School Status and Its Associations Among Children With Epilepsy in the Republic of Guinea
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CitationFitts, Whitney. 2019. School Status and Its Associations Among Children With Epilepsy in the Republic of Guinea. Doctoral dissertation, Harvard Medical School.
AbstractBackground: In low income countries, 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.
Methods: US and African doctors performed a cross-sectional study at Ignace Deen Hospital in Conakry, Guinea in August and September of 2018. CWE were given surveys, examined by a physician, and administered the Wechsler Nonverbal Scale of Ability (WNV). Surveys included information about epilepsy history, household financial information, educational history of the child and family, and the Stigma Scale of Epilepsy (SSE). We performed four logistic regression models looking at associations between high performing (defined as going to school and having never been held back) or a low performing (defined as having either dropped out of school or been held back at least once) students. The four models each examined a different potentially modifiable variable--life time seizures, WNV score, SSE score, and household finances respectively.
Results: Of the 128 CWE (mean age 11.6, 48.4 %F), 11.7% (n=15) had never attended school, 23.3% (n=30) previously attended school and had dropped out, and 64.8% (n=83) were currently in school. Of CWE currently attending school, approximately half (46.9%, n=39) had been held back a grade level at least once, 53.0% (n=44) had never been held back. More than 100 lifetime seizures (OR=8.81; 95% 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 when controlling for potential confounders. Models examining the SSE and household wealth quintile were not significantly associated with school outcome. We subsequently modeled the number of CWE who could become “high performing” if their seizures were treated to achieve a lifetime seizure burden of <10. In our model, 38 additional CWE (33.6%) could become high functioning at school if all CWE were treated to the lowest lifetime seizure category of <10 seizures. This would bring the total percentage of the “high performing” children from 38.9% (n=44) to 72.6% (n=82).
Conclusions: School performance was negatively impacted by epilepsy in our sample. Over 10% of individuals had never attended school, over 20% had dropped out of school, and of those currently in school more than 40% had been held back at least once. Fewer lifetime seizures and poorer cognitive performance were significantly associated with school performance in CWE in Guinea. We provide evidence that seizure control may improve school performance in this low-income setting.
Citable link to this pagehttp://nrs.harvard.edu/urn-3:HUL.InstRepos:42069200