Epilepsy knowledge, attitudes, behaviors, and associated factors among primary, post-primary, and secondary school teachers in Ouagadougou (Burkina Faso)

Epilepsy is one of the most common pediatric neurological disorders with a higher incidence during the school years (Jan, 2005). The prevalence rate of epilepsy in children in developed and developing countries ranges between 3/1000 and 22.2/1000 (Beilmann et al., 1999; Radhakrishnan et al., 2000). Children with epilepsy are at increased risk of educational underachievement, learning difficulties, mental health problems, social isolation, and poor self-esteem (Sbarra et al., 2002). The school period will significantly impact the child’s quality of life and future adult roles (Williams, 2003). At the global forum, it is estimated that approximately 0.5% of school-age children are affected by epilepsy (Leppick, 2001). School teachers play a central role in determining access to education for students living with epilepsy and may mediate epilepsy-associated stigma (Fernandes et al., 2007). Teachers’ level of knowledge and attitude toward epileptic students can be crucial in their characters, i.e., development and academic achievement (England et al., 2004). Several studies have been conducted on the knowledge of epilepsy among teachers and on their attitudes towards epilepsy in many countries, as in the United States (Bishop et al., 2004; 2006); in Europa (Prpic et al., 2003; Kaleyias et al., 2005; Mecarelli et al., 2010) and Asia (Bekiroglu et al., 2004; Lee et al., 2010; Thacker et al., 2008). Several studies have indicated that teachers often have insufficient knowledge, inadequate training, and misconceptions about epilepsy and its management (Prpic et al., 2003; Dantas et al.,2001). In Sub-Saharan Africa, the prevalence of epilepsy in children ranges between 7.3 per 1,000 to 41 per 1,000 (Christianson et al., 2000; Mung’ala-Odera et al., 2008). The most commonly prescribed antiepileptic drug in children was valproic acid, followed by phenobarbital and carbamazepine (Doumbia-Ouattara et al., 2013; Ibinga et al., 2015). The education of children with epilepsy remains much lower than that of the general population, with an enrollment rate varying between 2.8% in CAR to 91.7% in Nigeria (Mbelesso et al., 2009; Lagunju et al., 2012). This situation would be linked to the stigma that makes some parents oppose schooling to protect the child against the onset of crises in public (Chomba et al., 2008; Sharkawy et al., 2006). Furthermore, teachers usually do not have any formal training on dealing with epileptic children (Birbeck et al., 2006). The numerous studies carried out on the level of knowledge of teachers and their attitudes towards epilepsy show that African teachers have a low level of knowledge and practice in relation to epilepsy (Birbeck et al., 2006; Ojinnaka et al., 2002; Boubacar et al., 2016; Ategbo et al., 2014; Ndour et al., 2004; Mustapha et al., 2013; Sanya et al., 2005).

In Burkina Faso, the prevalence of epilepsy and the school enrollment rate of children with epilepsy are not known. Already, primary and secondary school teachers did not receive specific lessons on epilepsy. According to previous studies, schoolteachers had a good familiarity with epilepsy, poor knowledge of epilepsy, and poor practice in the face of epilepsy (Millogo et al., 2001; 2004). The objective of this study was to determine the current level of knowledge and behavior of primary and post-primary teachers in the city of Ouagadougou.

This study focused on determining the level of knowledge, attitude, and practice towards epilepsy and identified associated factors that affect the teachers’ knowledge, attitude, and practice towards epilepsy in Burkina Faso. This study showed that the majority of school teachers had a high level of familiarity with epilepsy. Indeed, almost all the teachers had already heard of epilepsy (98.6%), which was comparable to the data in the literature, which found a frequency between 91.5 and 100% (Thacker et al., 2008; Millogo et al., 2004; Assadeck et al., 2020; Goel et al., 2014; Elhassan et al., 2017; Oumer et al., 2020; Rambe et al., 2002). In addition, more than the majority of teachers (53.18%) had already seen an epileptic seizure. The main sources of epilepsy information were from a relative (47.27%), health personnel (18.18%), and mediaş (16.35%). The main sources of knowledge about the condition were media, the internet, and parents of students (Kaleyias et al., 2005; Birbeck et al., 2006; Mecarelli et al., 2010). This situation is different in developed countries, where 50% of teachers obtained information on epilepsy through conversations with doctors, reading scientific reports, or participation in educational courses (Mecarelli et al., 2010). The level of witnessing seizures (53.18%) was similar to those observed in Italy (57.5%) (Mecarelli et al., 2010) but lower than those observed in Sudan (83.5%) (Elhassan et al., 2017), in Burkina Faso (90.8%) (Millogo et al., 2004), in Brazil (79%) (Fernandes et al., 2007), in Mali (84%) (Maiga et al., 2015) and Niger (100%) (Toudou-Daouda et al., 2020). Regarding their specific knowledge of epilepsy, the majority of teachers identified the brain as the organ responsible for epileptic seizures (79.1%). This result was higher than that observed in other studies in India (49%) (Goel et al., 2014) and Niger (42.1%) (Assadeck et al., 2020). According to teachers, all ages and all social categories could be affected by epilepsy (80%). Knowledge of these data allows teachers to transmit the right information to students and their parents. Almost the majority of teachers knew the main symptoms of the disease, such as seizure occurrence (34.54%), loss of conscience (31.36%), and sudden fall (13.58%). The symptom most known by teachers was unconsciousness. These symptoms differed from one author to another. According to Khanal et al. (2015), in Nepal, the main signs of epilepsy were unconsciousness (82.4%), foaming from the mouth (67.9%), and tongue bite (43.0%). Knowledge of the symptoms of the disease is a considerable asset allowing the recognition of epileptic seizures that may occur in children. The main cause of epilepsy listed by schoolteachers in our study was brain disease (65%). The situation was similar in Italy, where the majority of schoolteachers considered epilepsy as a hereditary disease (55%) and birth defect (54.2%) (Mecarelli et al., 2010). The level of the non-contagious nature of epilepsy (74%) was comparable to that of Indian authors (85%) (Thacker et al., 2008; Goel et al., 2014). The rate of teachers (15%) who considered epilepsy as a contagious disease was lower than that reported in Niger by Assadeck et al. (2020) (46.2%) and Maiga et al. (2015) in Mali (40%). These differences could be explained by several parameters such as the socio-cultural context, the religious beliefs of the population, and the education system. The majority (70.9%) of schoolteachers believed that students with epilepsy usually had associated mental retardation. This rate is comparable to that reported in Ethiopia (95%) (Gebrewold et al., 2016) but higher in those in Egypt (52.9%) (Shehata et al., 2010) and Niger (57.4%) (Toudou-Daouda and Mamadou, 2020). In Europa, this proportion is lower, with 20% and 33.2% of schoolteachers who considered that epilepsy could affect children’s behavior and learning ability (Mecarelli et al., 2010; Iannone et al., 2021). The percentage of teachers in our study who believed epilepsy is curable (43.2%) was in the same proportion as in a study from Italy (40.6%) (Mecarelli et al., 2010) but lower than those observed in the study of Goel et al. (2014) (83%) and the study of Toudou-Daouda and Mamadou (2020) (85%) and (79.3%) (Assadeck et al., 2020). Socio-cultural factors could explain this situation. Few studies evaluated the level of knowledge of school teachers. The level of knowledge of epilepsy is high (75.9%) in comparison to those reported by several studies (51.9–59.8%) (Oumer et al., 2020; Zeleke et al., 2018; Elgarawany et al., 2009; Karimi et al., 2015). In practice, 50% of teachers said their knowledge of epilepsy was inadequate (Mott et al., 2013). In our study, witnessing an epileptic seizure would positively influence the knowledge of schoolteachers. Several other factors have been identified in the literature. Thus Oumer et al. (2020) in Ethiopia found that knowing a person living with epilepsy, having a family history of epilepsy, and having benefited a previous first aid training were factors associated with the knowledge level of epilepsy. In the United States, Bishop and Slevin (2004) found that longer teaching experience was correlated with a better knowledge of epilepsy. These differences could be related to the methodology used. The majority of schoolteachers (57.71%) had an inadequate attitude regarding the first aid provision for the student with seizure doing nothing (40%), by preventing the person from moving (13.63%), and by putting objects in the mouth (4.09 %). The majority of schoolteachers should place an object in the patient’s mouth (Mecarell et al., 2010). In contrast, Oumer et al. (2020) in Ethiopia found that most schoolteachers (55.3%) had adequate attitudes regarding first aid management.

Our result could be explained by the fact that almost all schoolteachers did not receive any training in first aid management. According to Al-Hashemi et al. (2016), few schoolteachers (8.5%) had sufficient training in first-aid management of seizures in Kuwait. At the end of the seizures, 33.7% of teachers planned to alert the help or bring the student to the hospital, rather a good attitude. According to Italian studies, the majority of schoolteachers would invariably call an ambulance (Mecarell et al., 2010; Iannone et al., 2021). In the majority of cases (56.4%), teachers planned to notify the administrator or shareholders. This situation is comparable to the one presented by the Toudou-Daouda and Mamadou (2020) study, in which 57% of teachers planned to refer the student to the school. Notifying the school administration would allow teachers to have reliable information on the child’s state of health to direct parents to structures for the care of epilepsy. A few teachers (3.2%) planned to exclude the student from school until the seizures altogether ceased. This attitude could be beneficial in the event of a single seizure but could also lead to longer schooling and stigmatization of the pupil in the event of repeated seizures. According to school life attitudes, the majority of teachers recommended personalized education to epileptic students (65.0%). This attitude is not unique for teachers in developing countries. In Italian studies, 36.4% and 55.8% of teachers believed that students with epilepsy require personal assistance at school (Mecarell et al., 2010; Iannone et al., 2021).

In contrast, Toudou-Daouda, and Mamadou (2020) in Niger found that 79.2% of schoolteachers think that students with epilepsy should not be placed in an adapted class. Several studies promote the treatment of epileptic students as any other student to enhance their confidence (Fernandes et al., 2011). However, children with epilepsy suffering from intellectual deficiencies are taken care of in specialized schools. Unlike European countries, our education system does not have many specialized schools that can care for epileptic students with specific physical and intellectual disabilities. Regarding school life-related attitudes of teachers and attitudes during and after a convulsive seizure, gender of a schoolteacher and having already witnessed an epileptic seizure were associated with good practice towards epilepsy. In the study of Mecarelli et al. (2014), direct experience with seizures, a larger number of students with epilepsy, witnessing an epileptic seizure, and participation in scientific meetings were all correlated with better knowledge of the correct management of an epileptic seizure, with some exceptions. Oumer et al. (2020) in Ethiopia found that previous first-aid training was a significant factor correlated with the attitude level of epilepsy. These differences would be related to methodological problems.

At the time of the investigations, the school teachers in Ouagadougou had a relatively low level of awareness and understanding of certain aspects of epilepsy. A minority of the study population demonstrated unfair discriminatory behavior toward children with epilepsy.

No funding.