Ethiopians' knowledge of and attitudes toward epilepsy: A systematic review and meta-analysis

Abstract

Background: Epilepsy remains one of the world's most common neurological diseases, but it appears to be widely misunderstood, particularly in under-resourced countries like Ethiopia. Improving individuals' knowledge and attitude toward epilepsy is critical for reducing the multifaceted impacts of epilepsy. Therefore, in this study, we sought to estimate the pooled levels of good knowledge and a favorable attitude toward epilepsy and also identify the associated factors using available data collected from different segments of the population.

Methods: Articles were searched in international electronic databases. A standardized Microsoft Excel spreadsheet and STATA software version 16 were used for data extraction and analysis, respectively. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) checklist was used to write this report. The random-effect meta-analysis model was used to estimate Der Simonian-Laird's pooled effect. Statistical heterogeneity of the meta-analysis was checked via Higgins and Thompson's I ² statistics (0-100%), and Cochran's Q test at P < 0.10. Subgroups, based on the study regions, and sensitivity analyses were also performed. Publication bias was examined subjectively using funnel plots and objectively using the nonparametric rank correlation test of Begg and the regression-based test of Egger for small study effects with P < 0.05 considered to indicate potential publication bias. Furthermore, the Trim-and-fill method of Duval and Tweedie was used to explore sources of publication bias for the favorable level of attitudes toward epilepsy.

Result: A total of 12 studies with 6,373 study participants and 10 studies with 5,336 study participants were included to estimate the pooled level of good epilepsy knowledge and favorable attitudes respectively. The overall estimated levels of good epilepsy knowledge and favorable attitudes toward epilepsy among Ethiopians were 47.37% [(95% CI: 35.00, 59.74), I ² = 99.2, P < 0.001] and 46.83%[(95% CI: 32.75, 60.90), I ² = 99.2, P < 0.001] respectively. Subgroup analysis revealed that the pooled level of good epilepsy knowledge was 48.51% [(95% CI: 38.95, 58.06), I ² = 95.6%, P < 0.001] in the Amhara region.

Conclusion: In the current review, we found out that there is a huge knowledge gap and an unfavorable level of attitudes towardepilepsy, which demand immediate public health action as well as a targeted policy intervention.

Keywords: Ethiopia; attitudes; awareness; epilepsy; knowledge.

Figure 1

PRISMA flow diagram of included studies in the systematic review and meta-analysis.

Figure 2

The map displays regions or city council where the primary studies included in the quantitative synthesis were conducted. (Composed by Woldegeorgis BZ. Via ArcGIS 10.4.1,2015 esri).

Figure 3

Forest plot showing the pooled prevalence of a good epilepsy knowledge among Ethiopians.

Figure 4

Forest plot showing the pooled level of favorable attitudes toward epilepsy among Ethiopians.

Figure 5

Forest plot showing subgroup meta-analysis by region for the overall prevalence of good epilepsy knowledge among Ethiopians.

Figure 6

Forest plot showing a subgroup meta-analysis by region for the overall prevalence of favorable attitudes toward epilepsy among Ethiopians.

Figure 7

Funnel plots of publication bias for a good level of epilepsy knowledge.

Figure 8

Funnel plots of publication bias for favorable level attitudes toward epilepsy.

Figure 9

Counter-enhanced funnel plots of publication bias for favorable attitude toward epilepsy.

Figure 10

Meric inverse counter enhanced funnel plots of publication bias for favorable attitude toward epilepsy.

Figure 11

Regression graph of favorable attitude toward epilepsy.

Figure 12

Trim and fill analysis for the prevalence of favorable attitude toward epilepsy.