Prevalence, Knowledge, Attitude, and Practice of Epilepsy in Kerala, South India

Abstract

Summary:Purpose: To ascertain the prevalence and pattern of epilepsy and to characterize and quantify knowledge, attitude, and practice (KAP) toward epilepsy among the people of the state of Kerala, which is distinguished from the rest of India by a high level of literacy and health awareness of its population.Methods: We conducted a door-to-door survey covering the entire population of 238, I02 people residing in 43,68 I households in a seniiurban area of central Kerala. The screening questionnaire administered by medical social workers had a sensitivity of 100% for identifying persons with epilepsy. Neurologists examined all the individuals suspected of having epilepsy. We evaluated KAP toward epilepsy among 1,118 subjects (439 males and 679 females; mean age, 33.3 years; age range, 15-85 years) from households without epilepsy in the study area.Results: Through a three-phased survey, we ascertained 1,175 cases (6 16 males and 559 females) with active epilepsy, providing a crude point prevalence ratio of 4.9 cases per 1,000 people and an age-adjusted prevalence ratio of 4.7 cases per 1,000 population. The highest age-specific prevalence rate of 6.5 per 1,000 occurred in the 10-to 19-year-old age group. Sex-specific prevalence rates did not significantly differ. The proportion of generalized and localization-related epilepsies was 58.8% and 30.6%, respectively. Ninety-nine percent of the KAP respondents had read or heard about epilepsy. Thirty-one percent and 27% thought epilepsy was a hereditary disorder and a form of insanity, respectively. About 40% of the respondents felt that individuals with epilepsy could not be properly educated or employed. Eleven percent would object to their children having contact with epileptic children.Conclusions: The prevalence and pattern of epilepsy in central Kerala, South India, do not differ from that of developed countries. Although the awareness of epilepsy among the people of Kerala was comparable to that of developed countries, the attitudes were much more negative. The need for educating the people of Kerala on epilepsy and for incorporating an adequate knowledge of epilepsy in the school curricula cannot be overemphasized. Key Words: Epidemiology-Epilepsy-Knowledge, attitude and practice-KAP-Prevalence.Population-based studies, in contrast to hospital-based studies, provide a relatively unbiased picture of various aspects of the disease in question. Prevalence is a measure of the disease burden in the community, which has to be considered when planning the health needs at local, regional, and national levels. Knowing the degree of awareness and attitude toward a disease in a society is a necessary first step in eliminating discrimination against persons with that disease.

Awareness, attitudes and perceptions on epilepsy in Southern Brazil

“…It has been clearly observed that the level of education infl uences the answers about the disease and leads to less pejorative attitudes to persons with epilepsy, corroborating with other researches designed for similar purposes 4,[6][7][8][9][10][11][13][14][15] . It is inferred that populations with a lower level of education and a lower income probably also have less access to information concerning epilepsy and this contributes to maintaining erroneous concepts about the disease.…”

“…Questionnaires that evaluate the perception of epilepsy in many different social segments have been used by a great number of authors [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15] . Although many limitations have been observed such as understanding the questions, diffi culty in achieving the right answer since there is a broad range of epilepsies, the tendency is to not expose negative positions on the subject and the non-validation of the instrument 23 .…”

Women with Onset of Epilepsy Prior to Marriage: Disclose or Conceal?

“…Nearly 90% of our patients expressed that society especially discriminated women with epilepsy. In a recently conducted populationbased knowledge, attitude, and practice survey in central Kerala, 39% of the respondents felt that epilepsy is a hindrance to married life (Radhakrishnan et al, 2000). Furthermore, until recently, an Indian law equated epilepsy with insanity as a ground for divorce (Mani, 1997).…”

Screening symptoms of depression and suicidal ideation in people with epilepsy using the Beck depression inventory

“…5 Sociocultural aspects of epilepsy appears also to affect depression. [6][7][8] Some of the antiepileptic drugs (AEDs) may cause depression. 9 Other factors, such as seizure frequency, degree of seizure freedom and duration of epilepsy, have been shown to considerably contribute to the prevalence of depression among PWE [10].…”