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Original Research (Original Article) 


Maria Suliman Mohammed Aljehani, 2019;3(10):059–064.

International Journal of Medicine in Developing Countries

Level of knowledge of first aid of epilepsy among female teachers of elementary schools in Makkah city, Saudi Arabia

Maria Suliman Mohammed Aljehani1*

Correspondence to: Maria Suliman Mohammed Aljehani

*King Abdullah Medical City, Makkah, Saudi Arabia.

Email: maria-jehani [at] live.com

Full list of author information is available at the end of the article.

Received: 04 July 2019 | Accepted: 10 August 2019


ABSTRACT

Background:

The role of teachers in the school as the first line-role model in emergencies situation could be only achieved through an evaluation of their awareness and knowledge about first-aid procedures. The present study aims to assess the level of knowledge regarding first aid procedures for seizure and its associated factors among female teachers at elementary school in Makkah city, Saudi Arabia.


Methodology:

A cross-sectional study was carried out among a sample of female teachers of elementary schools in Makkah city, Saudi Arabia. A self-administered validated questionnaire was utilized for the data collection.


Results:

Two hundred forty-seven (247) female teachers were included in the study. Among the total subjects studied, the total knowledge score percentage regarding epilepsy first aid ranged between 0% and 83.33% with a mean ± standard deviation of 36.50 ± 24.74%. Divorced/widowed female teachers were more knowledgeable regarding epilepsy first aid compared to single and married teachers (mean ranks was 150.83 vs. 105.56 and 124.62, respectively). Teachers who were aware of epilepsy first aid were more knowledgeable regarding it compared to those who were not aware (mean rank was 150.69 vs. 106.74), p < 0.001. Teachers who had experience with an epileptic student in the class the current or previous year or previously were more knowledgeable about epilepsy first aid compared with those without such experience (mean rank was 153.39 vs. 124.67), p = 0.016. Majority of the teachers (96.8%) perceived the importance of establishing an epilepsy first aid training course.


Conclusion:

Awareness and knowledge among female elementary school teachers in Makkah city, Saudi Arabia about epilepsy first aid were not satisfactory. This could largely due to the lack of proper and effective training regarding first aid procedures.


Keywords:

Epilepsy, epilepsy first aid, patient with epilepsy.


Introduction

Epilepsy is a chronic disorder of the brain that affects people worldwide. It is characterized by involuntary movement and intermittent fits associated sometimes with loss of consciousness and loss of bladder control, a seizure may involve a part of the body or the whole body, and it is classified into three categories: generalized, focal (formerly called partial), and epileptic spasms around [1]. Approximately 50 million people worldwide have epilepsy, and 80% of patients with epilepsy living in low socioeconomic areas, fortunately, around 70% of patient with epilepsy (PWE) can be successfully treated. Data from a cross-sectional study conducted in 2001 in Saudi Arabia aimed at assessing the prevalence of epilepsy and the causes of symptomatic epilepsies showed that the prevalence rate of active epilepsy was (6.5/1,000), 28% from the (PWE) were partial seizure, (21%) generalized seizure and (51%) not determined either focal or generalized, (32%) of patients are symptomatic, (23%) developed epilepsy due to perinatal encephalopathy, and due to head trauma (4%), childhood neurological infection (4%), stroke (1%), and (3.55/1,000) for febrile convulsion, they found that the most common cause for symptomatic epilepsy was inherited and perinatal factors [2]. A systematic review of the epidemiology of epilepsy in Arab countries was conducted in 2009, the study result showed that approximately (724,500) (PWE) live in the Arab world. A prevalence of (174 per 100,000) (PEW) in 2001 was recorded from Qatar, the incidence in Sudan was (0.9/1,000). All the studies revealed higher incidence in males, especially in the Saudi survey, The prevalence was higher by two times in children and young adults, the significant cause of symptomatic epilepsy was cerebral palsy and mental retardation in children [3]. Most of the studies conducted in Saudi Arabia have neglected schools health services due to the lack of awareness and education about the importance of first aid skills toward the schoolchildren those were more exposed to the dangers of accidents and attacks of seizure and other emergencies situations, Therefore the schoolchildren are to be considered more important in educating firstaid compared to adults in terms of physical activity and stress in school and the long time of the day they spend in schools. According to the National First-aid Science Advisory, everyone can and should learn firstaid, and the role of teachers in the school is to act as first-line role model in emergencies situation and this role could be achieved only through the evaluation of schoolteachers' knowledge about first-aid which could in turn consequently encourage to create health education training programs to improve teachers practice about first aid procedures [4]. The present study aims to evaluate the elementary school female teachers' knowledge of first aid about seizure toward the students with epilepsy and identify weak areas; therefore building up the ability to deal with schoolchildren in an urgent situation.


Subjects and Methods

A cross-sectional study was carried out among a sample of female teachers of elementary schools in Makkah city, Saudi Arabia. The study population included elementary school teachers in Makkah, City. The study included female elementary school teachers of all. Non-Arabic speakers, teachers on leave during the study period, and teachers who are assigned to work outside the targeted school during the study period were excluded. The sample size of 247 for the study was calculated by using online sample calculator provided by Raoasft website according to (5%) error and, (95%) confidence interval, assuming a prevalence rate of 21% for the generalized seizure in Saudi Arabia, and 7558 as population size. A self-administered questionnaire was instructed by the researcher and consisted of two parts. First part: sociodemographic (age, marital status, number of children, nationality, educational level, number of experience years, and school category, school name). Second part: knowledge of the first aid of seizure. The questionnaire was validated by three consultants. The questionnaire was translated from English to Arabic and was subjected to a reliability test. The Statistical Package for the Social Sciences software version 25 was used for data entry and analysis. Frequency and percentage were applied to describe categorical data, whereas mean and standard deviation (SD) for continuous variables. Shapiro–Wilk test of normality was adopted for knowledge percentage of the score of epilepsy first aid knowledge. Since this variable was abnormally distributed, a non-parametric test was done using Mann-Whitney and Kruskal– Wallis test to compare two and more than two groups, respectively and p-value (<0.05) was considered for significance.

A pilot study was conducted in Alabama-Alnojabaa elementary school, whose data were not considered in the present study. The same questionnaire used in the present study was used on 25 teachers (10% of the sample size). The deficit was identified and modified accordingly (e.g., in the first paper the researcher adds that the participant teacher's name will never be known), in the age category (less than 25 years choice is added), number of children and marital status added, question number two and three are added, reformulate questions number 12 and 4 to be more clear ). The ethical approval for the present study includes permission from the Makkah joint program of family and community medicine, Makkah, Saudi Arabia. The permission was obtained from the Ministry of Education. Written consent was obtained from each participant. All information was kept confidential and results would be submitted to the department as feedback.


Results

Two hundred forty-seven (247) female teachers were included in the study. The socio-demographic characteristics of the study subjects are presented in Table 1. The age of about half of them (48.2%) ranged between 31 and 40 years, whereas that of 36.4% ranged between 41 and 50 years. Most of them (73.7%) were married, and 40.8% of married teachers had more than three children. Majority of them (96.4%) were Saudis and held Bachelor degree (81.4%). The teaching experience of 38.8% of them ranged between 6 and 10 years, whereas that of 32% exceeded 15 years. Most of them (79.4%) were working in governmental schools.

As displayed from Figure 1, 39.3% of the female teachers were aware of the first aid of epilepsy. The commonest reported sources+ of information about epilepsy first aid were social media (37.1%), courses (24.7%), and epileptic relative (18.6%). Physicians were the source of information among only 12.4% of the participants (Figure 2). Twenty-eight (11.3%) of female teachers had an experience at least with an epileptic student in the class this year or previously. About one-fourth of the participants (24.7%) had witnessed a student with epileptic fits. More than half (54.1%) of female teachers who witnessed a student with an epileptic fit reported of providing first aid. Table 2 summarizes the responses of the participants to knowledge statements regarding epilepsy first aid. More than half of them (59.1%) could recognize that after complete stoppage of the fit and regain the patient’s consciousness, the ideal first aid measure to be followed is calling parents to take her back to home. Additionally, 47.8% of them knew correctly that upon stoppage of the epileptic fit, the patient should be transferred to a hospital in case of having difficulty/ inability to breath, whereas 43.7% of the teachers knew that after quietness of the fit, the ideal first aid measure to be done is tilting the patient to one side in order to open the airway. On the other hand only 21.5% of them knew that in case of continuing of the epileptic fit, they should contact an ambulance to take the patient to the hospital after 5 minutes and 21.1% reported that upon stoppage of the epileptic fit, the patient should be transferred to the hospital in case of having injury/pain. The total knowledge score percentage ranged between 0% and 83.33% with a mean ± SD of 36.50 ± 24.74%, as shown in Figure 3. It was abnormally distributed as shown by significant Shapiro–Wilk test, p < 0.001.

Table 1. Socio-demographic characteristics of female teachers working at elementary schools, Makkah city, Saudi Arabia.

Frequency Percentage
Age (years)
≤30 25 10.1
31–40 119 48.2
41–50 90 36.4
>50 13 5.3
Marital status
Single 41 16.6
Married 182 73.7
Divorced/widowed 24 9.7
Number of children*
None 38 18.4
One 29 14.1
Two 27 13.1
Three 28 13.6
>Three 84 40.8
Nationality
Saudi 238 96.4
Non-Saudi 9 3.6
Educational level
Diploma 29 11.7
Bachelor 201 81.4
Post-graduate 17 6.9
Experience in teaching (years)
≤5 40 16.2
6–10 96 38.8
11–15 32 13.0
>15 79 32.0
*Only for ever-married teachers (n = 206).

Only 16 teachers (6.5%) reported a history of attending epilepsy first aid training course. Majority of the teachers (96.8%) perceived the importance of establishing an epilepsy first aid training course. Factors associated with epilepsy first aid knowledge included:

Figure 1. History of awareness about first-aid of epilepsy among female elementary school teachers, Makkah city, Saudi Arabia.

Figure 2. Source of information about first-aid of epilepsy among female elementary school teachers, Makkah city, Saudi Arabia.

Socio-demographic factors

Divorced/widowed female teachers were more knowledgeable regarding epilepsy first aid compared to single and married teachers (mean ranks was150.83 vs. 105.56 and 124.62, respectively). This was statistically significant, p = 0.042. Other socio-demographic factors (age, number of children, nationality, educational level, and experience in teaching) were not significantly associated with epilepsy first aid knowledge, as shown in Table 3.

School category

There was no statistically significant association between school category and epilepsy first aid knowledge among the elementary schools’ female teachers.

Awareness about first aid of epilepsy

Teachers who were aware of epilepsy first aid were more knowledgeable regarding it compared to those who were not aware (mean rank was 150.69 vs. 106.74), p < 0.001. Source of information about first aid of epilepsy was not significantly associated with epilepsy first aid knowledge.

Table 2. Responses of the female elementary school teachers, Makkah city, Saudi Arabia to epilepsy first aid knowledge statements.

Statements Student’s response
Correct response No. %
The first aid measure supposed to be performed during an epileptic fit Removal of foreign bodies around the patient, supporting the head and observation during the fit. 64 25.9
After quietness of the fit, what is the ideal first aid measure to be done? Tilting the patient to one side in order to open the airway. 108 43.7
After complete stoppage of the fit and regain of the patient`s consciousness, what is the ideal first aid measure to be followed? Calling parents to take her back to home 146 59.1
In case of continuing of the epileptic fit, when we should contact ambulance to take the patient to the hospital? After 5 minutes 53 21.5
Upon stoppage of the epileptic fit, when the patient should be transferred to the hospital? -Difficulty/inability to breath
-Injury/pain feeling
118
52
47.8
21.1

Figure 3. Distribution of the percentage of the total epilepsy first aid knowledge score among the participants.

Experience with epilepsy

Teachers who had experience with an epileptic student in the class this year or previously were more knowledgeable about epilepsy first aid compared with those without such experience (mean rank was 153.39 vs. 124.67), p = 0.016. Histories of witnessing a student with an epileptic fit and providing first aid for a student in an epileptic fit were not significantly associated with epilepsy first aid knowledge.

Attending epilepsy first aid training courses

There was no statistically significant association between attending epilepsy first aid training courses and epilepsy first aid knowledge among the elementary schools’ female teachers.


Discussion

Despite the importance of school health services, they are often neglected in many parts of the world, including Saudi Arabia, which reflected on lack of teacher's awareness about first-aid care of common emergencies including epileptic fits [5]. Also, teachers are considered as the first line of protection for school children in cases of emergencies. They must be able to deal effectively with health emergencies in students [6]. Therefore, the present study was implemented to assess the elementary school female teachers` knowledge of first aid about seizures in student with epilepsy In the present study, only almost one-third of female elementary school teachers (39.3%) were aware of the first-aid of epilepsy. Therefore, there is a need for much more education programs for the public, including teachers about epilepsy and its first aid. The commonest sources of information on epilepsy and its first aid were friends and relatives, followed by reading, media, and education. Also, physicians had no appropriate role in providing such awareness. Ojinnaka [7] reported that the mass media was an important source of information in Nigeria. Concerning the familiarity of the teachers with epilepsy in the present study with epilepsy, even though three-quarters of the epileptic fits occur in school-age children [8], only 13.0% reported having a relative with epilepsy. However, 72.7% had witnessed a patient with an epileptic fit, and 39% had taught a student with epilepsy and, of those, 31.7% had seen students having an epileptic fit. In a study carried out in Nigeria [7], 23.2% of teachers had taught a child with epilepsy. Overall, we can conclude that the experience of teachers with epileptic fits is considerable, and this is an indication for them to be properly trained in first aid skills. In Abha, 28.3% of primary school teachers had previous training in general first aid, and 62.3% of them reported practical training [4]. In Turkey [9], 61.9% of teachers had previous training in first aid, and 54.2% of the courses were only theoretical. So, there is a shortage of conducting first aid training courses for female teachers in Makkah city. The more important point to be noted is that attending training courses did not improve the knowledge of the teachers regarding epilepsy first aid in the present study, which raises a concern regarding the quality of such courses. Thus, there is an urgent need for conducting effective training courses in first aid for epileptic fits. It had been previously documented that school health education programs, including first aid training courses, would improve knowledge of epilepsy and first aid skills of teachers [7]. Lack of experience and relevant knowledge about first aid measures among teachers led to anxiety, sense of scare, and lack of confidence when they had been present when someone had an epileptic fit [10]. In the current survey, only 21.5% of the surveyed teachers knew that in case of continuing of the epileptic fit, they should contact ambulance to take the patient to the hospital after five minutes and 21.1% reported that upon stoppage of the epileptic fit, the patient should be transferred to the hospital in case of having injury/pain feeling. The overall percentage of epilepsy first aid knowledge score was 36.5%, which reflects a bad level of knowledge. In a study carried out in Abha (Saudi Arabia) [4], most of the teachers knew correctly that during epileptic fits, it is mandatory to open the mouth of the affected student in order that he does not bite his tongue, and the epileptic student may present learning difficulties if he is not receiving adequate therapy. Additionally, misconceptions on the first aid of epilepsy and improper, harmful measures were reported in other similar oversea studies [11,12]. In Pakistan [13], most frequently reported the firstaid measure for an epileptic child by schoolteachers was laying the child on the bed, while about one-fifth advised putting a spoon in the mouth. However, about one-third were not sure of the effectiveness of therapy of epilepsy. It has been documented that better awareness and knowledge of first aid for epileptic fits can help improving attitudes toward the affected students [14,15]. In the present study, divorced/widowed female teachers were more knowledgeable regarding epilepsy first aid compared to single and married teachers. We could not find a logic explanation for this finding. Amongst important limitations of the present study is the crosssectional design which does not allow the temporal association between cause and effect and the selfreported nature of the study tool, which is subjected to information bias. Also, conduction of the study among only female teachers could impact the generalizability of results. However, the study identified weak areas in the knowledge of teachers regarding epilepsy first aid, which could help in organizing training programs for them.

Table 3. Association between teachers` socio-demographic characteristics and epilepsy first aid knowledge.

Epilepsy first aid knowledge percentage p-value
Median IQR Mean rank
Age (years)
≤30 (n = 25) 33.3 8.3–50.0 109.10 0.314**
31–40 (n = 119) 33.3 16.7–50.0 128.19
41–50 (n = 90) 33.3 16.7–50.0 126.47
>50 (n = 13) 16.7 8.3–50.0 97.23
Marital status
Single (n = 41) 33.3 0.0–50.0 105.56 0.042**
Married (n = 182) 33.3 16.7–50.0 124.62
Divorced/widowed (n = 24) 50.0 20.8–66.7 150.83
Number of children*
None (n = 38) 41.7 16.7–66.7 111.13 0.602**
One (n = 29) 33.3 16.7–50.0 94.95
Two (n = 27) 33.3 16.7–50.0 92.85
Three (n = 28) 33.3 33.3–62.5 111.95
>Three (n = 84) 33.3 16.7–50.0 103.61
Nationality
Saudi (n = 238) 33.3 16.7–50.0 124.32 0.713*
Non-Saudi (n = 9) 33.3 25.0–41.7 115.56
Educational level
Diploma (n = 29) 33.3 0-50.0 101.34 0.180**
Bachelor (n = 201) 33.3 16.7-50.0 127.14
Post-graduate (n = 17) 33.3 8.3-58.3 125.47
Experience in teaching (years)
≤5 (n = 40) 33.3 16.7–66.7 130.33 0.336**
6–10 (n = 96) 33.3 16.7–50.0 130.85
11–15 (n = 32) 33.3 16.7–66.7 124.08
>15 (n = 79) 33.3 16.7–50.0 112.44

**Kruskal–Wallis test. Mann–Whitney test.


Conclusion

Awareness and knowledge of female elementary school teachers in Makkah city, Saudi Arabia about epilepsy first aid are not satisfactory. This is largely due to a lack of proper and effective training. Divorced/widowed teachers and those having experience with epileptic students at classes were more knowledgeable. Having trained in first aid did not improve their knowledge about epilepsy first aid.


Acknowledgment

The author would like to express my sincere thanks and deepest gratitude to Dr. Mohammed Al-Shareef, Family Medicine consultant, for his endless guidance, keen supervision, constructive criticism, and great support during the whole research work. Also, the author would like to thank all the headmasters of the involved schools for facilitating the field part of my work. Finally, great thanks to all the teachers who participated in this study for their kind cooperation.


List of Abbreviations

PWE Patient with epilepsy
SD standard deviation

Conflict of interest

The author declares that there is no conflict of interest regarding the publication of this article.


Funding

None.


Consent for publication

Informed consent was obtained from all the participants.


Ethical approval

The ethical approval for the present study includes permission from the Makkah joint program of family and community medicine, obtained from the Ministry of Education. The research reviewed by SFHM (security forces hospital program in makkah) IRB registered at the National BioMedical Ethics Committee, King Abdula ziz Cily for Science and Technology on 19/2/2019 (Registration no. HAP-02-K-052). IRB number: 0294-120219.


Author details

Maria Suliman Mohammed Aljehani1

  1. King Abdullah Medical City, Makkah, Saudi Arabia

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How to Cite this Article
Pubmed Style

Maria Suliman Mohammed Aljehani. Level of knowledge of first aid of epilepsy among female teachers of elementary schools in Makkah city, Saudi Arabia. IJMDC. 2019; 3(10): 59-64. doi:10.24911/IJMDC.51-1562256348


Web Style

Maria Suliman Mohammed Aljehani. Level of knowledge of first aid of epilepsy among female teachers of elementary schools in Makkah city, Saudi Arabia. http://www.ijmdc.com/?mno=55429 [Access: October 18, 2019]. doi:10.24911/IJMDC.51-1562256348


AMA (American Medical Association) Style

Maria Suliman Mohammed Aljehani. Level of knowledge of first aid of epilepsy among female teachers of elementary schools in Makkah city, Saudi Arabia. IJMDC. 2019; 3(10): 59-64. doi:10.24911/IJMDC.51-1562256348



Vancouver/ICMJE Style

Maria Suliman Mohammed Aljehani. Level of knowledge of first aid of epilepsy among female teachers of elementary schools in Makkah city, Saudi Arabia. IJMDC. (2019), [cited October 18, 2019]; 3(10): 59-64. doi:10.24911/IJMDC.51-1562256348



Harvard Style

Maria Suliman Mohammed Aljehani (2019) Level of knowledge of first aid of epilepsy among female teachers of elementary schools in Makkah city, Saudi Arabia. IJMDC, 3 (10), 59-64. doi:10.24911/IJMDC.51-1562256348



Turabian Style

Maria Suliman Mohammed Aljehani. 2019. Level of knowledge of first aid of epilepsy among female teachers of elementary schools in Makkah city, Saudi Arabia. International Journal of Medicine in Developing Countries, 3 (10), 59-64. doi:10.24911/IJMDC.51-1562256348



Chicago Style

Maria Suliman Mohammed Aljehani. "Level of knowledge of first aid of epilepsy among female teachers of elementary schools in Makkah city, Saudi Arabia." International Journal of Medicine in Developing Countries 3 (2019), 59-64. doi:10.24911/IJMDC.51-1562256348



MLA (The Modern Language Association) Style

Maria Suliman Mohammed Aljehani. "Level of knowledge of first aid of epilepsy among female teachers of elementary schools in Makkah city, Saudi Arabia." International Journal of Medicine in Developing Countries 3.10 (2019), 59-64. Print. doi:10.24911/IJMDC.51-1562256348



APA (American Psychological Association) Style

Maria Suliman Mohammed Aljehani (2019) Level of knowledge of first aid of epilepsy among female teachers of elementary schools in Makkah city, Saudi Arabia. International Journal of Medicine in Developing Countries, 3 (10), 59-64. doi:10.24911/IJMDC.51-1562256348