Attitudes and perceptions towards epilepsy in an onchocerciasis-endemic region of Tanzania: a mixed approach to determine the magnitude and driving factors

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2024年9月27日

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Vivian P. Mushi,
Winifrida Kidima,
Isolide S. Massawe,
Pendo F. Magili,
Dan Bhwana,
Rahel Elishilia Kaaya,
Henrika Kimambo,
Herieth F. Hyera,
William Matuja,
Arjune Sen,
Josemir W. Sander,
Robert Colebunders,
Sloan Mahone,
Charles R. Newton,
Bruno P. Mmbando,
Albert Akpalu,
Anthony Godi,
Bruno Mmbando,
Cynthia Sottie,
Damazo T. Kadengye,
Daniel Mtai Mwanga,
Daniel Nana Yaw Abankwah,
David McDaid,
Dorcas Muli,
Emmanuel Darkwa,
Frederick Murunga Wekesah,
Gergana Manolova,
Gershim Asiki,
Herieth Hyera,
Helen Cross,
Isolide Sylvester,
Josemir Sander,
Mary Bitta,
Mercy Atieno,
Neerja Chowdhary,
Neerja Chowdhary,
Patrick Adjei,
Pendo Faustine,
Peter Otieno,
Richard Walker,
Ryan Wagner,
Sabina Asiamah,
Samuel Iddi,
Simone Grassi,
Sonia Vallentin,
Stella Waruingi,
Symon Kariuki,
Tarun Dua,
Thomas Kwasa,
Timothy Denison,
Vivian Mushi

摘要

Background

Epilepsy remains a significant public health concern in Tanzania, with affected individuals enduring stigma, whether through actions or perceptions. Myths, misunderstandings, and misconceptions about epilepsy have persisted due to a multitude of factors. Here, we assessed attitudes and perceptions toward epilepsy in Mahenge.

Methods

A cross-sectional study utilising a mixed-methods approach was undertaken in eight villages in the Ulanga district of Mahenge, integrating a semi-structured questionnaire and focus group discussions (FGDs). The questionnaire involved 778 community members, and 15 FGDs were conducted (seven groups with people with epilepsy and eight without). Descriptive statistics, chi-square, and logistic regression were used for quantitative analysis, while we used NVivo version 14 for thematic analysis of qualitative data.

Results

Of 778 participants, over half were women (425, 54.6%) with a median age of 41 years (IQR: 30–55) and most had completed primary education (79.9%). The majority of participants were aware of epilepsy (96.8%), yet they displayed low knowledge (51%), negative attitudes (45.5%), and perceptions (42.1%) towards the disorder. A low level of understanding was significantly associated with negative attitudes (Adjusted Odds Ratio [AOR] = 1.89, 95%CI: 1.41–2.53) and perceptions (AOR = 3.22, 95%CI: 2.05–5.04) towards epilepsy. In the qualitative analysis, often hereditary factors and infections were named as causes of epilepsy, along with misconceptions involving witchcraft and divine punishment. There was also a misconception about the contagiousness of epilepsy. Traditional healers were often the initial point of treatment. Epilepsy-related stigma was evident, with individuals with epilepsy facing derogatory labels, social isolation, and barriers to education. Lastly, there was a lack of understanding regarding a possible association between epilepsy and onchocerciasis.

Conclusions

Despite high awareness of epilepsy, there is insufficient understanding, negative attitudes, and perceptions, including misconceptions and stigma about this neurologic condition. Community-based education programmes are essential for promoting proper healthcare-seeking behaviour and dispelling myths.