School status and its associations among children with epilepsy in the Republic of Guinea

Whitney Fitts,Nana Tassiou Rahamatou,Cisse Fode Abass,Andre C Vogel,Atakla Hugues Ghislain,Foksouna Sakadi,Qiu Hongxiang,Mohamed Lamine Conde,Amadou Talibé Baldé,Abdoul Bachir Djibo Hamani,Aissatou Kenda Bah,Pria Anand,Bryan Patenaude,Farrah J Mateen

doi:10.1016/j.yebeh.2019.05.040

Abstract

BackgroundIn low-income countries (LICs), there are multiple barriers for children with epilepsy (CWE) to attend school. We examined potentially modifiable associations with poor school performance in CWE in the West African Republic of Guinea. MethodsChildren with epilepsy of school age were recruited using public announcements and a clinical register of people with epilepsy at the Ignace Deen Hospital in Conakry in 2018. A team of Guinean and U.S. neurologists and neurologists-in-training interviewed each CWE and parent for his/her epilepsy history, household finances, educational attainment level, and perceived stigma using the Stigma Scale of Epilepsy (SSE). Each child was also tested using the Wechsler Nonverbal Scale of Ability (WNV). Low school performance was defined as either not attending school or being held back a grade level at least once. Potential predictors of low school performance were analyzed. FindingsOf 128 CWE (mean age: 11.6 years, 48.4% female), 11.7% (n = 15) never attended school, 23.3% (n = 30) dropped out, and 64.8% (n = 83) were currently enrolled. Of CWE attending school, 46.9% (n = 39) were held back a grade level. Overall, 54 children were defined as low performers (LPs) (42%). ;Greater than 100 lifetime seizures (odds ratio (OR) = 8.81; 95% confidence interval (CI) = 2.51, 37.4; p = 0.001) and lower total WNV score (OR = 0.954; 95% CI = 0.926, 0.977; p < 0.001) were significantly associated with poor school performance in separate models, when controlling for potential confounders. Given the strong relationship between seizure freedom and school performance, we estimated that 38 additional CWE (33.6%) could become high performers (HPs) if all CWE were adequately treated to achieve the lifetime seizure category of <10 seizures and could be cognitively intact again. Models examining SSE and household wealth quintile were not significantly associated with school performance. ConclusionsHigher lifetime seizures and lower WNV score were significantly associated with low school performance in CWE in Guinea. In spite of our conservative definition of high school performance (attending without failing) and risk of referral bias at an academic center where patients were allowed to self-refer, we demonstrate that seizure control in this setting could increase the number of CWE who could attend and stay in school.

Highlights

More than 90% of people with epilepsy in low income countries (LICs) are younger than 20 years old [1]
134 children in the appropriate age range presented to the Ignace Deen Hospital during the study enrollment period and received the Wechsler Nonverbal Scale of Ability (WNV) assessment by study investigators
Based upon our regression predictions, 38 additional children with epilepsy (CWE) (33.6%) could become high functioning at school if all CWE were treated to the lowest lifetime seizure category of

Summary

Introduction

More than 90% of people with epilepsy in low income countries (LICs) are younger than 20 years old [1]. Given that 80% of the epilepsy world-wide occurs in LICs[2], this means that most of the world’s epilepsy is occurring in children in these countries The reasons for such high rates of epilepsy are multifactorial and include high rates of central nervous system infections, peri-natal injuries, and other head injuries [3]. More than 90% of epilepsy occurs in people younger than 20 years old. In this population, epilepsy can negatively affect education attainment. We sought to examine modifiable associations with poor school performance in children with epilepsy (CWE) in the Republic of Guinea

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