|Year : 2015 | Volume
| Issue : 1 | Page : 39-46
Perspectives of Mothers on Childhood Epilepsy in Kaduna, Northern Nigeria
Edwin E Eseigbe1, Jim Enogela2, Sam J Adama3, Folorunsho T Nuhu4, Taiwo L Sheikh4, Patricia Eseigbe5
1 Department of Paediatrics, Ahmadu Bello University Teaching Hospital, Shika, Nigeria
2 Department of Community Medicine, 44 Nigerian Army Reference Hospital, Kaduna, Nigeria
3 Department of Paediatrics, 44 Nigerian Army Reference Hospital, Kaduna, Nigeria
4 Department of Child and Adolescent Mental Health (CAMH) Unit, Federal Neuro Psychiatric Hospital, Kaduna, Nigeria
5 Department of Family Medicine, Ahmadu Bello University Teaching Hospital, Shika, Nigeria
|Date of Submission||13-Aug-2014|
|Date of Acceptance||18-Nov-2014|
|Date of Web Publication||17-Feb-2015|
Edwin E Eseigbe
Department of Paediatrics, Ahmadu Bello University Teaching Hospital, Shika, Zaria
Introduction: Epilepsy is one of the most common childhood neurological diseases and is associated with poor outcomes in developing countries where it is most prevalent. The epilepsy perspectives of adults in these countries have been found to influence epilepsy outcomes significantly. Assessing the epilepsy perspectives of mothers, who play a pivotal role in child care, is important to providing comprehensive epilepsy care and ensuring better outcomes. Objective: To assess the knowledge and attitude of mothers, as primary child care providers toward children with epilepsy. Materials and Methods: A structured questionnaire was administered to mothers attending a primary healthcare center, and it assessed their sociodemographic characteristics, knowledge and attitude with regards to childhood epilepsy. Knowledge was assessed based on responses to queries about etiology, manifestation, treatment and outcome of epilepsy in childhood. Attitude was assessed based on mothers' tendency toward stigmatization or discrimination against children with epilepsy. Results: A total of 523 mothers, whose age range was 17-52 years (mean 27.5 10.3 years), was interviewed. Most were <30 years old (300, 57.4%), petty traders (217, 41.5%) and had a primary education (221, 42.3%). Spiritual cause (247, 47.2%) and "falling to the ground" (361, 69%) were the commonest epilepsy etiology and manifestation indicated respectively. Orthodox medical therapy (239, 45.7%), prayers (138, 30.2%) and traditional medication (118, 22.6%) were the main treatment modalities indicated. Most of the mothers (277, 53%) were uncertain about the outcome in childhood epilepsy. Stigmatization and discrimination against children with epilepsy were indicated by 120 (22.9%) and 481 (92%) of the mothers respectively. Lack of any formal education, indication of a spiritual etiology and perception of a poor outcome for epilepsy were significantly (P < 0.05) associated with the attitudinal disposition of the mothers. Conclusion: Majority of the mothers demonstrated appreciable deficiencies in their knowledge of epilepsy and had a negative attitudinal disposition toward epilepsy in childhood.
Keywords: Attitude, childhood, epilepsy, knowledge, mothers
|How to cite this article:|
Eseigbe EE, Enogela J, Adama SJ, Nuhu FT, Sheikh TL, Eseigbe P. Perspectives of Mothers on Childhood Epilepsy in Kaduna, Northern Nigeria
. Sub-Saharan Afr J Med 2015;2:39-46
|How to cite this URL:|
Eseigbe EE, Enogela J, Adama SJ, Nuhu FT, Sheikh TL, Eseigbe P. Perspectives of Mothers on Childhood Epilepsy in Kaduna, Northern Nigeria
. Sub-Saharan Afr J Med [serial online] 2015 [cited 2019 Oct 17];2:39-46. Available from: http://www.ssajm.org/text.asp?2015/2/1/39/150470
| Introduction|| |
Epilepsy is one of the commonest of all neurological disorders, and it affects 70 million people worldwide.  According to the International League Against Epilepsy (ILAE) and the International Bureau for Epilepsy, epilepsy is a disease of the brain characterized by an enduring predisposition to generate epileptic seizures and by the neurobiologic, cognitive, psychological, and social consequences of this condition.  The definition of epilepsy requires the occurrence of at least one epileptic seizure. An epileptic seizure is a transient occurrence of signs and/or symptoms due to abnormal, excessive or synchronous neuronal activity in the brain.  Majority of those affected live in Africa and in low and middle income countries (LMICs) where access to effective treatment is limited.  Its incidence rate is higher in LMICs (49-215/100000) than that (40-70/100000) reported from developed regions of the world. , The global prevalence rate, estimated at 9/1000, is lower than that (11/1000) observed in sub-Saharan Africa.  A varying prevalence rate of epilepsy has been reported from child and adolescent populations in Hong Kong (4.3/1000), Turkey (8.6/1000), Brazil (7/1000), India (7/1000), Cameroon (26.1/1000) and Nigeria (6.4/1000). ,,,,, However, the highest age-specific incidence rate for epilepsy occurs in childhood.  Hauser and Nelson reported age-specific incidence rates of 121/100000 (<10-year), 63/100000 (1-4 years), and 44/100000 (5-14 years) respectively.  High incidence in childhood could be attributable to perinatal and postnatal morbidities, and central nervous system infections (bacterial meningitis, viral encephalitis) including parasitic infestations (cerebral malaria, neurocysticercosis), which are more common in childhood especially in regions most susceptible for epilepsy. , The high childhood incidence necessitates the institution of childhood oriented interventions to ensure better epilepsy outcomes.
Poor adult perspectives on epilepsy have been identified as factors limiting access to and utilization of appropriate therapy. , Reports on epilepsy perspectives from Sub-Saharan Africa indicate: The ascription of a supernatural etiology and infectious status to epilepsy, preferment of nonorthodox medical modalities of treatment, poor awareness on the efficacy of orthodox medical therapy, stigmatization and discrimination against persons with epilepsy. ,,,,,, A significant implication of these perspectives is the resultant limitation in accessing or adhering to appropriate treatment by those with epilepsy. This treatment gap in epilepsy has been defined as the difference between the number of people with active epilepsy and the number whose seizures are being appropriately treated in a given population at a given point of time, expressed as percentage.  This definition includes diagnostic and therapeutic deficits.  This treatment gap is as high as 75% in LMICs and low as <10% in high-income countries.  Poor epilepsy perspectives could also enhance other undesirable outcomes, such as poor quality of life and an increased risk of mortality, which have been associated with epilepsy. ,,
A high incidence of epilepsy in childhood, the dependence in childhood on caregivers and communities that are prone to exhibiting poor epilepsy perspectives coupled with the weakness in health systems of LMICs toward providing treatment for epilepsy, make childhood epilepsy in LMICs to be particularly susceptible to poor outcomes. ,, Mothers play a pivotal role in the provision of health care services to children. , It has also been observed that there could be significant gaps in their understanding of child health matters.  Consequently, bridging the gaps could enhance care and outcome in childhood disorders such as epilepsy. The Primary Healthcare Center (PHC) often represents a readily available and accessible source of health care in LMICs including Nigeria.  Its presence and utilization have been shown to influence health outcomes in childhood epilepsy.  Therefore, an appraisal of the perspectives of mothers concerning a childhood epilepsy in a PHC setting could provide valuable information toward improving the health and other related outcomes of epilepsy.
The aim of this study was to assess the perspectives of mothers, attending a PHC in one of the LMICs, on childhood epilepsy.
| Materials and methods|| |
The study was conducted in Kaduna North Local Government Area (KNLGA) of Kaduna state in Northwestern Nigeria. The PHC, Zakari Isa Memorial PHC (ZIM), was selected through a simple random selection from the three operational PHCs in KNLGA. The ZIM-PHC was established in 1960. Administratively, it is headed by a chief nursing officer (The Matron - in charge) who is assisted by three nursing officers, eight Community Health Extension Workers, and seven clinic attendants. The center offers the following services: Antenatal care, taking deliveries, immunizations/vaccinations, family planning, prevention of mother to child transmission of human immunodeficiency virus, and first aid services. It also offers referral services to those requiring higher levels of health care.
A structured questionnaire was administered by the authors to mothers who had visited ZIM-PHC. The questionnaire was administered in English language and where indicated the three commonest languages in the country (Hausa, which is the predominant language in the region, Ibo and Yoruba languages) after translation. This was after the initial translation and back translation to ensure consistency and validity of the questionnaire. For the purpose of this study, and as defined in epidemiological studies and retained in the more recent ILAE operational clinical definition, epilepsy was defined as the occurrence of at least two unprovoked seizures occurring >24 h apart. , Included in the study were all consenting mothers who had attended the PHC at least twice in the preceding 6 months. The number of visits were to underscore the regularity of attendance at the PHC. Excluded from the study were those who did not consent and had not fulfilled the required number of attendance at the PHC. Furthermore, any description of seizures that did not conform to that defined for epilepsy in the study was excluded from the analysis. Parameters of the mothers assessed were: Age, educational status, knowledge and attitude toward childhood epilepsy and frequency of utilization of ZIM-PHC facilities. Administration of each questionnaire took an average of 8 min.
A good knowledge of any disease condition encompasses having adequate and appropriate information about the clinical features, treatment modalities and outcome of the condition. Consequently, knowledge of childhood epilepsy in this study was assessed based on the mothers' response to a question about four parameters of epilepsy. The parameters were: Manifestation, cause, treatment modality, and outcome of epilepsy. The mothers' response to the outcome of epilepsy was categorized as "good" if they indicated that a child could be successfully treated with appropriate therapy and 'Bad' if they indicated otherwise. This is based on the fact epilepsy has been found to be successfully treated in over 70% of cases.  Attitude of the mothers was based on their tendency toward stigmatization and discrimination against a child with epilepsy. Stigma was indicated if a prejudicial feeling is expressed, and discrimination if a prejudicial act is meted out, as a result of having knowledge of epilepsy in a child.  Consequently, attitude was based on response to the following queries:
- Whether a mother would allow her child use the same washed eating utensil that has been used by a child she knows has epilepsy (discrimination).
- Whether a mother thinks a child with epilepsy could live a normal life (stigmatization).
In addition, the mothers were asked to describe their feelings toward children with epilepsy as well as action(s) they would take if they encounter a child with epilepsy having an epileptic seizure.
The study was conducted between July 2012 and October 2012, and all mothers who participated in the survey were given a postsurvey health talk on the basic characteristics of epilepsy and its management by the authors. All those who had features of epilepsy or had children with epilepsy were referred to the Federal Neuro Psychiatric Hospital Kaduna (FNPHK) in Northwest Nigeria, which has adequate facilities for management of persons with epilepsy, for further evaluation and management. For the study, informed consent was obtained from the mothers and ethical approval from the research ethics committee of the FNPHK.
Epi info 3.5.3 statistical package developed by Centers for Disease Control and Prevention (CDC) in Atlanta, USA (http://www.cdc.gov/epiinfo) was used in the analysis of data. Chi-square test, with Yates correction, were applicable, was used in determining the relationship between the mothers' sociodemographic variables, knowledge, and attitude outcomes. A P < 0.05 was regarded as significant.
| Results|| |
A total of 573 adults visited ZIM-PHC for consultation during the study period. Out of these, 560 (97.7%) were women, and 541 (94.4%) were mothers. A total of 523 (96.7%) mothers fulfilled the inclusion criteria. There was a family history of epilepsy in 40 (7.5%) of the mothers. Among the mothers with a positive family history of epilepsy, 3 (7.5%) had affected siblings while in the remaining 37 (92.5%) those affected were distant relatives. All the affected relatives were reported as being on oral traditional medication though 3 (7.5%) of them were reported to have received oral (phenobarbitone) orthodox medication in the past.
Age, Educational and Occupational Distribution of the Mothers
The age range of the mothers was 17-52 years (mean 27.5 ± 10.3 years). Most (300, 57.4%) of the mothers were <30 years old and had a primary education (221, 42.3%). Only 29 (5.5%) mothers had not received any form of formal education. Also, most of the mothers (217, 41.5%) were petty traders [Table 1].
|Table 1: Distribution of some sociodemographic variables of the mothers (n = 523)|
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Mothers' Knowledge of Epilepsy
The majority of the mothers (247, 47.2%) ascribed the etiology of epilepsy to a spiritual cause [Table 2]. All mothers with a primary or lack of formal education (221, 42.3%) indicated the spiritual etiological perspective and this was significant (χ2 = 424.00, df = 1, P = 0.00). "Falling to the ground" indicated by 361 (69%) mothers was the commonest manifestation of epilepsy expressed [Table 2]. Modalities for treating epilepsy as identified by the mothers are shown in [Table 2] with orthodox medical therapy being the most common modality (239, 45.7%) indicated. However 45 (18.8%) of the mothers who identified with orthodox medical therapy also indicated the use of prayers (32, 71.1%) or traditional medication (13, 28.9%) to complement the orthodox medical therapy.
Treatment outcome in childhood epilepsy was described as good and poor by 68 (13%) and 178 (34%) of the mothers respectively while 277 (53%) were uncertain about the treatment outcome. The mothers' primary sources of information were as follows: The community (298, 57%), the family (66, 12.6%), health institutions (43, 8.2%), the mass media (37, 7.1%), and educational institutions (26, 5%). Fifty-three (10.1%) of them had no information.
Mothers' Attitude toward Childhood Epilepsy
Most of the mothers (481, 92%) demonstrated a discriminatory attitude by indicating that, if they knew, they would not allow their child use a washed eating utensil that had been previously used by another child with epilepsy. All the mothers (40, 7.6%) who had a positive family history of epilepsy were not discriminatory in their response [Table 3] and this was significant (P < 0.05). Also, 120 (22.9%) mothers demonstrated a stigmatizing attitude by indicating that, in spite of treatment, life would still be abnormal in children with epilepsy. Furthermore, lacking any formal education and indicating a spiritual etiology for epilepsy were significantly (P < 0.05) associated with stigmatization [Table 3]. Both attitudinal disposition of discrimination and stigmatization were significantly (P < 0.05) associated with being <30 years of age, having a poor outcome perspective of epilepsy and the community being the source of epilepsy information [Table 3].
|Table 3: Relationship between some sociodemographic/knowledge variables and attitudinal disposition of the 523 mothers|
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As to what the mothers will do upon coming in contact with a child with epilepsy having an epileptic seizure, "rushing the child to hospital" was the commonest (251, 48%) initial intervention indicated [Table 4].
|Table 4: Initial interventions against seizures as indicated by the 523 mothers|
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| Discussion|| |
Majority of the mothers demonstrated appreciable deficiencies in the knowledge of epilepsy, particularly with regards to its etiology and outcome, and a negative attitudinal disposition toward children with epilepsy. Studies with similar poor epilepsy perspectives among adults have been reported from Nigeria and several LMICs. ,,,
Reports about perspectives of adults on epilepsy from Nigeria have consistently demonstrated: Misconceptions about the etiology and outcome of epilepsy, an infectious mode of transmission, spiritual or traditional mode of therapy, varying degrees of abuse, stigma and discrimination against those with the disease. ,,,,[ 18] Globally, having poor epilepsy perspectives has been associated with rural populations in LMICs, poor socioeconomic status, strong cultural beliefs about the etiology of epilepsy and health systems that are weak in the provision of epilepsy related health services. ,,
The variability in the knowledge and attitudinal outcomes of the mothers could have influenced by their sociodemographic diversity. Urban populations, with improved access to information generally, tend to be more informed about epilepsy and display a more position attitude toward persons with the disorder.  Though this study was conducted in an urban setting, significant gaps in the knowledge of epilepsy were observed among the mothers. The predominance of low educational and economic status among the mothers could have been contributory. Poor socioeconomic status with its attendant limitations could restrict access to qualitative epilepsy information. Remarkable gaps in the epilepsy knowledge among adult populations, with similar socio economic status, in urban settings, have been reported from Nigeria and Ghana. , It is pertinent to state that the impact of educational status on adult perspectives of epilepsy is equally variable. Paucity of knowledge about epilepsy has been reported among highly educated populations just as good knowledge about epilepsy has seen reported from populations with poor formal education.  The significant factor seems to be a degree of exposure to information on epilepsy within the context of formal or vocational education acquired.
Most of the mothers attributed the etiology of epilepsy to a spiritual cause. Kabir et al. and Sanya et al. in their studies from Nigeria reported that 16.3% and 27.7% of their respondents respectively attributed the etiology of epilepsy to supernatural causes while Nyame and Biritwum reported that 27.9% of respondents in their study from Ghana had a similar perspective. ,, These findings support the inclination of populations in sub-Sahara African toward cultural or religious beliefs on the origin of epilepsy. ,, These beliefs underscore the paucity of knowledge about epilepsy in the region where these communities are located. 
Most of the mothers also displayed an appreciable knowledge of the manifestations of epilepsy. However, the main manifestations of epilepsy indicated by the mothers were the quite obvious characteristics of epilepsy such as falling to the ground, jerky movements of the body and excessive salivation. This is also similar to epilepsy manifestations indicated in several earlier reports on epilepsy perspectives from the country. ,, One of the implications of such finding would be the under reporting or nonidentification, of those who have more subtle features of epilepsy.
Spiritual, traditional, and orthodox medical therapy are the commonest therapeutic modalities for epilepsy management in several LMICs.  Orthodox medical therapy was the commonest (45.7%) mode of therapy indicated in our study and in that of Owolabi et al.(55.5%) among teachers.  Spiritual healing was the commonest (47%) modality identified by respondents in the study by Kabir et al. from the same region of the country.  The difference could be attributable to the fact that our study was conducted among those who regularly patronize the orthodox health system, and the high educational status of the respondents in the study among teachers as oppose to the more socio economically and culturally diverse population in the study by Kabir et al. , Similarly several studies, ours inclusive, have also identified the use of traditional medication as a commonly identified mode of treatment for persons with epilepsy. , The opinion that these alternative modes of therapy, with or without orthodox medical therapy, are effective means of epilepsy treatment could have been influenced by the strong ethno-religious epilepsy etiological perspectives of respondents in these studies. The influential role of cultural and religious beliefs in shaping health seeking perspectives toward epilepsy has been reported severally from communities in sub-Sahara Africa. ,
A high percentage (87%) of the mothers was either uncertain or indicated a poor outcome for epilepsy. Only 13% of the mothers associated epilepsy with a good outcome. Similarly in studies by Owolabi et al. and Frank-Briggs and Alikor 30% and 17.5% of respondents in their respective studies associated epilepsy with a good outcome. , These findings are at variance with the fact that epilepsy can be effectively treated in over 70% of the cases. , The "poor outcome" perspective further highlights the degree of epilepsy awareness among adult populations in the country.
Perspectives about what to do on encountering an epileptic seizure also belie the poor knowledge of epilepsy in LMICs particularly those in Sub-Saharan Africa. These perspectives include: Running away from the patient to avoid contact with body fluids which are thought to transmit the disease, thrusting of objects in the mouth, application of onion squash to the eyes, and even burning of the feet in order to abort the seizures. ,,, Frank-Briggs and Alikor observed that 52.14% of parents who had children with epilepsy simply did not know about the initial intervention procedures for epileptic seizures.  Even though an appreciable number of mothers indicated rushing the child to the hospital as a primary option, majority still indicated nonorthodox medical interventions including 18.2% that indicated running away as action they would take, and 11.1% who did not know what to do.
Stigmatization and discrimination are negative attitudes that are commonly observed against persons with epilepsy. ,, These attitudes are also driven by the poor health outcomes that are often associated with epilepsy particularly in the LMICs. ,, Strong cultural beliefs about the etiology of epilepsy, which are mainly about evil supernatural forces, also propagate negative attitudes toward the disease ,, This could have contributed to the mothers' negative attitudes of stigmatization (22.9%) and discrimination (92%) in our study. In studies from Nigeria about the negative attitudinal disposition toward epilepsy, one-fifth of the teachers in the study by Sanya et al. and more than half (60%) of teachers in the study by Owolabi et al. opined that students with epilepsy could not achieve excellent academic performance (stigmatization) while 40% of teachers in another study by Mustapha et al. indicated that students should not be kept in regular classes (discrimination). ,, A relatively high proportion of mothers indicated a discriminatory attitude in our study. This observation could have been contributed to by the sociodemographic diversity of the mothers as compared to the more homogeneous and familial environment in the studies with lower discrimination rates.  Furthermore, filial relationships with persons with epilepsy have been demonstrated to have a positive impact on knowledge of epilepsy and attitude toward persons with the disease. , This was buttressed by the nondiscriminatory attitude of mothers with a positive family history of epilepsy in this study. Another attitudinal point to note in the study was the high rate of discrimination even among those who would not stigmatize children with epilepsy and those who had conventional propositions about the etiology of epilepsy. The discriminatory attitude by the mothers could have been influenced by the fear of their children contacting the disorder as an infectious disease or as an affliction from an evil supernatural source. The latter could be further explained from the viewpoint of what has been described as the philosophy behind the African cultural perspective of sickness.  Within this philosophical context sickness or disease is viewed as the outcome of a complex interplay between the natural and supernatural.  Thus, the occurrence and persistence of a chronic disorder such as an epilepsy could be viewed as being under the control of a stronger supernatural force that is difficult to contend with or appeased. Consequently, contact or interaction with those who are affected by such disorders is avoided or reduced significantly to prevent being afflicted with the same disorder. Though negative attitudinal disposition toward epilepsy tends to be consistent findings in several reports, positive attitudes of sympathy, kindness, and tolerance have also been reported. 
The consequences of having poor knowledge of epilepsy, and a negative attitude toward persons with epilepsy are grim to both those with the disorder and their caregivers. ,,, These consequences include development of depression in persons with epilepsy and their caregivers, community isolation, limited access to appropriate treatment resulting in a widened treatment gap, restricted educational and economic opportunities, refusal of those affected to come out, poor quality of life and an increased risk of mortality. ,,,,
Addressing poor perspectives about childhood epilepsy is vital to improving its health and socioeconomic outcomes. ,, To achieve, this would require a multidimensional approach. This approach should include a comprehensive community epilepsy education initiative, women socioeconomic development, capacity development of the health systems toward epilepsy management in susceptible countries and an effective utilization of the mass media in promoting positive attitudinal disposition toward epilepsy.
The comprehensive educational initiative should address the negative etiological perspectives of epilepsy such as the opinion that the condition is infectious or is a supernatural affliction. Such an initiative should include and involve all members of the community. The community plays a pivotal role in disseminating epilepsy information and attitudinal disposition toward the disorder. The community was the main primary source of information for most of the mothers. Paucity of appropriate epilepsy information has been reported from several communities in Sub-Sahara Africa.  In the absence of credible source of information or presence of a less emphatic contribution from the health system or mass media as observed in this study, information obtained could be predicated on communal norms. Consequently, an uninformed or ill-informed community has a tendency of propagating poor knowledge and attitude as it concerns epilepsy. Community epilepsy enlightenment campaigns should also be conducted in places commonly visited by mothers such as community social group meetings and markets. The socio-culturally influential women in African communities such as grandmothers and family matriarchs should be targeted and engaged in such campaigns. Additionally programs oriented toward developing the productive capacity of women, such as the propagated by Millennium Development Goal (MDG) 2 which also focuses on achieving female education and the MDG 3 which promotes female empowerment, should also be instituted and advanced.  Furthermore, community enlightenment should also include practitioners of traditional or alternative medicine. The high patronage of the traditional health system for epilepsy management and the belief in the efficacy by populations in LMICs necessitates an informed and productive interaction between the orthodox and nonorthodox health systems.  This would also be in the spirit of the African declaration on epilepsy. 
The development of the capacity of the orthodox health systems in providing wholesome epilepsy management in epilepsy burdened countries is another positive approach. This development would increase epilepsy awareness, decrease epilepsy treatment gap and improve the quality of living in those with epilepsy. Furthermore, it would reduce the psycho social burden of care experienced by caregivers of persons with epilepsy. This capacity development can be effected at the PHC, which are available in LMICs. It should include provision of anti epileptic drugs (AEDs) and making available manpower trained in basic epilepsy care. The study showed a high patronage of PHC services by mothers. Similar finding of a high patronage of PHCs by mothers have been reported by Nteta et al.  It underscores the significant utilization of PHC services by mothers and highlights the potential of PHCs in addressing issues in childhood epilepsy.
Guinhouya et al. reported significant positive outcomes among persons with epilepsy that were attending PHCs after upgrading epilepsy services in those centers. 
The mass media have been reported to significantly influence change in health behavior.  Wakefield et al. reported the ability of the mass media in disseminating well defined behaviorally focused messages to large audiences and at a low cost as their great potential.  Taking advantage of these characteristics while driving epilepsy awareness campaigns would improve knowledge of epilepsy and facilitate change in a negative attitude toward persons with epilepsy. In view of the strong association of the etiology of epilepsy with spiritual forces in our environment and the need to support and protect those with epilepsy, organizations such as faith based organizations, governmental and nongovernmental organizations in charge of information, welfare, social support and justice should be actively engaged in promoting epilepsy care. Finally, there should be an integration of local initiatives or programs against epilepsy with related regional or global initiatives in order to optimize desirable outcomes. One of the such programs that should be keyed into is the global campaign against epilepsy (GCAE) which seeks to improve the acceptability, treatment, services, and prevention of epilepsy worldwide. 
Limitations of the Study
The perspectives of mothers attending this lowest level of formal health care delivery might not be representative of the perspectives of other mothers in attendance at other levels, particularly the higher levels, of health care delivery. However, the sociodemographic distribution of the mothers provides an insight into how mothers in the environment, irrespective of the health facility they attend, would respond to issues concerning childhood epilepsy.
| Conclusion|| |
The study highlighted a high proportion of mothers attending a PHC displaying poor knowledge and predominantly negative attitudinal disposition toward epilepsy in childhood. Poor educational status and a spiritual etiological perspective of epilepsy were significant contributory factors. The study emphasized the need to pursue epilepsy enlightenment initiatives in susceptible communities and particularly among mothers of low socioeconomic status. It also underscored the need to maximize the potential of PHCs in the provision of epilepsy information and health services.
| Acknowledgment|| |
We (Authors) wish to thank the entire members of staff of ZIM-PHC and the mothers who participated in the study for their Cooperation in the course of the study. We would also like to thank the Maternal and Child Health Practitioners Association (MACHPA) in Kaduna for provision of information materials on epilepsy that were used during the post-survey health talk.
| References|| |
Katchanov J, Birbeck GL. Epilepsy care guidelines for low- and middle- income countries: From WHO mental health GAP to national programs. BMC Med 2012;10:107.
Fisher RS, van Emde Boas W, Blume W, Elger C, Genton P, Lee P, et al.
Epileptic seizures and epilepsy: Definitions proposed by the International League Against Epilepsy (ILAE) and the International Bureau for Epilepsy (IBE). Epilepsia 2005;46:470-2.
Epilepsy in the World Health Organization African region: Bridging the Gap. Available from: http://www.who.int/mental_health/management/epilepsy_in_African-region.pdf. [Last accessed on 2014 Oct 20].
Dua T. Global Perspectives on Epilepsy: Improving Access to Epilepsy Care. World Health Organization; 2011. Available from: http://www.global-perspective of epilepsy_meeting-tarum-dua-3.pdf. [Last accessed on 2014 Oct 21].
Wong V. Study of seizure and epilepsy in Chinese children in Hong Kong: Period prevalence and patterns. J Child Neurol 2004;19:19-25.
Topbas M, Ozgün S, Sönmez MF, Aksoy A, Can G, Yavuzyilmaz A, et al.
Epilepsy prevalence in the 0-17 age group in trabzon, Turkey. Iran J Pediatr 2012;22:344-50.
Sampaio LP, Caboclo LO, Kuramoto K, Reche A, Yacubian EM, Manreza ML. Prevalence of epilepsy in children from a Brazilian area of high deprivation. Pediatr Neurol 2010;42:111-7.
Banerjee TK, Hazra A, Biswas A, Ray J, Roy T, Raut DK, et al.
Neurological disorders in children and adolescents. Indian J Pediatr 2009;76:139-46.
Prischich F, De Rinaldis M, Bruno F, Egeo G, Santori C, Zappaterreno A, et al.
High prevalence of epilepsy in a village in the Littoral Province of Cameroon. Epilepsy Res 2008;82:200-10.
Eseigbe EE, Sheikh TL, Aderinoye A, Eseigbe P, Nuhu FT, Adebayo O, et al
. Factors associated with treatment gap in children and adolescents with epilepsy in a rural Nigerian community. Niger J Paediatr 2014;41:22-7.
Hauser WA, Nelson KB. Epidemiology of epilepsy in children. Cleve Clin J Med 1989;56 Suppl:S185-94.
Paul A, Adeloye D, George-Carey R, Kolcic I, Grant L, Chan KY. An estimate of the prevalence of epilepsy in Sub-Saharan Africa: A systematic analysis. J Glob Health 2012;2:020405.
Kabir M, Iliyasu Z, Abubakar IS, Kabir ZS, Farinyaro AU. Knowledge, attitude and beliefs about epilepsy among adults in a Northern Nigeria Urban Community. Ann Afr Med 2005;4:107-12.
Sanya EO, Salami TA, Goodman OO, Buhari OI, Araoye MO. Perception and attitude to epilepsy among teachers in primary, secondary and tertiary educational institutions in middle belt Nigeria. Trop Doct 2005;35:153-6.
Nyame PK, Biritwum RB. Epilepsy: Knowledge, attitude and practice in literate urban population, Accra, Ghana. West Afr J Med 1997;16:139-45.
Owolabi LF, Shehu NM, Owolabi SD. Epilepsy and education in developing countries: A survey of school teachers' knowledge about epilepsy and their attitude towards students with epilepsy in Northwestern Nigeria. Pan Afr Med J 2014;18:255.
Frank-Briggs AI, Alikor EA. Knowledge and attitudes of parents toward children with epilepsy. Ann Afr Med 2011;10:238-42.
Mustapha AF, Odu OO, Akande O. Knowledge, attitudes and perceptions of epilepsy among secondary school teachers in Osogbo South-West Nigeria: A community based study. Niger J Clin Pract 2013;16:12-8.
Chin JH. Epilepsy treatment in sub-Saharan Africa: Closing the gap. Afr Health Sci 2012;12:186-92.
Lagunju IO, Akinyinka O, Orimadegun A, Akinbami FO, Brown BJ, Olorundare E, et al
. Health-related quality of life of Nigerian children with epilepsy. Afr J Neurol Sci 2009;28. Available from: http://ajns.paans.org/article.php3?id_article=299.pdf [Last accessed on 2014 Nov 25].
Stevanovic D, Tadic I, Novakovic T. Health-related quality of life in children and adolescents with epilepsy: A systematic review. In: Gadze ZP, editor. Epilepsy in Children - Clinical and Social Aspects. Croatia: InTech; 2011. p. 162-82. Available from: http://www.intechopen.com/books/epilepsy-in-children-clinical-and-social-aspects/health-related-quality-of-lifein-children-and-adolescents-with-epilepsy-a-systematic-review. [Last accessed on 2014 Oct 20].
Lhatoo SD, Sander JW. Cause-specific mortality in epilepsy. Epilepsia 2005;46:36-9.
Asamoah F, Sarfo LA, Awuah-Peasah D. The role of mothers in the care of children under five years on admission. Int J Res Soc Sci 2013;1:18-27.
Eseigbe EE, Anyiam JO, Wammanda RD. Care of the child with special health care needs: A report on 2 Nigerian children with muscular dystrophy. Ann Niger Med 2006;2:29-31.
Al-Ayed IH. Mothers' knowledge of child health matters: Are we doing enough? J Family Community Med 2010;17:22-8.
Adogu PO, Nnebue CK, Ebenebe UE, Ezechukwu CC. Caregiver's satisfaction and supervision of primary health care services in Nnewi, Nigeria. Niger J Paediatr 2012;39:179-84.
Guinhouya KM, Aboki A, Kombaté D, Kumako V, Apétsé K, Belo M, et al.
The epilepsy treatment gap in six primary care centres in Togo (2007-2009). Sante 2010;20:93-7.
Guidelines for epidemiologic studies on epilepsy. Commission on epidemiology and prognosis, international league against epilepsy. Epilepsia 1993;34:592-6.
Fisher RS, Acevedo C, Arzimanoglou A, Bogacz A, Cross JH, Elger CE, et al.
ILAE official report: A practical clinical definition of epilepsy. Epilepsia 2014;55:475-82.
Arboleda-Florez J. Stigma and discrimination: An overview. World Psychiatry 2005;4 Suppl 1:8-10.
Lua PL, Neni SW. Awareness, knowledge and attitudes towards epilepsy, a reviewed of a decade's research between 2002 and 2010. Available from: http://www.ajns.paans.org/articlesphp3?id_article=360. [Last accessed on 2014 Oct 20].
Eseigbe EE, Adama SJ, Eseigbe P. Febrile seizures in Kaduna, North western Nigeria. Niger Med J 2012;53:140-4.
Ofovwe GE, Ibadin OM, Ofovwe EC, Okolo AA. Home management of febrile convulsion in an African population: A comparison of urban and rural mothers' knowledge attitude and practice. J Neurol Sci 2002;200:49-52.
Saengpattrachai M, Srinualta D, Lorlertratna N, Pradermduzzadeeporn E, Poonpol F. Public familiarity with, knowledge of, and predictors of negative attitudes toward epilepsy in Thailand. Epilepsy Behav 2010;17:497-505.
Onwuanibe RC. The philosophy of African medical practice. J Opin 1979;9:25-8. Available from: http://www.jstor.org/stable/1166259 [Last accessed on 2014 Oct 20].
Komolafe MA, Sunmonu TA, Fabusiwa F, Komolafe EO, Afolabi O, Kett M, et al
. Women's perspectives on epilepsy and its socio cultural impact in south western Nigeria. Afr J Neurol Sci 2011;30. Available from: http://www.ajns.paans.org/article.php3?id_article=376. [Last accessed on 2014 Oct 21].
United Nations Millennium Development Goals. Available from: http://www.un.org/millenniumgoals/education.shtml. [Last accessed on 2014 Oct 20].
African Declaration on Epilepsy. Available from: http://www.int/mental_health/neurology/african_declaration_epilepsy_english.pdf. [Last accessed on 2014 Oct 20].
Nteta TP, Mokgatle-Nthabu M, Oguntibeju OO. Utilization of the primary health care services in the Tshwane Region of Gauteng Province, South Africa. PLoS One 2010;5:e13909.
Wakefield MA, Loken B, Hornik RC. Use of mass media campaigns to change health behaviour. Lancet 2010;376:1261-71.
[Table 1], [Table 2], [Table 3], [Table 4]