Anne-Cécile Zoung-Kanyi Bissek

A community survey of knowledge, perceptions, and practice with respect to epilepsy among traditional healers in the Batibo Health District, Cameroon

OBJECTIVE The purpose of this study was to gain an understanding of the approach of traditional healers to epilepsy care, in order to develop a community-based epilepsy care program in Batibo Health District. METHODS With an 18-item questionnaire, interviews were carried out with 102 traditional healers randomly selected from two associations of traditional healers in the Batibo Health District. RESULTS Most traditional healers had heard about epilepsy (98.0%), knew someone with epilepsy (97.8%), or had witnessed a seizure (92.2%). About 40% would object to their children associating with people with epilepsy (PWE), 46.1% would object to their children marrying PWE, and 51% linked the disease to insanity. Though 61.8% of the traditional healers could not offer any treatment for epilepsy, most of them thought it was treatable (74.5%) and would readily refer a patient to the hospital (95.1%). The independent predictors of attitudes were: middle age (30-49 years), P=0.00003; female gender, P=0.007; correct knowledge of the cause(s) of epilepsy, P=0.001; and the misconceptions that epilepsy is contagious and that epilepsy is a form of insanity, P=0.003 and 0.019, respectively. CONCLUSION Traditional healers constituted the focus group studied so far in Cameroon that is most familiar with epilepsy. Although they still have some negative practices, the attitudes of traditional healers toward PWE in Batibo Health District are satisfactory, compared with those of the general public and students in the same community. These findings provide evidence for the first time in Cameroon suggesting that collaboration between the modern and traditional health systems with the view of bridging the epilepsy treatment gap is possible. There is a need to train traditional healers in epilepsy care in our context.

Knowledge, attitudes and practice with respect to epilepsy among secondary school students in the Kumbo West Health District - North West Region- Cameroon

BACKGROUND The main goal of this study was to obtain baseline data on awareness and attitudes and practices with respect to epilepsy among secondary school students. METHODS We interviewed a total of 659 students from three randomly selected secondary schools in the Kumbo West Health District, using a 12-item questionnaire in English. RESULTS About 94.7% had heard about epilepsy, 25.8% had read on the subject, 55.2% knew someone with epilepsy and 77.7% had witnessed a seizure. While 37.9% of students would object to association with people with epilepsy (PWE), 47.8% would object to marriage with PWE. About 77.2% would offer equal employment to PWE although 72.7% believed there were jobs not suitable for PWE. Up to 58% of our sample thought epilepsy is contagious and about 62.2% of them declared that epilepsy is curable. Respectively 65%, 9%, and 30% would recommend a medical doctor, a traditional healer and Gods help for treatment of epilepsy. Independent determinants of attitudes were found to be: the belief that epilepsy is a form of insanity or is contagious, having witnessed a seizure, being female, being a Christian and having a higher level of education. CONCLUSION There was a high level of awareness on epilepsy and the negative attitudes observed among these students were better than those reported in the same community. The determinants of negative attitudes were found to be diversified, confirming our hypothesis of variation, and our data further suggest that the interplay between these factors may be more complex than generally thought. This requires further qualitative study.

Knowledge, attitudes and practices with respect to epilepsy among student nurses and laboratory assistants in the South West Region of Cameroon

OBJECTIVE This study was designed as part of a series of studies mandated by the Cameroon Ministry of Public Health (National Epilepsy Control Program) to obtain new data for improvement of the epilepsy teaching program in schools training health personnel in the South West Region of Cameroon. METHOD A 12-item semistructured questionnaire was self-administered to 340 student nurses and laboratory assistants in five training schools for health personnel in the South West Region of Cameroon. RESULTS All of them had heard about epilepsy, 86.5% knew someone with epilepsy, 88.5% had witnessed a seizure, but only 48.8% had read about epilepsy. About 33% and 52% would, respectively, object to their children associating with and marrying people with epilepsy (PWE). About 15.3% believed that epilepsy is a form of insanity, 10% thought epilepsy is contagious, 67.4% (P<0.001) would recommend medical treatment for epilepsy, 22% would offer prayers only, and 6% would recommend traditional medicine. Independent predictors of attitudes were: acquaintance with someone with epilepsy, knowledge of the cause of epilepsy, the belief that epilepsy is contagious or is a form of insanity, being male, and being in the first year of studies. CONCLUSION The knowledge level in this student sample is high, but the relatively low proportion of respondents who have read about epilepsy suggests that the observed high level of awareness of epilepsy may be from knowledge gained in the community; thus, there exist knowledge gaps. Therefore, a teaching course on epilepsy needs to be introduced into the curriculum of these training schools as early as the first year of studies. The course content must take into account the belief and value systems of the community and address misconceptions about epilepsy.

Evaluation of the diethylcarbamazine patch to evaluate onchocerciasis endemicity in Central Africa.

Objective  As part of a baseline data collection for assessing the impact of the African Programme for Onchocerciasis Control, to evaluate the diethylcarbamazine (DEC) patch test in determining the endemicity of onchocerciasis.

The spectrum of skin diseases in a rural setting in Cameroon (sub-Saharan Africa)

BackgroundSkin disorders are generally considered to be more prevalent in the rural areas of Cameroon. This study was carried out to verify this assumption by describing the spectrum of skin disorders in a rural setting of Cameroon.MethodsWe carried out a community-based clinical skin examination of 400 consenting subjects from 4 villages of Cameroon: Nyamanga (27%), Yebekolo (24%), Mbangassina (23%) and Bilomo (26%).ResultsThe overall prevalence of skin diseases in our sample was 62% {95% CI: 57.2%, 66.8%} (248/400). The commonest skin disorders were: fungal infections (25.4%), parasitic infestations (21.4%), atrophic skin disorders (11.7%), hypertrophic skin disorders (9.7%), disorders of skin appendages {acne} (8.9%), benign neoplasm (6.5%), bacterial skin infections (5.2%), pigmentation disorders (4.8%), and dermatitis/eczema (4.0%). Skin infections and infestations constituted 52.82% of all skin disorders. The overall prevalence of infectious and parasitic infestation was 32.75% {95%CI: 28.17%, 37.59%} (131/400) as against 29.25% {95%CI: 24.83%, 33.98%} (117/400) for non-infectious disorders.Among people with skin infections/parasitic infestations, those with fungal infections and onchocercal skin lesions were the most prevalent, accounting for 48.1% (63/131) and 35.1% (46/131); and an overall prevalence of 15.75% {95%CI: 12.3%, 19.7%} (63/400) and 11.5% {95%CI: 8.5%, 15.0%} (46/400) respectively.There was secondary bacterial infection in 12.1% {95%CI: 8.31%, 16.82%} (30/248) of subjects with skin diseases. Hypertrophic and atrophic disorders of the skin were mainly keloids (9.68%), scarification marks (6.05%) and burn scars (5.65%). Skin diseases like dermatitis and eczema (4.03%), malignant tumours and pigmentation disorders were rare in our sample.The proportion of subjects diagnosed with skin disorders after examination (62.8%) was significantly higher than the proportion of 40.8% that declared having skin diseases (p < 0.0001).ConclusionThe prevalence of skin diseases in the rural Mbam valley is alarming, dominated by easily treatable or preventable skin infections and their magnitude is highly neglected by the community, contrasting with findings in the urban setting. Similar studies are needed in other ecological/demographic settings of the country in order to construct a better understanding of the epidemiology of skin disorders. This would lead to the development of national policies to improve skin care.

A survey of public knowledge, attitudes, and practices with respect to epilepsy in Badissa Village, Centre Region of Cameroon

OBJECTIVE The aim of this study was to assess knowledge, attitudes, and practices (KAP) with respect to epilepsy in Badissa, as part of a series of studies mandated by the Cameroon Ministry of Public Health. METHOD We interviewed 164 subjects face-to-face during a door-to-door survey. RESULTS All of the subjects had heard about epilepsy; 98.8% knew at least one patient with epilepsy, and 97.6% had seen at least one epileptic seizure. With respect to attitudes, 16% and 32% would respectively prevent their children from associating with and marrying, people with epilepsy; 55.5% would offer people with epilepsy equal employment. The independent determinants of attitudes were the belief that epilepsy is a form of insanity (P=0.004) or is caused by a mental illness (P=0.003), having read about epilepsy (P=0.018), and being married (P=0.007). CONCLUSIONS Our study demonstrates a high level of awareness and fairly good knowledge of epilepsy, a lower level of misconceptions, and better attitudes, in the study area confirming our hypothesis of a regional variation in these characteristics. This model of care may be useful in scaling up the epilepsy education program in Cameroon.

Onchocerciasis: Neurological Involvement

Onchocerciasis or “river blindness” is an endemic parasitic disease caused by the filarial nematode Onchocerca volvulus, transmitted by a blackfly of the genius Simulium. It has a serious public health impact in 39 countries worldwide, particularly in sub-Saharan Africa where the burden is highest. The neurological involvement in onchocerciasis includes both the peripheral and central nervous system. The clinical manifestations constitute a spectrum of disorders spanning from the very stigmatizing onchocercal itch to optic nerve disease, epilepsy and post-treatment encephalopathy. There has been significant progress in recent years in the understanding of the neuroscience of itching in general, with the discovery of itch-specific neurons and their pathways. However, the exact mechanisms of the onchocercal itch, as well as the pathogenesis of optic nerve disease, epilepsy or encephalopathy are yet to be fully understood. Nevertheless, the relatively new concepts such as “pruritoception” on one hand, and “river epilepsy” on the other hand, may become future active areas of neuroscience research. This may lead eventually not only to novel basic and translational knowledge but also to drug development and improved control strategies for onchocerciasis and associated nervous system complications.