title: Zambian teachers: what do they know about epilepsy and how can we work with them to decrease stigma?
abstract: OBJECTIVE
  Teachers play a central role in determining access to education and may mediate epilepsy-associated stigma. We developed and administered a teacher-specific survey to assess teachers' knowledge, attitudes, behaviors, and practices (KABPs) regarding epilepsy in Zambia and social and demographic determinants of KABPs.
  
  
  METHODS
  In 2004, we surveyed 171 teachers in urban and rural regions using a 46-item questionnaire. Knowledge and tolerance composite scores were developed and analyses completed to identify demographic and social determinants of KABPs and evaluate whether generic tolerance questions were associated with stigmatizing practices.
  
  
  RESULTS
  The response rate was 93% (n=159). Knowledge regarding epilepsy ranged broadly. Misattribution was evident for etiology (spirit possession 17.3%; contagion 28.2%; witchcraft 16.8%), and individuals with poorer knowledge were more likely to recommend traditional healers (p=0.0004) rather than physicians for epilepsy care. Higher knowledge was associated with higher tolerance (p=0.01). Tolerance was highest among urban residents (p=0.002) and individuals with personal familiarity/experience with epilepsy. More tolerant teachers were less likely to report stigmatizing practices, such as ejecting children with seizures from school.
  
  
  CONCLUSIONS
  Teacher-targeted interventions aimed at reducing epilepsy-associated stigma and its sequelae in Zambia should include both an educational component and a social component in which teachers are exposed to a person or persons with the condition. Education programs led by person(s) with epilepsy may be ideal.
authors.affiliation: Michigan State University's International Neurologic and Psychiatric Epidemiology Program (INPEP), East Lansing, MI, USA. birbeck@msu.edu
authors.forename: Gretchen L
authors.initials: GL
authors.lastname: Birbeck
authors.forename: Elwyn
authors.initials: E
authors.lastname: Chomba
authors.forename: Masharip
authors.initials: M
authors.lastname: Atadzhanov
authors.forename: Edaward
authors.initials: E
authors.lastname: Mbewe
authors.forename: Alan
authors.initials: A
authors.lastname: Haworth
mesh_terms: D000328:Adult; D003625:Data Collection / Q000379:methods; D004827:Epilepsy / Q000523:psychology*; D005178:Faculty; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008875:Middle Aged; D013240:Stereotyping; D011795:Surveys and Questionnaires