1 INTRODUCTION

One of the most common chronic neurological diseases, epilepsy affects more than 50 million people worldwide, and nearly 80% of them live in developing countries (Ngugi, Bottomley, Kleinschmidt, Sander, & Newton, 2010). In Niger, epilepsy is poorly studied, and there is no study realized in the general population determining the incidence and prevalence of this condition. However, a recent study reports a hospital frequency of epilepsy of 29.5%, affecting mainly men and people younger than 20 years (Assadeck et al., 2019). In sub-Saharan Africa, epilepsy remains a major public health concern with significant economic and socio-cultural consequences. It is considered as a serious illness because of its alleged contagiousness and incurability resulting in rejection of people with epilepsy by the society responsible for problems of social integration (Maiga et al., 2011; Millogo & Siranyan, 2004). People with epilepsy suffer more from social discrimination than the disease itself. The negative attitudes and beliefs about epilepsy are rife not only in the general population but also in the school environment. In general, school teachers do not receive any formal instruction on epilepsy during their training and most cases of epilepsy tend to occur in childhood and adolescence. We know that epilepsy is the most common neurological disease in school-age (Seidenberg & Berent, 1992), a period during which children begin and complete a critical part of their social and educational development. Negative attitudes and beliefs about epilepsy of the school teachers can lead to the expulsion of the child and even the nonschooling. Besides, some children with epilepsy may be rejected from their peers for fear of being contaminated. A study conducted in Sakoira in northeastern of Niger regarding knowledge and attitudes about epilepsy of primary and secondary school teachers revealed that 42% of teachers considered epilepsy as a contagious disease and 45% thought that it is not a brain disease (Boubacar et al., 2016). To remedy the problem of school and social discrimination in children with epilepsy, school teachers could play an important role in this affair by providing them information about epilepsy.

The present study was designed firstly to evaluate knowledge, attitudes, and practices about epilepsy of primary and secondary schools teachers in the city of Niamey and secondly to formulate targeted sensitization messages for these teachers.

2 METHODS

We conducted a descriptive cross-sectional survey between May and June 2019 regarding knowledge, attitudes, and practices about epilepsy of primary and secondary school teachers in the city of Niamey, capital of Niger. We have personally visited primary and secondary schools and distributed to school teachers (after obtaining their informed consent and those wishing to participate in the survey) questionnaires (Appendix 1) including questions regarding knowledge, attitudes, and practices about epilepsy that they fill themselves. We ask each participant to complete the questionnaire alone based on their knowledge about epilepsy without resorting to a colleague to limit the influence of each other in the responses. We stay beside the participant when he completes the questionnaire, and at the end, we recover the completed form. At the same opportunity, we take advantage to address awareness messages to the participants regardless of their answers.

The study was approved by the Institutional Review Board of the Faculty of Medicine of Abdou Moumouni University of Niamey (Niger) in accordance with the Declaration of Helsinki.

The data analysis was performed with SPSS software version 20.0 (SPSS Inc.). The qualitative variables were expressed as percentages and the quantitative variables as mean ± standard deviation. The chi-square test of Pearson was used to compare the proportions of the qualitative variables. p-values < .05 were considered statistically significant.

3 RESULTS

4 DISCUSSION

In this study, we evaluate knowledge, attitudes, and practices about epilepsy among primary and secondary school teachers in the city of Niamey, capital of Niger. Because epilepsy mainly affects people younger than 20 years in Niger (Assadeck et al., 2019), we have chosen to specifically conduct the survey among primary and secondary school teachers who are responsible for the social and educational development of people in this age group and to transmit them targeted awareness messages about epilepsy so that they can transmit these messages to a larger number of students to avoid the rejection of epileptic students by their peers. The majority of teachers (62.1%) who completed the questionnaire had a bachelor degree in education signifying a high level of education. However, the study results revealed a low level of general knowledge about epilepsy among respondents, of whom only 42.1% think that epilepsy is a brain disease. Epilepsy is considered to be a psychiatric illness by 15.9% of respondents, an impurity by 38.6% of teachers, and a contagious disease by 46.2% of respondents. In the study conducted in Sakoira in northeastern of Niger (Boubacar et al., 2016), the percentage of the primary and secondary school teachers of this city considering epilepsy as a brain disease seems to be higher than that of teachers in the city of Niamey (52% vs. 42.1%; p > .2). In the same study, 42% of respondents considered epilepsy to be a contagious disease, whereas in the present study 46.2% of teachers think that epilepsy is contagious (p > .2). In other African studies conducted among school teachers, epilepsy is considered as a contagious disease in 28.2–39% of teachers surveyed and in 22.8–53.4% considered as a brain disease (Ategbo et al., 2014; Birbeck, Chomba, Atadzhanov, Mbewe, & Haworth, 2006; Maiga et al., 2015). The main routes of transmission reported in these studies were saliva, sweat, and urine. In this study, the main transmission routes reported were the contact with the places of crisis, physical contact with an epileptic person, and contact with saliva. On the other hand, low proportions ranging from 1% to 11.9% of teachers considering epilepsy as a contagious disease have been reported in other African studies (Gebrewold, Enquselassie, Teklehaimanot, & Gugssa, 2016; Millogo & Siranyan, 2004; Shehata & Mahran, 2010). In some Asian studies, epilepsy is considered to be contagious in 0.2–15.3% of teachers surveyed and in 44.4–83.6% as a brain disease (Alkhamra, Tannous, Hadidi, & Alkhateeb, 2012; Lee, Lee, Chung, Yun, & Choi-Kwon, 2010; Thacker, Verma, Ji, Thacker, & Mishra, 2008). Epilepsy is considered to be a psychiatric illness by 15.9% of teachers surveyed in our study. This percentage is higher than the percentages observed among South Korean teachers (3.5%) and Egyptian teachers (10.2%) and lower than that observed among Ethiopian teachers (25.9%) (Gebrewold et al., 2016; Lee et al., 2010; Shehata & Mahran, 2010). These differences could be explained by several parameters such as the socio-cultural context, the religious beliefs of the population, and the education system. In Niger, several infectious and tropical diseases and deficiency diseases are taught in secondary schools, but epilepsy is not taught although it is common. This would explain the low level of knowledge about epilepsy among school teachers in Niger.

Although all respondents in our study had ever heard about epilepsy, 12.4% of the respondents were unable to give a major clinical sign of an epileptic seizure. Epilepsy is considered to be an incurable disease by 6.9% of respondents in our study. This proportion is lower than those reported in Burkina Faso (13.5%), in Mali (34.8%), in Jordan (52%), in India (21.4%), in South Korea (22%), and to that reported in a previous study from Niger (35%) (Alkhamra et al., 2012; Boubacar et al., 2016; Lee et al., 2010; Maiga et al., 2015; Millogo & Siranyan, 2004; Thacker et al., 2008). Of the respondents who consider epilepsy as a curable disease, 21.4% of them think that epilepsy can be treated by both modern and traditional medicine. On the other hand, 31.7% think that epilepsy is treated only by traditional medicine, while 26.2% only advise modern medicine. In Burkina Faso, only 15% of teachers think that epilepsy is treated only by modern medicine, and 56% by the combination of modern and traditional medicine (Millogo & Siranyan, 2004). In Mali, 83.7% of teachers advise modern medicine (Maiga et al., 2015).

Although the general level of knowledge about epilepsy was low among the respondents in our study, 32.4% of teachers reported appropriate attitudes when someone has an epileptic seizure such as “Maintain the person on the side until the crisis passes,” “Withdrawal dangerous objects around the person.” This percentage of appropriate attitudes found in our study is comparable to that found in Malian teachers (35%) and lower than that found in teachers in Burkina Faso (40%) (Maiga et al., 2015; Millogo & Siranyan, 2004).

At the end of the survey, school teachers' responses demonstrate that they were less knowledgeable about epilepsy. Many school teachers emphasized the impact of negative religious and cultural beliefs about epilepsy in their attitude toward people with epilepsy. Besides, many school teachers had shown their satisfaction with the information provided concerning epilepsy, and some of them would like to have more information on this superstitious and mythical disease. Therefore, this underlines the need to integrate well-targeted information modules on epilepsy as well as the adapted gestures to perform when a child has an epileptic seizure. School teachers underlined the interest of stopping to send at home the students with epilepsy and helping them in the school learning and social integration by changing the negative attitudes of students without medical conditions and promoting positive attitudes toward students with epilepsy. Considering that epilepsy is a common disease in school-age, it is very important to minimize the negative consequences of this disease in a school environment because it can lead to problems of schooling for children with epilepsy.

5 CONCLUSION AND RECOMMENDATIONS

In this study assessing knowledge, attitudes, and practices about epilepsy, we find a low overall level of knowledge about this condition among school teachers in the city of Niamey. The study results encourage special attention in the epileptic children in school-age to avoid the rejection of these children by the society responsible for problems of social integration. This low level of general knowledge about epilepsy among school teachers, knowing that epilepsy is common among school-age children, justifies the need to integrate into the training modules of the future school teachers information modules related to epilepsy to enable them to acquire know-how about epilepsy. It is also necessary to organize continuing education seminars for teachers already in post. The study recommends further research to evaluate knowledge, practices, and attitudes regarding epilepsy among school teachers of other cities of Niger and at the same opportunity to address targeted awareness messages for these teachers. The study also recommends conducting research on knowledge, practices, and attitudes of health workers. The study also recommends public education about epilepsy using possible avenues such as the integration of information modules regarding epilepsy into the national education program, the mass media especially radio and television which are an important source of information in most developing countries, and awareness campaigns to change any misconceptions about epilepsy and to promote positive attitudes toward people with epilepsy.

CONFLICT OF INTEREST

All authors have read and agreed to the content of the manuscript. None of the authors has any conflict of interest to declare. The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. We confirm that this manuscript has not previously been published and is not being considered for publication by another journal. The authors alone are responsible for the content and writing of the paper.