. Seizure 2007;16:313–9. [11] Mecarelli O, Capovilla G, Romeo A, Rubboli G, Tinuper P, Beghi E. Past and present public knowledge and attitudes toward epilepsy in Italy. Epilepsy Behav 2010;18:110–5. [12] Jensen R, Dam M. Public attitudes toward epilepsy in Denmark. Epilepsia 1992;33: 459–63. [13] Mirnics Z, Czikora G, Zavecs T, Halasz P. Changes in public attitudes toward epilepsy in Hungary: results of surveys conducted in 1994 and 2000. Epilepsia 2001;42: 86–93. [14] Novotna I, Rektor I. The trend in public attitudes in the Czech Republic towards persons with epilepsy. Eur J Neurol 2002;9:535–40. [15] Kobau R, Price P. Knowledge of epilepsy and familiarity with this disorder in the U.S. population: results from the 2002 HealthStyles Surveys. Epilepsia 2003;44:1449–54. [16] Jacoby A, Gorry J, Gamble C, Baker GA. Public knowledge, private grief: a study of public attitudes to epilepsy in the United Kingdom and implications for stigma. Epilepsia 2004;45:1405–15. [17] Spatt J, Bauer G, Baumgartner C, Feucht M, Graf M, Mamoli B, et al, for the Austrian Section of the International League against Epilepsy. Predictors of negative attitudes toward subjects with epilepsy: a representative survey in the general public in Austria. Epilepsia 2005;46:736–42. [18] Diamantopoulos N, Kaleyias J, Tzoufi M, Kootsalis C. A survey of public awareness, understanding, and attitudes toward epilepsy in Greece. Epilepsia 2006;47: 2154–64. [19] Bagic A, Bagic D, Zivkovic I. First population study of the general public awareness and perception of epilepsy in Bosnia and Herzegovina. Epilepsy Behav 2009;14: 154–61. [20] Bagic A, Bagic D, Zivkovic I. First population study of the general public awareness and perception of epilepsy in Croatia. Epilepsy Behav 2009;15:170–8. [21] Lai CW, Huang XS, Lai YH, Zang ZQ, Liu GJ, Yang MZ. Survey of public awareness, understanding, and attitudes toward epilepsy in Henan province, China. Epilepsia 1990;31:182–7.

46

E. Pupillo et al. / Epilepsy & Behavior 34 (2014) 42–46

[22] Chung MY, Chang YC, Lai YHC, Lai CW. Survey of public awareness, understanding, and attitudes toward epilepsy in Taiwan. Epilepsia 1995;36:488–93. [23] Radhakrishnan K, Pandian JD, Santhoshkumar T, Thomas SV, Deetha TD, Sarma PS, et al. Prevalence, knowledge, attitude, and practice of epilepsy in Kerala, South India. Epilepsia 2000;41:1027–35. [24] Hills MD, Mackenzie HC. New Zealand community attitudes toward people with epilepsy. Epilepsia 2002;43:1583–9. [25] Daoud A, Al-Safi S, Otoom S, Wahba L, Alkofahi A. Public knowledge and attitudes towards epilepsy in Jordan. Seizure 2007;16:521–6. [26] Awad A, Sarkhoo F. Public knowledge and attitudes toward epilepsy in Kuwait. Epilepsia 2008;49:564–72. [27] Masoudnia E. Awareness, understanding and attitudes towards epilepsy among Iranian ethnic groups. Seizure 2009;18:369–73. [28] Lim KS, Hills MD, Choo WY, Wong MH, Wu C, Tan CT, et al. A web-based survey of attitudes toward epilepsy in secondary and tertiary students in Malaysia, using the Public Attitudes Toward Epilepsy (PATE) scale. Epilepsy Behav 2013;26:158–61. [29] Saengsuwan J, Boonyaleepan S, Srijakkot J, Sawanyawisuth K, Tiamkao S, Integrated Epilepsy Research Group. Factors associated with knowledge and attitudes in persons with epilepsy. Epilepsy Behav 2012;24:23–9. [30] Gzirishvili N, Kasradze S, Lomidze G, Okujava N, Toidze O, de Boer HM, et al. Knowledge, attitudes, and stigma towards epilepsy in different walks of life: a study in Georgia. Epilepsy Behav 2013;27:315–8. [31] Fernandes PT, Noronha AL, Sander JW, LiL M. Stigma Scale of Epilepsy: the perception of epilepsy stigma in different cities in Brazil. Arq Neuropsiquiatr 2008;66(3A): 471–6. [32] Bruno E, Bartoloni A, Sofia V, Rafael F, Magnelli D, Padilla S, et al. Epilepsy-associated stigma in Bolivia: a community based study among the Guarani population. An International League Against Epilepsy/International Bureau for Epilepsy/World Health Organization Global Campaign Against Epilepsy Regional Project. Epilepsy Behav, 25; 2012. p. 131–6. [33] Nijamnshi AK, Angwafor SA, Tabah EN, Jallon P, Muna WFT. General public knowledge, attitudes, and practice with respect to epilepsy in the Batibo Health District, Cameroon. Epilepsy Behav 2009;14:83–8. [34] Njamnshi AK, Tabah EN, Yepnjio FN, Angwafor SA, Dema F, Fonsah JY, et al. General public awareness, perceptions, and attitudes with respect to epilepsy in the Akwaya Health District, South West Region, Cameroon. Epilepsy Behav 2009;15:179–85. [35] Bain LE, Awah PK, Takougang I, Sigal Y, Ajime TT. Public awareness, knowledge and practice relating to epilepsy amongst adult residents in rural Cameroon. Case study of the Fundong health district. Pan Afr Med J 2013;14:32.

[36] Osungbade KO, Siyanbade SL. Myths, misconceptions, and misunderstandings about epilepsy in a Nigerian rural community: implications for community health interventions. Epilepsy Behav 2011;21:425–9. [37] Rafael F, Houinato D, Nubukpo P, Dubreuil CM, Tran DS, Odermatt P, et al. Sociocultural and psychological features of perceived stigma reported by people with epilepsy in Benin. Epilepsia 2010;51:1061–8. [38] Winkler AS, Mayer M, Schnaitmann S, Ombay M, Mathias B, Schmutzhard E, et al. Belief systems of epilepsy and attitudes toward people living with epilepsy in a rural community of northern Tanzania. Epilepsy Behav 2010;19:596–601. [39] Birbeck GL. Seizures in rural Zambia. Epilepsia 2000;41:277–81. [40] Baskind R, Birbeck GL. Epilepsy-associated stigma in sub-Saharan Africa: the social landscape of a disease. Epilepsy Behav 2005;7:68–73. [41] Birbeck GL, Chomba E, Atadzhanov M, Mbewe E, Haworth A. The social and economic impact of epilepsy in Zambia: a cross-sectional study. Lancet Neurol 2007;6: 39–44. [42] Atadzhanov M, Haworth A, Chomba E, Mbewe E, Birbeck GL. Epilepsy-associated stigma in Zambia: what factors predict greater felt stigma in a highly stigmatized population? Epilepsy Behav 2010;19:414–8. [43] Elafros MA, Mulenga J, Mbewe E, Haworth A, Chomba E, Atadzhanov M, et al. Peer support group as an intervention to decrease epilepsy-associated stigma. Epilepsy Behav 2013;27:188–92. [44] Baskind R, Birbeck GL. Epilepsy care in Zambia: a study of traditional healers. Epilepsia 2005;46:1121–6. [45] Atadzhanov M, Chomba E, Haworth A, Mbewe E, Birbeck GL. Knowledge, attitudes, behaviors, and practices regarding epilepsy among Zambian clerics. Epilepsy Behav 2006;9:83–8. [46] Mbewe E, Haworth A, Atadzhanov M, Chomba E, Birbeck GL. Epilepsy-related knowledge, attitudes, and practices among Zambian police officers. Epilepsy Behav 2007;10:456–62. [47] Chomba E, Haworth A, Atadzhanov M, Mbewe E, Birbeck GL. Zambian health care workers' knowledge, attitudes, beliefs, and practices regarding epilepsy. Epilepsy Behav 2007;10:111–9. [48] Birbeck GL, Chomba E, Atadzhanov M, Mbewe E, Haworth A. Women's experiences living with epilepsy in Zambia. Am J Trop Med Hyg 2008;79:168–72. [49] Ekenze OS, Ndukuba AC. Perception of epilepsy among public workers: perspectives from a developing country. Epilepsy Behav 2013;26:87–90. [50] Birbeck GL, Kalichi EMN. The functional status of people with epilepsy in rural subSaharan Africa. J Neurol Sci 2003;209:65–8.

Knowledge and attitudes towards epilepsy in Zambia: a questionnaire survey.

Misconception and stigma towards epilepsy have a profound impact on this disease in Africa. An unselected sample of Zambian people was interviewed to ...
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