The influence of knowledge, attitudes and practice of people living with epilepsy on seizure control

Abstract

Background The prevalence of People Living with Epilepsy (PLWE) in developing nations is estimated at 40 million with 13 million reported to reside in Africa. Epilepsy ranks among the non-communicable diseases (NCDs) that contribute to significant morbidity and mortality. A lack of knowledge around the disease process, coupled with stigma and cultural dogma, has been shown to directly influence compliance to medication, reflected in poor seizure control. Objective To describe the relationship between the knowledge, attitudes and practice of People Living with Epilepsy and seizure control at the Kenyatta National Hospital. Study Design/Site Hospital based cross-sectional descriptive study at KNH Neurology Clinic Study Subjects All patients with a seizure disorder on follow up for at least two years at KNH neurology clinic. Methods The study was a cross sectional descriptive study done over three months at the KNH outpatient neurology clinic which sees roughly 540 PLWE annually. Data was collected using validated tools; the Epilepsy Patient Knowledge Questionnaire (EPKQ), and the Kilifi Epilepsy Beliefs and Attitude Scale (KEBAS) for assessing the knowledge, attitudes and practice of PLWE. Poor seizure control was defined as >1 seizure in the previous six months. Results A total of 118 attendees of the outpatient Neurology clinic were consecutively screened during the 11 week period. 6 were ineligible while 112 met the study inclusion criteria; of the eligible, 4 declined consent thus 108(91.52 % of total screened) were recruited. The Epilepsy Patient Knowledge Questionnaire (EPKQ) revealed patients were well versed in medical knowledge and practice in respect to their illness, with 80.6% (CI, 0.72 – 0.87) of patients having good knowledge and 66.7% (CI, 0.57 – 0.75) having good practice with a cumulative EPQK score of 91.7% (CI, 0.85 – 0.96).The Kilifi Epilepsy Beliefs and Attitude Scale (KEBAS) found patients to have an overall good attitude and belief towards epilepsy with a KEBAS score of 92.6% (CI, 0.86 – 0.96).Poor seizure control was found to be 56.5% (CI, 0.47 – 0.65) 32.4% of respondents reported to regularly failing to take their medication, with 38.2% (CI, 0.29 – 0.47) citing financial difficulties as the reason. Formal employment was associated with positive beliefs towards epilepsy (p= 0.008).There was an association between level of knowledge and seizure control (OR 6.1). Conclusion Despite the fact that a large percentage of the PLWE attending the neurology outpatient clinic had a good background in knowledge and practice as well as a positive attitude towards their disease process, 56.5% of patients had a poor level of seizure control. Recommendation We recommend the development of a standardized comprehensive package for medical education around epilepsy for patients and health care providers taking into account factors affecting knowledge, diagnostics to strengthen the pre-existing knowledge base and looking at translating knowledge into practice. We recommend further studies on other factors that contribute to seizure control.