Knowledge,attitude and practice of schoolteachers towards students with epilepsy in Al-Jouf,Saudi Arabia

Abstract

BACKGROUND:

Epilepsy is a common disorder in which brain activity becomes abnormal that causes recurrent seizures or periods of jerky movement of the whole body. Immediately after a seizure, people are often transiently confused, weak and unable to communicate.

OBJECTIVE:

This study assesses the knowledge, attitude, and practice (KAP) of school teachers towards an epileptic child.

METHODS:

This cross-sectional study was conducted among primary and secondary school teachers from different schools in Sakaka, Domat Al-Jandal, Al-Qurayyat, Tabarjal Northern region of Aljouf, Saudi Arabia. They were assessed on their KAP toward students with epilepsy using a self-administrated questionnaire.

RESULTS:

306 respondents participated and completed the questionnaire. The practice was poor among the teachers. Practice scores were significantly different among the male and female teachers. Teachers would do the following to the seizing child: 159 (52%) would pull the child’s tongue out (p-value 0.012), 66 (21.6%) would put a spoon in the mouth (p-value 0.055), 43 (14.1%) would remove any tight clothes (p-value 0.009) and 244 (79.7 %) would take the child to the hospital (p-value 0.029). There were significant differences among senior teachers and those with longer years of teaching experience: 83.6% of teachers with > 20 years of teaching experience think that the student with epilepsy has no need of a special classroom (P = 0.053), 89.6% of those with > 20 years of teaching experience said that they did not move the child during seizure in comparison with less years of teaching experience (p = 0.048), in which 97% of those with experience > 20 years said that they would ensure normal breathing (p = 0.015).

CONCLUSION:

The majority of Aljouf schoolteachers were adequately knowledgeable about students with epilepsy, but they need more information about the correct way of practice towards the student with epilepsy.

Keywords

Epilepsy seizure epileptic child primary and secondary school teachers knowledge attitude practice

1 Introduction

Epilepsy is one of the most common chronic neurologic disorders found in the world [1]. It is characterized by recurrent seizures, which are brief episodes of involuntary movement that may involve a part of the body or the entire body, and sometimes are accompanied by loss of consciousness and control of bowel or bladder function. The major problems faced by people with epilepsy are a lack of knowledge and awareness in the community, along with cultural beliefs and stigma [2]. Approximately 50 million people worldwide have epilepsy, and nearly 80% of them live in developing regions [3]. Data from Arab countries revealed prevalence rates of 6.54/1000in Saudi Arabia [4]. Studies have revealed that epilepsy has a major influence on children, especially schoolchildren and socially. Sometimes, social attitude and discrimination against children with epilepsy are more distressful than the disease itself. Knowledge about epilepsy is very important in determining the teacher’s attitudes toward students with epilepsy. Overall, teachers do not receive any official instructions on epilepsy during their education in spite of the fact that as much as 40% of the children’s time is spent at school [5].

The appropriate awareness about epilepsy would result in positive attitudes and practices toward children leading to proper management of epilepsy and decreasing the complications [2, 6]. For example, the tragic death of a 16-year-old boy in a middle school in Kuwait due to the lack of first aid training among teachers [5]. School teacher’s knowledge, awareness and practice towards epilepsy have been studied in few countries including Kuwait, Thailand, Pakistan, India and Sudan [5 , 8–10]. Despite this, insufficient research has been conducted in Saudi Arabia to assess these issues. In a southern Saudi study, it was reported that primary school teachers’ attitudes of epilepsy needed improvement and that educational campaigns on epilepsy were required [1]. Another study reported that the Saudi population still believes that jinn possession by demons (Jinns). They are concealed creatures that are accepted to exist in all religions, and have the ability to possesses people and cause them hurt. Jinn power can show with a scope of strange practices which could be explain as various psychotic or mental issues and seizure problems including (this needs to be explained-explanation added) epilepsy [11].

Till now there was no such study conducted in northern Saudi Arabia. School teachers of this region yet to receive any guideline or practice parameter towards epilepsy students. The determination of inadequate knowledge towards epilepsy students is vital for attitude, practice planning, both on a teacher’s level as well as an individual level. Increased rates of anxiety and depression are also linked to childhood epilepsy. Children with epilepsy risk feeling loss of control and learned helplessness. Thus, knowledge about epilepsy among school teachers would result in positive attitude and practice towards epilepsy students. Hence, this study was to assess the knowledge, attitude and practice towards students with epilepsy within the Saudi Arabian school teachers living in Aljouf region.

2 Materials and methods

This cross-sectional study was conducted during April 2019 in Saudi Arabia. The study duration was six months; data collection was started after the university ethical clearance (Approval no. LCBE 5-20-3/40). In this study, 10 schools (Sakaka 4, Domat Al-Jandal 2, Al-Qurayyat 2, Tabarjal 2) were selected based on old and renowned government Arabic school both for males and females. The sampling method was a convenient survey. The total number of teachers who were participated was 306 and who were aged > 25 years, were included in this study.

Step 1: Investigators with the letter of ethical approval directly contacted with School Principal. A meeting was first organized and subsequently research details (aims and objectives) had been discussed and then Research Questionnaire distributed through teacher’s email.

Step 2: Each participant was asked to complete the self-administered questionnaire with a cover letter explaining the aim of the research, the questionnaire consist of 32 multiple choice questions designed in four parts; the first part included demographic data such as age, gender and year of graduation of teachers; the second part included MCQ to assess knowledge such as “Have you ever heard or read about epilepsy?; the third part included MCQ to assess the attitude such as “Do you think epilepsy is a contagious disease?; and the fourth part included a teacher’s practice toward epilepsy such as “when the student experiences a seizure do you move the child? Most of the questions were adapted from previous study which is tested valid and reliable [2]. The questionnaire was initially drafted in English and subsequently translated into Arabic and validated.

3 Result

All primary and secondary school teachers had heard about epilepsy. 306 respondents participated and completed the questionnaire The demographics of the teachers are presented in Table 1. Of the respondents, ninety-one (29.7%) were male and 215 (70.3%) were female teachers, the mean age was 40–49 (46.7%) years. Regarding the nationality 305 (99.7%) were Saudis and only 1 (0.3%) non-Saudi. Teachers’ graduation dates were between 2004 and 2014, and they had 11 to 15 years of teaching experience. Overall, 41.5% of participants were primary and 58.5% were secondary school teachers. Most of the respondents were from different schools of Sakaka 43.8%, Al-Qurayyat 13.4%, Dumat al Jandal 22.9% and Tabarjal 19.9%.

Table 1
Sociodemographic distribution

No. %

Gender

Male 91 29.7

Female 215 70.3

Age

< 30 36 11.8

30–39 107 35

40–49 143 46.7

> = 55 20 6.5

Mean 40–49

Nationality

Saudi 305 99.7

Non-Saudi 1 0.3

Graduation year Number of participant?

Male and female?

< = 1984 6 2

1985–2003 111 36.3

2004–2014 174 56.9

> = 2015 15 4.9

Mean 2004–2014

Years of experience

< = 10 82 2

11–15 88 36.3

16–20 69 56.9

>20 67 4.9

Mean 11–15

Work place

Sakaka 134 43.8

Al-Qurayyat 41 13.4

Domat Al-Jandal 70 22.9

Tabarjal 61 19.9

School level

Primary 127 41.5

Secondary 179 58.5

Total 306 100

	No.	%
Gender
Male	91	29.7
Female	215	70.3
Age
< 30	36	11.8
30–39	107	35
40–49	143	46.7
> = 55	20	6.5
Mean	40–49
Nationality
Saudi	305	99.7
Non-Saudi	1	0.3
Graduation year	Number of participant?
	Male and female?
< = 1984	6	2
1985–2003	111	36.3
2004–2014	174	56.9
> = 2015	15	4.9
Mean	2004–2014
Years of experience
< = 10	82	2
11–15	88	36.3
16–20	69	56.9
>20	67	4.9
Mean	11–15
Work place
Sakaka	134	43.8
Al-Qurayyat	41	13.4
Domat Al-Jandal	70	22.9
Tabarjal	61	19.9
School level
Primary	127	41.5
Secondary	179	58.5
Total	306	100

3.1 Level of knowledge among the respondents

The majority of female teachers 93.5% had heard about epilepsy in comparison with male teachers 86.8% (p-value.056). A total of 73 (23.9 %) had witnessed someone having an epileptic seizure among their family and had experience of students with epilepsy in their classroom (Table 2).

Table 2
Knowledge of schoolteachers toward students with epilepsy

Total female/ male Female Male P-value Female /Male

Knowledge Yes Yes Yes NO Do not know

No. (%) No. (%) No. (%)

1 Have you ever heard or read about epilepsy? 280 (91.5) 201 (93.5) 79 (86.8) 0.056 ^** 26 (8.5)

2 Has any one in your family ever had seizure? 73 (23.9) 54 (25.1) 19 (20.9) 0.604 220 (71.9) 13 (4.2)

3 Have you ever had students with epilepsy in your classroom? 73 (23.9) 53 (24.7) 20 (22) 0.856 229 (74.8) 4 (1.3)

		Total female/ male	Female	Male	P-value	Female /Male
Knowledge		Yes	Yes	Yes		NO	Do not know
		No. (%)	No. (%)	No. (%)
1	Have you ever heard or read about epilepsy?	280 (91.5)	201 (93.5)	79 (86.8)	0.056 ^**	26 (8.5)
2	Has any one in your family ever had seizure?	73 (23.9)	54 (25.1)	19 (20.9)	0.604	220 (71.9)	13 (4.2)
3	Have you ever had students with epilepsy in your classroom?	73 (23.9)	53 (24.7)	20 (22)	0.856	229 (74.8)	4 (1.3)

The source of knowledge on epilepsy for the teachers was public media 48%, the parents of the students with epilepsy 11.1 %, unspecified source 31.7 % and only 9.5 % of the teachers had the information from doctors (Table 3).

Table 3

Teachers’ source of information about causes of epilepsy

	Source	no.	%
1	Independent study/books	31	10.1
2	Public media	147	48
3	Doctors	29	9.5
4	Parents of students with epilepsy	34	11.1
5	Unspecified	97	31.7
	Causes
1	Genetics	102	33.3
2	Trauma	83	27.1
3	Infection	0	0
4	Tumor	15	4.9
5	Brain disease	24	7.8
6	Insanity	12	3.9
7	Malformation or crippling	11	3.6
8	Possession	20	6.5
9	I don’t know	96	31.4

Regarding causes of epilepsy most of the teachers 33.3% believed that epilepsy may be related to genetics, 27.1% teachers thought epilepsy due to trauma, only 7.8% mentioned epilepsy is a brain disease, however, 31.4% did not know the cause of epilepsy (Table 3).

3.2 Level of attitude among the respondents

The 7 items of attitude score showed a positive attitude among both male and female teachers toward students with epilepsy. Most of the teachers 97.4% believed that epilepsy was not contagious diseases and 79.7% of teachers thought epilepsy can be cured/controlled. Most teachers 74.2% believed that epileptic child was not mentally retarded, only 14 (6.5%) female and 7 (7.7%) male teachers believed that epileptic children had a higher incidence of insanity/mentally retardation (p-value 0.013). One hundred fifty (49%) of the teachers were not afraid of having epileptic students in their classroom, 241 (78.8 %) of the teachers believed that epileptic students had no need any special classroom, 227 (74.2%) of the teachers would allow their child to play or sit in the same class. Almost more than half of respondents 207 (67.6 %) believed that epileptic children have normal intelligence (Table 4).

Table 4
Attitude of schoolteachers toward students with epilepsy

Female/Male Female Male P-value Female/Male

Attitude Yes Yes Yes No Do not know

No. (%) No. (%) No. (%) No. (%) No. (%)

1 Do you think epilepsy is a contagious disease? 1 (0.3) 0 (0) 1 (0.3) 0.083 298 (97.4) 7 (2.3)

2 Do you think children with epilepsy have a higher incidence of insanity? 21 (6.9) 14 (6.5) 7 (7.7) 0.013^* 227 (74.2) 58 (19)

3 Do you think that epilepsy is a chronic brain disease that cannot be cured or controlled? 29 (9.5) 23 (10.7) 6 (6.6) 0.4 244 (79.7) 33 (10.8)

4 Are you afraid of having a student with epilepsy in your classroom and/or would prefer to have student’s epilepsy cured or under control before entering your classroom? 129 (42.2) 98 (45.9) 31 (34.1) 0.163 150 (49) 27 (8.8)

5 Would you prefer to have all students with epilepsy placed in special classroom? 49 (16) 35 (16.3) 14 (15.4) 0.975 241 (78.8) 16 (5.2)

6 Would you allow your child to play or sit in the same class with a child with epilepsy? 227 (74.2) 158 (73.5) 69 (75.8) 0.643 42 (13.7) 37 (12.1)

7 What do you think is the average intelligence of a person with epilepsy? Normal Less than average Above average Do not know

207 (67.6) 63 (69.2) 0.707 30 (9.8)

		Female/Male	Female	Male	P-value	Female/Male
	Attitude		Yes	Yes	Yes		No	Do not know
		No. (%)	No. (%)	No. (%)		No. (%)	No. (%)
1	Do you think epilepsy is a contagious disease?	1 (0.3)	0 (0)	1 (0.3)	0.083	298 (97.4)	7 (2.3)
2	Do you think children with epilepsy have a higher incidence of insanity?	21 (6.9)	14 (6.5)	7 (7.7)	0.013^*	227 (74.2)	58 (19)
3	Do you think that epilepsy is a chronic brain disease that cannot be cured or controlled?	29 (9.5)	23 (10.7)	6 (6.6)	0.4	244 (79.7)	33 (10.8)
4	Are you afraid of having a student with epilepsy in your classroom and/or would prefer to have student’s epilepsy cured or under control before entering your classroom?	129 (42.2)	98 (45.9)	31 (34.1)	0.163	150 (49)	27 (8.8)
5	Would you prefer to have all students with epilepsy placed in special classroom?	49 (16)	35 (16.3)	14 (15.4)	0.975	241 (78.8)	16 (5.2)
6	Would you allow your child to play or sit in the same class with a child with epilepsy?	227 (74.2)	158 (73.5)	69 (75.8)	0.643	42 (13.7)	37 (12.1)
7	What do you think is the average intelligence of a person with epilepsy?	Normal	Less than average	Above average	Do not know
		207 (67.6)	63 (69.2)	0.707	30 (9.8)

3.3 Level of practice among the respondents

The majority of the teachers were not aware of the correct practice toward their students with seizure, there was a significant difference among male and female teachers in their practice level towards student’s association with seizure.

Table 5 shows the majority of the teachers would do the following to the seizing child: a. Pulls the child tongue out, 56.7% female and 40.7% male (p-value 0.012), b. Put a spoon in the mouth, 24.2% female and 15.4 % male (p-value 0.055), c. Remove any tight clothes, 15.3% female and 11% male (p-value 0.009), d. Take child to the hospital 83.7% female, 70.3% male (p-value 0.029). The teachers of both groups agreed to wait for the end of the seizure.

Table 5
Practice of schoolteachers toward students with epilepsy

Total female/male Female Male P-value Female/male

Practice Yes Yes Yes No Do not know

No. (%) No. (%) No. (%) No. (%)

1 Move away from child 23 (7.5) 20 (9.0) 3 (3.3) 0.148 256 (83.7) 27 (8.8)

2 Pull the child’s tongue out 159 (52) 122 (56.7) 37 (40.7) 0.012 74 (24.2) 73 (23.9)

3 Put a spoon between 66 (21.6) 52 (24.2) 14 (15.4) 0.055 140 (45.8) 100 (32.7)

4 Remove nearby objects 276 (90.2) 196 (91.2) 80 (87.9) 0.452 14 (4.6) 16 (5.2)

5 Position the child safely 298 (97.4) 209 (97.2) 89 (97.8) 0.766 0 (0) 8 (2.6)

6 Protect the child head 290 (94.8) 205 (95.3) 85 (93.4) 0.548 1 (0.3) 15 (4.9)

7 Ensure normal breathing 286 (93.5) 202 (94) 84 (92.3) 0.308 3 (1) 17 (5.6)

8 Remove the clothes 43 (14.1) 33 (15.3) 10 (11.0) 0.009 199 (65) 64 (20.9)

9 Take child to hospital 244 (79.7) 180 (83.7) 64 (70.3) 0.029 39 (12.7) 23 (7.5)

10 Wait for the end of seizure 101 (33) 71 (33.0) 30 (33.0) 0.825 157 (51.3) 48 (15.7)

		Total female/male	Female	Male	P-value	Female/male
	Practice	Yes	Yes	Yes		No	Do not know
		No. (%)	No. (%)	No. (%)	No. (%)
1	Move away from child	23 (7.5)	20 (9.0)	3 (3.3)	0.148	256 (83.7)	27 (8.8)
2	Pull the child’s tongue out	159 (52)	122 (56.7)	37 (40.7)	0.012	74 (24.2)	73 (23.9)
3	Put a spoon between	66 (21.6)	52 (24.2)	14 (15.4)	0.055	140 (45.8)	100 (32.7)
4	Remove nearby objects	276 (90.2)	196 (91.2)	80 (87.9)	0.452	14 (4.6)	16 (5.2)
5	Position the child safely	298 (97.4)	209 (97.2)	89 (97.8)	0.766	0 (0)	8 (2.6)
6	Protect the child head	290 (94.8)	205 (95.3)	85 (93.4)	0.548	1 (0.3)	15 (4.9)
7	Ensure normal breathing	286 (93.5)	202 (94)	84 (92.3)	0.308	3 (1)	17 (5.6)
8	Remove the clothes	43 (14.1)	33 (15.3)	10 (11.0)	0.009	199 (65)	64 (20.9)
9	Take child to hospital	244 (79.7)	180 (83.7)	64 (70.3)	0.029	39 (12.7)	23 (7.5)
10	Wait for the end of seizure	101 (33)	71 (33.0)	30 (33.0)	0.825	157 (51.3)	48 (15.7)

The result of a comparison of knowledge level among the respondents teaching years of experience:

There was significant difference showed among senior teachers and in those with longer teaching years of experience: 86.6% of the responders less than 10 years of experience and 92% of those with 11–15 years, 91.3% of those with 16–20, and 97% of the ones with > 20 years had heard about epilepsy.

There is also significant difference among School teachers’ knowledge by the years of experience. Teachers considered the malformation or crippling as the main cause of epilepsy with response rates of 98.8% with less than 10 years of experience and 100% of those with 11–15 years, 91.3% of those with 16–20, and 94.0% of the ones with > 20 years (P-value 0.012) (Table 6).

Table 6

Schoolteacher’s knowledge with the years of experience

Experience	<10 Y		11–15 Y		16 –20Y		>20Y		P-value
Knowledge	Yes	No	Yes	No	Yes	No	Yes	No
Have you heard about epilepsy?	86.6%	13.4%	92.0%	8.0%	91.3%	8.7%	97.0%	3.0%	0.157
Causes of epilepsy
Genetic	41.5%	58.5%	30.7%	69.3%	24.6%	75.4%	35.8%	62.7%	0.178
Trauma	25.6%	73.2%	30.7%	69.3%	27.5%	71.0%	23.9%	76.1%	0.797
Tumor	6.1%	93.9%	2.3%	97.7%	2.9%	97.1%	9.0%	91.0%	0.211
Brain diseases	9.8%	90.2%	6.8%	93.2%	5.8%	94.2%	9.0%	91.0%	0.787
Insanity	2.4%	97.6%	2.3%	97.7%	5.8%	94.2%	6.0%	94.0%	0.475
Malformation crippling	1.2%	98.8%	0.0%	100.0%	8.7%	91.3%	6.0%	94.0%	0.012
Possession	4.9%	95.1%	5.7%	94.3%	10.1%	88.4%	6.0%	94.0%	0.481

The result of a comparison of attitude level among the respondents’ teaching years of experience:

There was a significant difference regarding the attitude of the senior teachers and in those with longer teaching years of experience: 69.5% of teachers who experience < 10 years and 83% of teachers who had experience of 11 to 15 years, 79.7% of those with 16–20 years, and 83.6% of the ones with > 20 years thinks that student with epilepsy had no need special classroom (P = 0.053) (Table 7).

Table 7

Schoolteacher’s attitude level by the years of experience

Experience	<10 Y		11–15 Y		16 –20Y		>20Y		P-value
Attitude towards epilepsy student	Yes	No	Yes	No	Yes	No	Yes	No
Do you think epilepsy contagious diseases?	1.2%	95.1%	0.0%	97.7%	0.0%	97.1%	0.0%	100%	0.526
Do you think epilepsy have a higher incidence in insanity?	6.1%	74.4%	6.8%	76.1%	4.3%	73.9%	10.4%	71.6%	0.861
Do you think epilepsy chronic diseases that cannot be cured?	14.6%	73.2%	6.8%	80.7%	8.7%	84.1%	7.5%	82.1%	0.525
Are you afraid of having a student with epilepsy in your classroom?	41.5%	46.3%	38.6%	52.3%	40.6%	53.6%	49.3%	43.3%	0.665
Do you prefer student with epilepsy need special classroom?	26.8%	69.5%	9.1%	83.0%	15.9%	79.7%	11.9%	83.6%	0.053
Do you allow your child to play with a child with epilepsy?	72.0%	12.2%	71.6%	17.0%	78.3%	11.6%	76.1%	13.4%	0.837

The result of a comparison of practice level among the respondents’ teaching years of experience:

There was a significant difference of practice between the teachers with different years of experience, 84.1% of those with experience years < 10, 75% of those with 11–15 years, 88.4% of those with 16–20 years and 89.6% of the ones with > 20 years said that they did not move the child away during seizure, (p = 0.048). 95.1% of those with < 10 years of experience, 87.5% of those with 11–15 years, 95.7% of those with 16–20 years and 97% of those with experience > 20 years said yes, they were ensuring the child normal breathing (p = 0.015). Regarding taking the child to the hospital, the result showed that 80.5% of those with < 10 years of experience, 70.5% of those with 11–15 years, 81.2% of those with 16–20 years and 89.6% of those with experience > 20 years said they took the child to the hospital (p = 0.053) (Table 8).

Table 8

Schoolteacher’s practice level by the years of experience

Experience	<10 Y		11–15 Y		16 –20Y		>20Y		P-value
Practice	Yes	No	Yes	No	Yes	No	Yes	No
Move away the child	3.7%	84.1%	14.8%	75.0%	5.8%	88.4%	4.5%	89.6%	0.048
Pull the child’s tongue out	48.8%	22.0%	47.7%	23.9%	52.2%	30.4%	61.2%	20.9%	0.310
Put a spoon between teeth	23.2%	35.4%	20.5%	50.0%	23.2%	46.4%	19.4%	52.2%	0.427
Remove nearby object	91.5%	2.4%	84.1%	9.1%	91.3%	4.3%	95.5%	1.5%	0.236
Position of child safely	97.6%	2.4%	94.3%	5.7%	98.6%	1.4%	100.0%	0.0%	0.143
Protect the child head	97.6%	0.0%	92.0%	0.0%	92.8%	1.4%	97.0%	0.0%	0.327
Ensure normal breathing	95.1%	1.2%	87.5%	0.0%	95.7%	2.9%	97.0%	0.0%	0.015
Remove clothes	19.5%	57.3%	11.4%	65.9%	5.8%	78.3%	19.4%	59.7%	0.089
Take the child to hospital	80.5%	8.5%	70.5%	19.3%	81.2%	14.5%	89.6%	7.5%	0.053
Wait for the end of seizure	34.1%	48.8%	35.2%	45.5%	29.0%	56.5%	32.8%	56.7%	0.675

4 Discussion

This study showed that majority of the teachers (91.5%) had a prior knowledge about epilepsy. Teachers are an important part of all communities as they participate in raising new generations. The knowledge, attitude and practice about epilepsy will be transmitted to the students, thereby it will increase their awareness which will be also transmitted back to other parts of the community. Epilepsy affects adults at a productive age and interferes with their ability to work therefore, social security and medical advisory decisions that will support the epilepsy individual and provide benefit for their future guidelines [12] are needed.

In our study, the overall awareness level towards epilepsy students among the teachers was quite high, 93.5% female and 86.8% male teachers. The source of their knowledge was mainly from public media 48% and from doctors 9.5%. These findings reflect two points about health education: first, the doctors need to participate in health education activities toward the community and secondly, the public media will need to play an essential role in health awareness. These percentages are comparable with those reported in Kuwait, Pakistan, Sudan but are greater than those reported in India and lesser than those reported in Thailand [5 , 8–10].

Our findings about the cause of epilepsy revealed that 33.3% of schoolteachers believed that epilepsy is due to a genetic cause, 27.1% thought it’s due to trauma and 7.8% believed it is due to brain disease, compared with previous studies conducted in India where 44.4% stated that it is due to brain disease, in Pakistan 1.5% teachers consider it is a contagious disease, in southern Saudi 46% believed that it is caused by electrical discharge [2 , 9].

On the other hand, there are still 6.5% of teachers who believed that epilepsy is related to possessions and 3.9% thought epilepsy was related to insanity. This is in comparison to studies conducted in Sudan where 21.1% of teachers related epilepsy to devils, 26% of Nigerian teachers also believed epilepsy was related to the evil spirit and in Jeddah, 40.3% of the school teachers also believed epilepsy is related to evil spirits [10 , 14].

Regarding the association of epilepsy with insanity, 74.2% of teachers believed that there was no association, compared to a study from Taiwan, where more than 30% of participants thought epileptic seizures were associated with insanity [13]. There was strong positive attitude, with 79% of teachers seeing epilepsy as a curable disease that can be controlled with medicine in comparison to a study from Southern Saudi Arabia where 38.7% of teachers agree with it [2].

The majority, 49% did not mind having a student with epilepsy in the same class, same as the study conducted in the USA by M. Bishop who reported that students with epilepsy in regular classroom have no problems [14]. Only, 16 % of teachers felt that epilepsy students should need a separate special classroom, similar studies conducted in Jeddah 28%, Riyadh 14.3%, India 20.8 %, and 15.4% in Burkina Faso; Africa, objected to having epileptic students in their classes [9 , 18].

A study conducted in Jeddah showed 25% of teachers think that students with epilepsy have below-average intelligence in contrast to this study, most of the teachers 67.6% think that students with epilepsy have an average/normal intelligence [14]. Bannon et al. reported that 68% of 142 schoolteachers in Staffordshire, UK, did not think that students with epilepsy were more likely to have problems with learning [19]. The attitude toward epileptic patients is an important aspect that can affect the quality of the epileptic students’ lives in many ways, especially socially.

Lastly, the initial practices toward epileptic children were inappropriate by the teachers where 56.7% female and 40.7% male teachers would pull the child’s tongue and 24.2% female and 15.4% male teachers agreed on putting a spoon in the mouth to prevent tongue injury and 32.7% do not know what they needed to do. These negative results can harm the students during seizing by causing teeth fractures or harm to their tongues. A percentage of participants answered “Don’t know” to the questions of practice, which highlight the need for more health education about epilepsy.

4.1 Comparison of knowledge with years of experience

Knowledge scores are significantly different among teachers with fewer years of experience, a positive trend with respect to young teachers with less experience showed a significant result (p-value 0.012), considering the question of malformation or crippling causes epilepsy.

4.2 Comparison of attitude with years of experience

The teachers who were older and with more years of experience have a positive attitude toward children with epilepsy needing a special classroom. Maximum senior and long experience teachers responded that there was no need special classroom (p = 0.05), compared to the Turkish study where younger teachers had positive attitudes [20]. Similarly, a group of studies that were conducted in Saudi Arabia, Sudan, Kuwait and America showed that the relationship between higher levels of education and long experience had a more positive attitude towards the child with epilepsy [1 , 14].

4.3 Comparison of practices with years of experience

As for the difference of practice between school teachers’ years of experience, there was a significant difference of practice regarding the question of moving the child away during seizing (p = 0.04), ensuring normal breathing (p = 0.01) and taking the child to the hospital (p = 0.053) that indicates more years of teaching experience provide good practices towards student with epilepsy. Similarly, a study in Khartoum, Sudan showed teachers with long years of experience displayed good practice [9]. Overall, the teachers had positive attitudes and practices with long years of experience, which correlated highly with their adequate knowledge.

5 Limitation of the study

It is possible that by increasing the parameters of analyzed samples in this study, we may arrive at even more certain conclusions. Hence, the importance of future similar studies done in other parts of Saudi Arabia cannot be overstated.

6 Conclusion

The results of the present research showed that northern region Saudi school teachers had adequate knowledge of epilepsy. They were mostly aware of the cause of epilepsy and their attitude towards epilepsy student was highly positive. In general, Primary and Secondary school teachers showed lack of knowledge in practice towards epilepsy students, their practices were poor during seizure stage. On the other side, good practice was observed with long years of teaching experience. That’s why, it is necessary to educate the school teachers on how to appropriately handle epilepsy students during seizing. A complete health educational program about knowledge, attitude and practice towards epileptic students need to improve the perception of epilepsy by teachers in Saudi. Doctors and specialists need to provide epilepsy education programs to the community and schools nationwide.

Footnotes

Acknowledgments

Deanship of Scientific Research, Jouf University, research grant no. DSR2020-04-434.

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