Epilepsy & Behavior 133 (2022) 108764

Contents lists available at ScienceDirect

Epilepsy & Behavior

journal homepage: www.elsevier.com/locate/yebeh

Review

Public knowledge toward Epilepsy and its determinants in Ethiopia:

A systematic review and meta-analysis
Bekahegn Girma ⇑, Jemberu Nigussie, Takla Tamir, Etaferaw Bekele
Dilla University, College of Medicine and Health Science, Department of Nursing, Dilla, Ethiopia

a r t i c l e i n f o a b s t r a c t

Article history: Background: Epilepsy is a global problem that affects all countries and people of all ages. However, the
Revised 11 May 2022 disease burden is high in low- and middle-income countries. Poor public knowledge of epilepsy increases
Accepted 17 May 2022 the rate of stigma and discrimination. However, in our country, there is a scarcity of summarized evi-
Available online 8 June 2022
dence about the level of public knowledge toward epilepsy. Therefore, to fill this gap, conducting this
review and meta-analysis has a preponderant significance.
Keywords: Methods: Articles were explored from PubMed, PsycINFO, Hinari, Science Direct, web of science, and
Knowledge
African journal of online (AJOL) databases, Google, and Google scholar. For data extraction and analysis
Determinants
Epilepsy
purposes, Microsoft Excel spreadsheet and STATA software version 16 were used. To write this report,
Ethiopia we used the Preferred Reporting Items for systematic reviews and Meta-Analysis. To assess the
pooled magnitude of public knowledge toward epilepsy, we used a random-effects meta-analysis model.
We checked the Heterogeneity by I2. To detect publication bias, Begg’s test, Egger’s test, and funnel plot
were conducted. Furthermore, subgroup analysis was conducted. Association was expressed through a
pooled odds ratio with a 95% confidence interval.
Result: Our review and meta-analysis included 9 studies with 5658 participants. The pooled magnitude
of poor knowledge toward epilepsy was 48.54% [95% CI (33.57, 63.51)]. I2 was 99.4% (P < 0.01). Begg’s and
Egger’s test results were 0.92 and 0.06, respectively. Cannot read and write OR: 2.86 [95 CI (2.04, 4.00])
and not witnessing seizure episode OR: 3.00 [95% CI (2.46, 3.66)]) were significant determinants of poor
knowledge.
Conclusion: In this review and meta-analysis, around half of the participants had poor knowledge about
epilepsy. Individuals who cannot read and write, and could not witness seizure episodes had more likely
to have poor knowledge toward epilepsy as compared to their counterparts. Health education through
different methods should be provided to the public, and our educational system should focus on this glo-
bal problem. Furthermore, it is better to give training for community key informants.
Ó 2022 Elsevier Inc. All rights reserved.

1. Background
Epilepsy is a chronic disease of the central nervous system char-
acterized by two or more seizure episodes [1]. Despite the decrease
in disease burden from 1990 to 2016, globally, there are 45.9 mil-
lion people with epilepsy. In 2016, epilepsy accounted for more
than 13 million DALYs; 0.56% of total DALYs [2]. Approximately
80% of people with epilepsy live in low- and middle-income coun-
tries, where the disease remains a major public health problem,
Abbreviations: AJOL, African journal online; CI, confidence interval; OR, odds
ratio; SNNP, South nations and nationalities people; USA, United States of America;
WHO, World Health Organization.
⇑ Corresponding author.
E-mail address: Bekahegng@du.edu.et (B. Girma).
not only because of its health implications but also for its social,
cultural, psychological, and economic effects [3–5]. In developing
countries, the prevalence of epilepsy ranges from 5 to 10 per
1,000 people; it is more prevalent in rural communities [6,7].
The incidence of epilepsy is high in less developed countries as
compared to developed countries [8]. The prevalence of epilepsy in
developing countries varies from 0.5 to 1%; it is more prevalent in
rural communities [8,9]. In sub-Saharan Africa, the prevalence of
epilepsy is 9
39 per 1000 [9]. In Ethiopia, it is 64 per 100,000 [7].
Congenital infections, degenerative brain diseases, tumors,
cerebral hypoxia, brain injury, and stroke are the common causa-
tive agents of epilepsy [10–13]. Epilepsy is a culturally unrecog-
nized disorder [14,15]. Patients with epilepsy and their families

https://doi.org/10.1016/j.yebeh.2022.108764
1525-5050/Ó 2022 Elsevier Inc. All rights reserved.
B. Girma, J. Nigussie, T. Tamir et al. Epilepsy & Behavior 133 (2022) 108764

have suffered from isolation from society and deprivation of treat- 2.4. Exclusion criteria
ment, leading to frequent injuries and death [16].
Epilepsy is poorly understood by the public and deficiency of Studies that did not report the overall magnitude of public
public knowledge leads to negative attitudes, beliefs, stigma, poor knowledge toward epilepsy were excluded from this review and
quality of life, and discrimination [4,17,18]. Due to poor public meta-analysis.
knowledge toward epilepsy, mostly patients with epilepsy become
discriminated against and stigmatized. As a result, an individual
2.5. Outcome measures
with epilepsy drops out of school, loses his or her job, and finds
it difficult to make friends [19,20].
Two objectives were assessed in this review and meta-analysis.
The global magnitude of poor knowledge toward epilepsy
The first was to assess the pooled overall magnitude of public
ranges from 40 to 86% [16,21]. Even though most of the African
knowledge toward epilepsy in Ethiopia and it was calculated by
countries are developing, ,there is variation in the public knowl-
dividing the number of persons who had poor knowledge for epi-
edge toward epilepsy [22,23]. In Ethiopia, it varies from 27 to
lepsy by the total number of individuals included in this review
86.8% [16,24].
and meta-analysis and multiplied by 100. The second objective
Due to this disparity, summarized evidence is necessary.
was to assess the determinants of public knowledge toward epi-
Assessing the public knowledge toward epilepsy is the first mea-
lepsy in Ethiopia. In this review and meta-analysis, factors identi-
sure for assuaging stigma and discrimination [5]. The finding will
fied as determinants of public knowledge in at least two studies
help policymakers, district health teams, community members,
were considered for meta-analysis. To express the pooled effect,
affected families, and people with epilepsy. Therefore, this review
odds ratio (OR) was used [26].
aimed to assess the pooled magnitude of public knowledge toward
epilepsy and its determinants in Ethiopia.
2.6. Quality assessment and data extraction

To assess the quality of studies, Newcastle Ottawa Scale was

2. Methods
2.1. Searching strategy
The Preferred Reporting Items for Systematic reviews and Meta-
Analysis (PRISMA) guidelines were used to write this review and
meta-analysis [25]. The existence of related reviews was checked
through online searching on the review registration database.
PubMed, PsycINFO, Hinari, Science Direct, web of science and Afri-
can journal of online (AJOL) databases were examined for primary
studies related to our title. Moreover, from Google and Google
Scholar gray kinds of literature were retrieved. Furthermore, the
reference lists of the published articles were searched to recognize
other relevant articles that did not show in the above database.
Our searching domain was limited to studies conducted on
humans between 2010 and 2021 and had full English version arti-
cles. Examining of primary articles was started on March 1, 2021
and ended on June 27, 2021. We used ‘‘public OR community
AND knowledge AND Epilepsy AND Ethiopia” for objective one
and ‘‘Determinants OR factors OR predictors AND knowledge
AND Epilepsy AND Ethiopia for the second objective as keywords
for searching. In this systematic review and meta-analysis, we
searched both published and unpublished articles. To succeed cita-
tions and to check the duplication of articles, Endnote version X6
was used.
2.2. Eligibility criteria
BG and JN independently executed eligibility assessments in an
unblinded identical manner based on the stated inclusion and
exclusion criteria. We solved the disagreements by consensus.
2.3. Inclusion criteria
Observational studies conducted between 2010 and 2020 in
Ethiopia on the general population and published in English were
included. Furthermore, articles reporting the magnitude of public
knowledge toward epilepsy in proportion were included. Unpub-
lished and published full articles describing the magnitude and/
or determinant factors were considered.
2
used [27]. BG and JN evaluated the studies independently using
the above tool. During evaluation of studies, selection criteria,
comparability, and ascertainment of the outcome of the studies
were considered. The tool comprehended 10 criteria for the assess-
ment of different quality elements, and studies scored 6 and above
out of 10 were included in this review and meta-analysis.
During quality assessment, any incongruities were solved
through discussion and by taking the average results of the two
evaluators. Using a standardized Microsoft Excel independently,
BG and JN extracted all necessary data. Two data extraction for-
mats were used. The first data extraction format that was orga-
nized for the objective one (proportion of public knowledge)
comprised author name, publication year, region, study design,
sampling technique, sample size, response rate, quality score, and
proportion of knowledge. We used two-by-two tables to extract
data for objective two (determinants of poor knowledge). During
data extraction time, any disagreements between us were deci-
phered through discussion and by two-fold scrutiny of the varying
data.
2.7. Publication bias and heterogeneity
In this review and meta-analysis, Begg’s test, Egger’s statistical
test [28], and funnel plots [29] were conducted to check publica-
tion bias. A p-value of <0.05 was used to declare the occurrence
of publication bias. I2 test was done to assess heterogeneity
between studies and declared as low, moderate, and high hetero-
geneity if it is <50%, 50–75%, and >75%, respectively [30].
2.8. Statistical methods and analysis
After extraction, data were exported to STATA version 16 for
analysis. To calculate the standard error of proportion for each
original article, a binomial distribution formula was used. We used
a random-effect model for analysis due to high heterogeneity
between the included studies [31]. To check the source of hetero-
geneity, subgroup analysis was conducted [32–34]. In this review
and meta-analysis, for objective two, the effect of the selected
determinants was examined. To display the findings of this sys-
tematic review and meta-analysis, we used texts, tables, forest
plots, and OR with 95% confidence intervals (CI).
B. Girma, J. Nigussie, T. Tamir et al.
3. Result
3.1. Study search and selection
When searching primary articles, our domain was limited to
full-text articles, published in English and conducted on human
beings from 2010 up to 2021. A total of 736 articles were scruti-
nized from PubMed, HINARI, PsycInfo, AJOL and science direct
databases, Google, and Google scholar. From the total of studies,
501 and 221 articles were excluded due to duplication and dissim-
ilar to our study, respectively. Only 14 articles were selected for
full reading and 5 were excluded because their overall outcome
was not reported [5,35–38]. At last, a total of 9 studies that fulfilled
our inclusion criteria were selected for this review and meta-
analysis [5,16,24,39–44] (Fig. 1).
3.2. Characteristics of the included studies
A total of 9 studies with 5658 participants were included in our
review and meta-analysis. Above half of the included studies
(55.5%) were conducted in the Amhara region and except for one
study, almost all were conducted in the past five years. All included
studies were cross-sectional in design and out of which seven
(77.8%) were community-based. Regarding sampling, four (44.4%)
studies were used for multistage sampling. Using Newcastle
Ottawa Scale, five (55.6%) studies scored nine out of ten. The
Fig. 1. Flow diagram of studies included in the review of public knowledge toward epilepsy in Ethiopia, 2021.
3
Epilepsy & Behavior 133 (2022) 108764
response rates of the included primary articles were above 95%
except for one study. Lastly, the minimum magnitude of poor
knowledge was 27% and the maximum was 86.8% (Table 1).
3.3. Meta-analysis
The pooled magnitude of poor knowledge toward epilepsy in
Ethiopia was 48.54% [95% CI (33.57, 63.51)]. The heterogeneity
(I2) among included studies was 99.4% (P < 0.01) [Fig. 2].To assess
publication bias, the objective tests Begg’s and Egger’s reported
insignificant p-values of 0.92 and 0.06, respectively. We have no
evidence of publication bias.
To detect the source of heterogeneity, subgroup analysis was
done. As shown in Table 2, the subgroup analysis showed high
heterogeneity between studies done in South nation nationalities
and people (SNNP) 56.9[95% CI (1.69,115.5)] (I2 = 99.9%, P < 0.01)
[16,24], systematic sampling 58.3 [95%CI (26.9, 89.7)] (I2 = 99.6%,
P < 0.01) [16,42,43] and conducted at community level 58.8 [95%
CI (30.0, 68.6)] (I2 = 99.5%, P < 0.01) [16,24,41–45].
3.4. Determinants of poor knowledge toward epilepsy
Determinants related to poor knowledge toward epilepsy in at
least two studies were selected for meta-analysis. Four determi-
nants, educational status, residency, hear about epilepsy, and wit-
nessed seizure episodes, were included in this review and meta-
B. Girma, J. Nigussie, T. Tamir et al. Epilepsy & Behavior 133 (2022) 108764

Table 1
Characteristics of the included primary articles for public knowledge toward epilepsy in Ethiopia, 2021(n = 9).

Author Publication year Region Design Sampling Quality score (10%) Response rate Magnitude (%)
Molla A et al 2021 SNNP CBCS Multi stage 9 97 27
Berhe T et al 2017 AA IBCS Cluster 10 94 32.3
Tirukelem H et al 2021 Amhara CBCS Systematic 9 98.8 44.5
Henok A et al 2017 SNNP CBCS Systematic 8 99.3 86.8
Dargie A et al 2020 Amhara CBCS Systematic 9 98 43.6
Asnakew S et al 2021 Amhara CBCS Multi stage 10 96.1 66.2
Zeleke H et al 2018 Amhara CBCS Multi stage 9 94.6 47.5
Teferi J et al 2015 Oromia CBCS Multi stage 9 96.8 40.2
Oumer et al 2020 Amhara IBCS Cluster 10 97.8 48.2

Hint: AA: - Addis Ababa; SNNP: South nation and nationalities People; IBCS: Institutional based cross-sectional study; CBCS: Community based cross-sectional study.

Study

ID ES (95% CI)

Molla A et al (2021) 27.00 (23.78, 30.22)

Berhe T et al (2017) 32.30 (24.17, 40.43)

Tirukelem H et al (2021) 44.50 (40.95, 48.05)

Henok A et al (2017) 86.80 (84.51, 89.09)

Dargie A et al (2020) 43.60 (39.62, 47.58)

Asnakew S et al (2021) 66.20 (62.88, 69.52)

Zeleke H et al (2018) 47.50 (43.50, 51.50)

Teferi J et al (2015) 40.20 (36.46, 43.94)

Oumer et al (2020) 48.20 (44.09, 52.31)

Overall (I-squared = 99.4%, p ≤0.01 48.54 (33.57, 63.51)

NOTE: Weights are from random effects analysis

0 10 20

Fig. 2. Forest plot for public knowledge toward epilepsy in Ethiopia, 2021 (n = 9).

Table 2
Subgroup analysis of the included studies for public knowledge toward epilepsy in Ethiopia, 2021 (n = 9).

Variable Groups Number of studies Heterogeneity Pooled magnitude (95% CI)

I2 (%) P value
Region Amhara 5 96.4 P < 0.01 50.0 (41.1, 58.9)
SNNP 2 99.9 P < 0.01 56.9 (1.69,115.5)
AA 1 - - 32.3 (24.2, 40.4)
Oromia 1 - - 40.2 (36.5, 43.9)
Sampling technique Multistage 4 98.9 P < 0.01 45.2 (27.9, 62.5)
Systematic 3 99.6 P < 0.01 58.3 (26.9, 89.7)
Cluster 2 99.1 P < 0.01 36.5 (23.8, 52.3)
Study design Institution based CSS 2 91.5 P < 0.01 40.6 (25.0, 56.2)
Community based CSS 7 99.5 P < 0.01 58.8 (30.0, 68.6)
Overall pooled magnitude 9 99.4 P < 0.01 48.5% (33.6, 63.5)

4
B. Girma, J. Nigussie, T. Tamir et al.
Table 3
Meta-analysis of determinants for public knowledge toward epilepsy in Ethiopia,
2021.
Variables No of OR with 95% CI Heterogeneity
studies I2
Residency 4 1.52 [0.91, 2.52] 88.7%
Educational status 4 2.86 [2.04, 4.00] * 70.3%
Witnessing seizure episode 3 3.00 [2.46, 3.66] * 0%
Heard about epilepsy 2 0.57 [0.01, 22.25] 98.5%
*= significant determinants.
analysis. However, the two determinants’ educational status and
witnessing seizure episodes were significantly related to poor
knowledge toward epilepsy.
Participants who cannot read and write were 2.8 (OR: 2.86 [95
CI (2.04, 4.00)]) times more likely to have poor knowledge of epi-
lepsy as compared to their counterparts. Individuals who cannot
witness seizure episodes were 3 (OR: 3.00 [95% CI (2.46, 3.66)])
times more likely to have poor knowledge toward epilepsy as com-
pared to their comparison groups (Table 3).
4. Discussion
Despite epilepsy being one of the most common neurological
disorders, our review and meta-analysis showed that 48.5% of
the community had poor knowledge of epilepsy. Educational status
and witnessing seizure episodes were significantly related to poor
public knowledge.
The pooled magnitude of poor knowledge was comparable with
studies done in Uganda [10], Nigeria, and Sudan [46,47]. However,
the level of knowledge toward epilepsy was low as compared to
studies conducted in USA [21], Italy [48], Cameroon [22], Sudan
[49], South Korea [50], Egypt [51], Brazil [52], Pakistan [53],
WHO report [54], and Thailand [55]. This might be due to sociocul-
tural, study population, study setting, and sample size variations.
The level of knowledge was good as compared with a review con-
ducted in 36 countries [56] and with a study conducted in Nigeria
[23]. The discrepancy might be because of methodological differ-
ences and the study period.
In this review and meta-analysis, participants who could not
read and write were more likely to have poor knowledge as com-
pared to their counterparts. This finding was buttressed by a sys-
tematic review done in different countries [57] and with studies
done in Nigeria [58], Ghana [59], and Sudan [60]. This might be
due to the fact that education affects the ability to comprehend
and recognize epilepsy.
Individuals who could not witness seizure episodes were more
likely to have poor knowledge as compared to their opposite
groups. This result was supported by studies conducted in Brazil
[61] and Saudi Arabia [62]. This similarity might be due to the fact
that witnessing the seizure episode may trigger individuals to ask/
read about epilepsy, which lets them have good knowledge.
It was difficult to detect a temporal relationship between the
outcome and independent variables due to the cross-sectional nat-
ure of the included studies. High heterogeneity between the
included studies was another limitation. Lastly, the evidence might
not be generalized to other countries in the world.
5. Conclusion
In this review and meta-analysis, around half of the participants
had poor knowledge of epilepsy. Educational level and witnessing
seizure episodes were significantly related to poor knowledge of
epilepsy. To increase the level of public knowledge toward epi-
Epilepsy & Behavior 133 (2022) 108764
lepsy, health education should be provided through different pro-
grams including the incorporation of the issue in our country’s
educational system. Furthermore, since most of our population
lives in rural areas, provision of training for key informants might
P-value be necessary.
<0.01
0.02 Ethical approval and consent for participation
0.61
<0.01
Not applicable.
Consent for publication
Not applicable.
Availability of data and materials
The data included in this study are available and can be
accessed by contacting the corresponding author.
Funding
Not applicable.
Authors’ contributions
BG, JN, TT, and EB conceived the idea, participated in data
extraction, analysis, manuscript preparation, and revision. All
authors read and approved the final version of the manuscript to
be considered for publication.
Declaration of Competing Interest
The authors declare that they have no known competing finan-
cial interests or personal relationships that could have appeared
to influence the work reported in this paper.
Acknowledgement
None.
Appendix A. Supplementary data
Supplementary data to this article can be found online at
https://doi.org/10.1016/j.yebeh.2022.108764.
References
[1] Neligan A, Hauser WA, Sander JW. The epidemiology of the epilepsies.
Handbook Clin Neurol 2012;107:113–33.
[2] Beghi E, Giussani G, Nichols E, Abd-Allah F, Abdela J, Abdelalim A, et al. Global,
regional, and national burden of epilepsy, 1990–2016: a systematic analysis
for the Global Burden of Disease Study 2016. Lancet Neurol 2019;18
(4):357–75.
[3] Harden CL, Maroof DA, Nikolov B, Fowler K, Sperling M, Liporace J, et al. The
effect of seizure severity on quality of life in epilepsy. Epilepsy Behav 2007;11
(2):208–11.
[4] Yemadje LP, Houinato D, Quet F, Druet-Cabanac M, Preux PM. Understanding
the differences in prevalence of epilepsy in tropical regions. Epilepsia 2011;52
(8):1376–81.
[5] Gedefa M, Wolde T, Solomon G. Knowledge, attitudes and practices with
respect to epilepsy among preparatory school students in Mekelle city,
Ethiopia. Int J Collab Res Internal Med Public Health 2012;4(3).
[6] Sander JW. The epidemiology of epilepsy revisited. Curr Opin Neurol 2003;16
(2):165–70.
[7] Duncan JS, Sander JW, Sisodiya SM, Walker MC. Adult epilepsy. Lancet
2006;367(9516):1087–100.
[8] Ngugi AK, Kariuki S, Bottomley C, Kleinschmidt I, Sander J, Newton C. Incidence
of epilepsy: a systematic review and meta-analysis. Neurology 2011;77
(10):1005–12.
5
B. Girma, J. Nigussie, T. Tamir et al.
[9] Ba-Diop A, Marin B, Druet-Cabanac M, Ngoungou EB, Newton CR, Preux P-M.
Epidemiology, causes, and treatment of epilepsy in sub-Saharan Africa. Lancet
Neurol 2014;13(10):1029–44.
[10] Kiwanuka F, Anyango Olyet C. Knowledge, attitude, and beliefs on epilepsy
among adults in Erute South, Lira District, Uganda. Epilepsia Open 2018;3
(2):264–9.
[11] Newton CR, Garcia HH. Epilepsy in poor regions of the world. Lancet 2012;380
(9848):1193–201.
[12] Lee S-A, Yoo H-J, Lee B-I. Group KQiES: factors contributing to the stigma of
epilepsy. Seizure 2005;14(3):157–63.
[13] Fehintola FO, Olowookere SA, Adegbenro CA, Afolabi TO, Oladapo V, Oladimeji
AO, et al. Knowledge of and attitude towards epilepsy among women in Ile-Ife,
Nigeria. Sudan J Med Sci 2019;14(1):31–44.
[14] Wiebe S, Eliasziw M, Bellhouse DR, Fallahay C. Burden of epilepsy: the Ontario
health survey. Can J Neurol Sci 1999;26(4):263–70.
[15] Lawal M, Omobayo H, Lawal K. Epilepsy: pathophysiology, clinical
manifestations and treatment options. Br J Neurosci Nurs 2018;14(2):58–72.
[16] Henok A, Lamaro T. Knowledge about and attitude towards epilepsy among
Menit Community, Southwest Ethiopia. Ethiopian J Health Sci 2017;27
(1):47–58.
[17] Brodie M. The history and stigma of epilepsy. Epilepsia 2003;44(Suppl
6):12–4.
[18] Westphal-Guitti AC, Alonso NB, Migliorini RCVP, da Silva TI, Azevedo AM,
Caboclo LOSF, et al. Quality of life and burden in caregivers of patients with
epilepsy. J Neurosci Nurs 2007;39(6):354–60.
[19] Aldenkamp AP, Krom MD, Reijs R. Newer antiepileptic drugs and cognitive
issues. Epilepsia 2003;44:21–9.
[20] Mangena-Netshikweta M. Perceptions about epilepsy in the Limpopo Province
of the Republic of South Africa. Curationis 2003;26(4):51–6.
[21] Kobau R, Price P. Knowledge of epilepsy and familiarity with this disorder in
the US population: results from the 2002 HealthStyles Survey. Epilepsia
2003;44(11):1449–54.
[22] Njamnshi AK, Angwafor SA, Tabah EN, Jallon P, Muna WF. General public
knowledge, attitudes, and practices with respect to epilepsy in the Batibo
Health District, Cameroon. Epilepsy Behav 2009;14(1):83–8.
[23] Owolabi LF, Shehu NM, Owolabi SD. Epilepsy and education in developing
countries: a survey of school teachers’ knowledge about epilepsy and their
attitude towards students with epilepsy in Northwestern Nigeria. Pan Afri Med
J 2014;18.
[24] Molla A, Mekuriaw B, Habtamu E, Mareg M. Knowledge and attitude towards
epilepsy among rural residents in southern Ethiopia: a cross-sectional study.
BMC Public Health 2021;21(1):1–9.
[25] Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for
systematic reviews and meta-analyses: the PRISMA statement. Ann Int Med
2009;151(4):264–9. w264.
[26] Girma B, Nigussie J, Molla A, Mareg M. Under nutrition and associated factors
among lactating mothers in Ethiopia: a systematic review and meta-analysis.
2020.
[27] Peterson J, Welch V, Losos M, Tugwell P. The Newcastle-Ottawa scale (NOS) for
assessing the quality of nonrandomised studies in meta-
analyses. Ottawa: Ottawa Hospital Research Institute; 2011.
[28] Egger M, Smith GD, Schneider M, Minder C. Bias in meta-analysis detected by a
simple, graphical test. BMJ 1997;315(7109):629–34.
[29] Sterne JA, Egger M. Funnel plots for detecting bias in meta-analysis: guidelines
on choice of axis. J Clin Epidemiol 2001;54(10):1046–55.
[30] Higgins JP, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in
meta-analyses. BMJ 2003;327(7414):557–60.
[31] Borenstein M, Hedges LV, Higgins JP, Rothstein HR. Fixed-effect versus
random-effects models. Introduction Meta-analysis 2009;77:85.
[32] Patsopoulos NA, Evangelou E, Ioannidis JP. Sensitivity of between-study
heterogeneity in meta-analysis: proposed metrics and empirical evaluation.
Int J Epidemiol 2008;37(5):1148–57.
[33] Bown MJ, Sutton AJ. Quality control in systematic reviews and meta-analyses.
Eur J Vasc Endovasc Surg 2010;40(5):669–77.
[34] Marušić MF, Fidahić M, Cepeha CM, Farcaș LG, Tseke A, Puljak L.
Methodological tools and sensitivity analysis for assessing quality or risk of
bias used in systematic reviews published in the high-impact anesthesiology
journals. BMC Med Res Method 2020;20(1):121.
[35] Gugssa SA, Haidar J. Knowledge, attitude, and practice towards epilepsy
among religious cleric and traditional healers of Addis Ababa, Ethiopia. Seizure
2020;78:57–62.
[36] Fekadu W, Mekonen T, Bitew S, Mekonnen TC, Menberu M, Shewangizaw S.
Community’s perception and attitude towards people with epilepsy in
ethiopia. Behav Neurol 2019;2019.
[37] Deresse B, Shaweno D. General public knowledge, attitudes, and practices
towards persons with epilepsy in South Ethiopia: a comparative community-
based cross-sectional study. Epilepsy Behav 2016;58:106–10.
Epilepsy & Behavior 133 (2022) 108764
[38] Murugan P, Workineh T. Knowledge and beliefs of the general public towards
epilepsy and the discriminations of people with epilepsy in Ethiopia. Italian
Sociol Rev 2020;10(1):1–116.
[39] Berhe T, Yihun B, Abebe E, Abera H. Knowledge, attitude, and practice about
epilepsy among teachers at Ethio-National School, Addis Ababa, Ethiopia.
Epilepsy Behav 2017;70:150–3.
[40] Oumer M, Girma A, Ayeligne A. Epilepsy knowledge, attitude, practice, and
associated factors among primary, secondary, and preparatory schoolteachers
in Lay-Armachiho District, Northwest Ethiopia. Epilepsy Behav
2020;112:107387.
[41] Teferi J, Shewangizaw Z. Assessment of knowledge, attitude, and practice
related to epilepsy: a community-based study. Neuropsychiatr Dis Treat
2015;11:1239.
[42] Tirukelem H, Nigatu SG, Angaw DA, Azale T. Community attitude towards
epilepsy patients and associated factors in South Achefer District, Northwest
Ethiopia: a mixed-methods study. Neuropsychiatr Dis Treat 2021;17:365.
[43] Wubetu AD, Admasu Basha E, Alemnew Engidaw N. Public knowledge and
attitude towards epilepsy and its associated factors: community-based cross-
sectional study, Ethiopia, 2019. J Environ Public Health 2020;2020.
[44] Zeleke H, Gualu T, Sharew Y, Alem G. Knowledge, practice and attitude
towards epilepsy and associated factors among adults in Goncha Siso Enesie
Woreda Rural Kebeles, East Gojjam, Ethiopia 2016. Epilepsy J 2018, 4
(1000126):2472-0895.1000126.
[45] Asnakew S, Legas G, Belete A, Admasu FT, Demilie K, Bayih WA, et al.
Knowledge and attitude of the community towards epilepsy in Northwest
Ethiopia: a huge gap on knowledge and attitude of the community. Epilepsy
Behav Rep 2021;15:100422.
[46] Ezeala-Adikaibe BA, Achor JU, Nwabueze AC, Agomoh AO, Chikani M, Ekenze
OS, et al. Knowledge, attitude and practice of epilepsy among community
residents in Enugu, South East Nigeria. Seizure 2014;23(10):882–8.
[47] Jack-Ide IO, Maliki AE, Onasoga O. Community members’ perception of
epilepsy and their attitude towards persons living with epilepsy disorders in
a rural community of Bayelsa State, Nigeria. Int Neuropsych Dis J 2015:161–7.
[48] Mecarelli O, Capovilla G, Romeo A, Rubboli G, Tinuper P, Beghi E. Past and
present public knowledge and attitudes toward epilepsy in Italy. Epilepsy
Behav 2010;18(1–2):110–5.
[49] Elhassan MA, Alemairy AA, Amara ZM, Hamadelneel AA, Mohamed AH,
Elaimeri AA. Epilepsy: knowledge, attitude, and practice among secondary
school teachers in Khartoum State. Neurol Ther 2017;6(2):225–35.
[50] Yoo J-K, Jung K-Y, Park K-W, Lee D-H, Lee SK, Lee IK, et al. Familiarity with,
understanding of, and attitudes toward epilepsy among people with epilepsy
and healthy controls in South Korea. Epilepsy Behav 2009;16(2):260–7.
[51] Shehata GA, Mahran DG. Knowledge, attitude and practice with respect to
epilepsy among school teachers in Assiut city, Egypt. Epilepsy Res 2010;92(2–
3):191–200.
[52] Dantas FG, Cariri GA, Cariri GA, Ribeiro Filho ARV. Knowledge and attitudes
toward epilepsy among primary, secondary and tertiary level teachers. Arq
Neuropsiquiatr 2001;59:712–6.
[53] Shafiq M, Tanwir M, Tariq A, Kasi P, Zafar M, Saleem A, et al. Epilepsy: public
knowledge and attitude in a slum area of Karachi, Pakistan. Seizure 2007;16
(4):330–7.
[54] Ndoye N, Sow A, Diop A, Sessouma B, Sene-Diouf F, Boissy L, et al. Prevalence of
epilepsy its treatment gap and knowledge, attitude and practice of its
population in sub-urban Senegal an ILAE/IBE/WHO study. Seizure 2005;14
(2):106–11.
[55] Saengsuwan J, Boonyaleepan S, Srijakkot J, Sawanyawisuth K, Arunpongpaisal
S, Chaiyakum A, et al. Public perception of epilepsy: a survey from the rural
population in Northeastern Thailand. J Neurosci Behav Health 2009;1
(1):006–11.
[56] Lua P, Neni S. Awareness, knowledge and attitudes towards epilepsy: a review
of a decade’s research between 200 and 2010. Afr J Neurol Sciences 2011;30
(1).
[57] Hasan SS, Allen Y, Wayne W, Ahmadi K, Anwar M, Goh G. Understanding of
and attitudes toward epilepsy among the urban Chinese population in
Malaysia. Singapore Med J 2010;51(4):290.
[58] Kabir M, Iliyasu Z, Abubakar I, Kabir Z, Farinyaro A. Knowledge, attitude and
beliefs about epilepsy among adults in a northern Nigerian urban community.
Ann Afr Med 2005;4(3):107–12.
[59] Nyame P, Biritwum R. Epilepsy: knowledge, attitude and practice in literate
urban population, Accra, Ghana. West Afr J Med 1997;16(3):139–45.
[60] Osama A, El Smahy MAEF, Moawad S. Public attitudes and knowledge toward
epilepsy in Ismailia governorate. Egypt J Psych 2016;37(2):104.
[61] Fernandes PT, Noronha AL, Araújo U, Cabral P, Pataro R, De Boer HM, et al.
Teachers perception about epilepsy. Arq Neuropsiquiatr 2007;65:28–34.
[62] Al-Dossari KK, Al-Ghamdi S, Al-Zahrani J, Abdulmajeed I, Alotaibi M, Almutairi
H, et al. Public knowledge awareness and attitudes toward epilepsy in Al-Kharj
Governorate Saudi Arabia. J Family Med Primary Care 2018;7(1):184.