AbstractKnowledge, attitude, and practice in relation to epilepsy in developing countries appears to be different from that in developed countries. This study was conducted to evaluate knowledge, attitudes, expectations, sociocultural aspects, patient characteristics, disease characteristics, pattern of drug therapy, and outcome of patients with epilepsy in rural Sri Lanka. Data were collected from 207 patients attending an epilepsy clinic. In general the study shows a positive trend in knowledge, expectations and attitude toward epilepsy. Social morbidity is reported from 53.6% indicating that public attitude towards epilepsy needs to be changed. Alternative modes of treatment have been tried by 45.9%, reflecting the cultural beliefs in the society. 75% are on monotherapy and carbamazepine is the most commonly used drug. Seizure control is excellent (no seizures during the preceding 6 months) in 33.8%. Side effects of antiepileptic drugs are reported by 76.3%. Various kinds of medical morbidity have been experienced by 32.9% of patients

Pathirana, Rasika

Rajapakse, Padmamali

Seetha, T

Seneviratne, Udaya

Elsevier - Publisher Connector 

Knowledge, attitude, and practice of epilepsy in rural Sri Lanka 

doi:10.1053/seiz.2001.0579, available online at http://www.idealibrary.com on
Seizure 2002; 11: 40–43
Knowledge, attitude, and practice of epilepsy in rural
Sri Lanka
UDAYA SENEVIRATNE, PADMAMALI RAJAPAKSE, RASIKA PATHIRANA & T. SEETHA
Epilepsy Clinic, Ratnapura General Hospital, Ratnapura, Sri Lanka
Correspondence to: Udaya Seneviratne, Consultant Neurologist, Department of Neurology, Singapore General
Hospital, Outram Road, Singapore 169608. E-mail: gnrswr@sgh.com.sg or udayasen@hotmail.com
Knowledge, attitude, and practice in relation to epilepsy in developing countries appears to be different from that in developed
countries. This study was conducted to evaluate knowledge, attitudes, expectations, sociocultural aspects, patient characteristics,
disease characteristics, pattern of drug therapy, and outcome of patients with epilepsy in rural Sri Lanka. Data were collected
from 207 patients attending an epilepsy clinic. In general the study shows a positive trend in knowledge, expectations and
attitude toward epilepsy. Social morbidity is reported from 53.6% indicating that public attitude towards epilepsy needs to
be changed. Alternative modes of treatment have been tried by 45.9%, reflecting the cultural beliefs in the society. 75% are on
monotherapy and carbamazepine is the most commonly used drug. Seizure control is excellent (no seizures during the preceding
6 months) in 33.8%. Side effects of antiepileptic drugs are reported by 76.3%. Various kinds of medical morbidity have been
experienced by 32.9% of patients.
c© 2002 BEA Trading Ltd
Key words: epilepsy; knowledge, attitude, and practice; developing countries.
INTRODUCTION
Epilepsy has a higher incidence in developing
countries than in developed countries1. Studies from
the developing world indicate that misconceptions and
negative attitude toward epilepsy are still prevalent
among the general public2, 3. Furthermore, patient
characteristics, disease spectrum and pattern of drug
therapy can also be different in those countries. For
example, age-specific prevalence rates seem to show a
different pattern in developing regions3, 4. Epidemio-
logical studies also show a different disease spectrum
in the tropical regions5. With that background,
this study was designed to evaluate knowledge,
attitude, expectations, sociocultural aspects, patient
characteristics, disease characteristics, pattern of drug
therapy, and outcome of patients with epilepsy in rural
Sri Lanka, a country representative of the developing
world.
SUBJECTS AND METHODS
The study was conducted in the epilepsy clinic at
Ratnapura General Hospital which caters to a rural
population in Sri Lanka. All patients with epilepsy
who sought treatment over a period of three months
from 01.11.2000 to 31.01.2001 were recruited to
this study. Both new and follow-up patients were
included. Informed consent was obtained from all.
Data were collected from clinic records and by
personal interview using a questionnaire.
RESULTS
A total of 207 patients were interviewed. Their ages
ranged from 12 to 73 years. There were 114 (55%)
males and 93 (45%) females. Seven (3.4%) were
illiterate. School education up to or below grade 10
was reported in 178 (86%), whereas 21 (10.1%) had
made it to the advanced examination level. Only one
had received university education. Most of the patients
(112; 54.1%) were unemployed, while only 4 (1.9%)
had white-collar jobs (Table 1).
Their knowledge was assessed by asking the
question, what is epilepsy? In 108 (52.2%) the answer
was ‘do not know’, while 86 (41.5%) identified it as a
disorder of the nervous system. 13 (6.3%) attributed it
to evil spirits and supernatural causes.
1059–1311/02/010040 + 04 $35.00/0 c© 2002 BEA Trading Ltd
Knowledge, attitude, and practice of epilepsy in rural Sri Lanka 41
Table 1: Characteristics of patients.
Characteristics Number of patients Percentage
Gender
Male 114 55
Female 93 45
Age groups
10–30 124 59.9
31–50 64 30.9
51–70 17 8.2
>70 2 1
Level of education
Illiterate 7 3.4
Up to or below grade 10 178 86
Up to A/L exam 21 10.1
University education 1 0.5
Occupation
Unemployed 112 54.1
Manual labourers 36 17.4
Farmers 9 4.4
Businessmen 18 8.7
White-collar jobs 4 1.9
Schooling 28 13.5
When was treatment sought?
After the 1st fit 101 48.8
After the 2nd fit 21 10.2
After the 3rd fit 17 8.2
After the 4th fit 6 2.9
After the 5th fit 5 2.4
After 6 or more fits 57 27.5
Table 2: Characteristics of epilepsy.
Characteristics Number of patients Percentage
Aetiology
Febrile fits 44 21.3
Head injury 43 20.8
Birth asphyxia 4 1.9
Central nervous system infections 3 1.4
Stroke 1 0.5
None identified 112 54.1
Family history of epilepsy
Present 23 11.1
Absent 184 88.9
Precipitating factors
Breaking sleep 103 49.8
Mental stress 67 32.4
Physical exertion 38 18.4
Fasting 21 10.4
Alcohol 13 6.3
Menstruation 9 4.3
Cold weather 3 1.4
To quantify the attitude toward epilepsy, subjects
were asked to express their opinion on social stigma,
quality of life, rights, and marriage of epileptics.
62 (30%) were of the view that there was social stigma
attached to epilepsy. The majority believed that they
could lead a normal life (166; 80.2%), and have equal
rights in society (205; 99%). 112 (54.1%) said that
they should get married like any non-epileptic person.
Table 3: Pattern of drug therapy.
Number of patients Percentage
Number of drugs used
Monotherapy 156 75.4
Two drugs 38 18.3
Three drugs 13 6.3
Which drug?
Carbamazepine 100 48.3
Phenytoin 68 32.9
Sodium valproate 66 31.9
Phenobarbitone 23 11.1
Clobazam 7 3.4
Clonazepam 7 3.4
Table 4: Outcome.
Parameter Number of patients Percentage
Seizure control(preceding 6 months)
Excellent (no fits) 70 33.8
Good (occasional fits) 77 37.2
Reasonable (1 fit per month) 28 13.5
Bad (>1 fits a month) 32 15.5
Medical morbidity
Abrasions and lacerations 38 18.4
Head injury 21 10.1
Fractures 7 3.4
Drowning 6 2.9
Burns 4 1.9
No morbidity reported 139 67.1
Side effects of drugs
Sedation 90 43.5
Increased appetite 67 32.4
Hair loss 54 26.1
Loss of appetite 29 14
Gum hypertrophy 22 10.6
Skin rash 11 5.3
Gastritis 11 5.3
Headache 5 2.4
Body aches and lethargy 9 4.3
Tremors 1 0.5
No side effects reported 49 23.7
Patients were questioned about their expectations of
outcome. The majority (147; 71%) expected epilepsy
to be completely curable while 30 (14.5%) believed it
was controllable though not fully curable. Only nine
(4.4%) thought it was incurable. The answer was ‘do
not know’ for 21 (10.1%).
Various alternative modes of treatment such as
aurveda, homeopathy, acupuncture, and spiritual
healing methods either alone or in combination had
been tried by 95 (45.9%). Out of them, 86 (41.5%)
had resorted to spiritual healing methods. 39 (41%)
had tried those before, and 56 (59%) while, taking
western medicine. 37 (39%) did so because of strong
faith in those methods and 26 (27.4%) on others’
recommendations. Reasons given by the rest included
lack of awareness or faith in western medicine, fear of
side effects, and poor response to drugs.
Their social morbidity was assessed by several
parameters. 40 (19.3%) had to stop schooling due to
42 P. Rajapakse et al.
Table 5: Assessment parameters used and trends seen in the sample.
Assessment parameter Trend Percentage of patients
Knowledge–‘What is epilepsy?’
Disorder of the nervous system Basic understanding 41.5
Attitude
No social stigma attached to epilepsy Positive attitude 75.8
Epileptics can lead a normal life
Epileptics have equal rights
Epileptics should get married
Expectations
Epilepsy is completely curable Positive expectations 85.5
Controllable though not fully curable
Use of alternative modes of treatment Same 45.9
Social morbidity
Stopped schooling Presence of social morbidity 53.6
Disturbed schooling
Job loss
Divorce
Marital disharmony
Breaking down of relationships
Discrimination by others
epilepsy whereas 43 (20.8%) experienced significant
disturbances in schooling. Only one had a divorce and
none reported marital disharmony or breakdown of
relationships due to epilepsy. 31 (15%) had lost jobs
due to their illness. Only 13 (6.3%) had experienced
discrimination. Overall 111 (53.6%) reported to have
social morbidity as reflected by parameters mentioned
above either alone or in combination.
Aetiology of epilepsy could not be found in about
one-half of patients. The commonest aetiological
factors reported were febrile fits and head injury.
Positive family history of epilepsy was found in
about one-tenth. Patients’ subjective perceptions of
precipitating factors of seizures were assessed. The
majority reported sleep deprivation and mental stress
(Table 2).
The analysis of pattern of drug therapy revealed
that the majority were on monotherapy. The most
frequently used drug was carbamazepine followed by
phenytoin and sodium valproate (Table 3).
The outcome of the sample was assessed by three
parameters; seizure control during the preceding six
months, medical morbidity, and side effects of drugs
(Table 4). Seizure control was arbitrarily classified
to be excellent if there were no fits during the six
month period, good if there were only occasional fits,
reasonable if there was one fit a month, and bad if
more than one fit a month. According to that scheme,
seizure control was found to be excellent in about one-
third. Some form of medical morbidity was reported
by 36.7% of patients, and head injuries due to epilepsy
constituted about one-tenth of cases. Side effects of
antiepileptic drugs were reported by 76.3%.
DISCUSSION AND CONCLUSIONS
This study shows a healthy trend among patients with
epilepsy in regard to their knowledge, expectations,
and attitude (Table 5). However, a significant per-
centage still resort to alternative modes of treatment.
In that group the majority have tried religious and
spiritual healing methods, reflecting the traditional
thinking and beliefs in the rural society. Over 50%
have some form of social morbidity, indicating that
the attitude of the general public toward epilepsy
needs to be changed. Despite that, divorce, marital
disharmony, and the breakdown of relationships seem
to be extremely rare. This probably reflects the strong
intra-family relationships and family support found in
Sri Lankan society, particularly in rural areas. It is an
encouraging finding, which could be of help in the
management of these patients.
About 75% are on monotherapy which is compara-
ble to 76% reported from Scotland6 and 61.04% from
Taiwan7. Patterns of drug therapy also appear to be
similar to the study from Scotland—carbamazepine,
phenytoin, and sodium valproate being the most
frequently prescribed drugs6.
Seizure control appears to be satisfactory, with
only 15.5% belonging to the poorly controlled group.
This is comparable to 13% of refractory epilepsy
reported from Singapore, a developed Asian country8.
However, some form of medical morbidity due to
epilepsy was reported by about one-third of patients.
This could well be an underestimate due to under-
reporting. At least part of that morbidity, such as burns
Knowledge, attitude, and practice of epilepsy in rural Sri Lanka 43
and drowning, could be preventable. Seizure-related
burns have been caused by bottle lamps used to light
homes with no electricity in rural areas and by falling
into fire during cooking using firewood. It stresses
the importance of taking prophylactic measures and
providing better health education to patients.
REFERENCES
1. Sander, J. W. A. S. and Shorvon, S. D. Epidemiology of the
epilepsies. Journal of Neurology, Neurosurgery and Psychiatry
1996; 61: 433–443.
2. Rwiza, H. T., Matuja, W. B. P., Kilonzo, G. P., Haule, J.,
Mbena, P., Mwang’ombola, R. and Jilek-Aall, L. Knowledge,
attitude, and practice toward epilepsy among rural Tanzanian
residents. Epilepsia 1993; 34: 1017–1023.
3. Radhakrishnan, K., Pandian, J. D., Santhoshkumar, T. et
al. Prevalence, knowledge, attitude, and practice of epilepsy
in Kerala, South India. Epilepsia 2000; 41: 1027–1035.
4. Sridharan, R. and Murthy, B. N. Prevalence and pattern of
epilepsy in India. Epilepsia 1999; 40: 631–636.
5. de Bittencourt, P. R., Adamolekum, B., Bharucha, N. et
al. ILAE Commision Report. Epilepsy in tropics: I epidemiol-
ogy, socioeconomic risk factors and etiology. Epilepsia 1996;
37: 1121–1127.
6. Muir, T. M., Bradley, A., Wood, S. F., Murray, G. D. and
Brodie, M. J. An audit of treated epilepsy in Glasgow. West
of Scotland Epilepsy Research Group. Seizure 1996; 5: 41–46.
7. Chen, L. C., Chen, Y. F., Yang, L. L., Chou, M. H. and
Lin, M. F. Drug utilization pattern of antiepileptic drugs
and traditional Chinese medicines in a general hospital
in Taiwan—a pharmaco-epidemiologic study. Journal of
Clinical Pharmacy and Therapeutics 2000; 25: 125–129.
8. Loh, N. K., Lee, W. L., Yew, W. W. and Tjia, T. L. Refractory
seizures in a young army cohort. Annals of the Academy of
Medicine Singapore 1997; 26: 471–474.


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Knowledge, attitude, and practice of epilepsy in rural Sri Lanka

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