EPILEPSY IN PAKISTAN - STIGMA AND PSYCHOSOCIAL PROBLEMS - A POPULATION-BASED EPIDEMIOLOGIC-STUDY

Purpose: To assess the stigmatization and psychosocial problems of per sons with epilepsy in Pakistan. Methods.-A population-based, cross-sec tional epidemiologic study of 241 persons with epilepsy identified fro m an at-risk population of 24,130 individuals (64.7% from urban and 35 .3% from rural areas). Of these patients, 77% suffered from recurrent non-febrile generalized convulsions. Pie evaluated degree of stigmatiz ations (i.e., avoidance by friends, neighbors, and others), and the ef fect of epilepsy on other psychosocial aspects (e.g., marriage), and a lso the relationships between gender and level of education of the pat ients, and stigmatization. Results: Patients with epilepsy in Pakistan do not appear to be highly stigmatized, but their education and grade s are affected by the disorder. They have difficulty performing activi ties of daily living and find it hard to make decisions about whether to many or to have children. Women believed that they were more danger ous to others, received less help from their families, and, more frequ ently than men, encouraged others to avoid them. Women were also more likely than men to express the belief that people with epilepsy should not marry, but in fact, women more frequently married as compared men -a fact influenced by social and cultural pressures, including pressur e from family, because it is nearly always the responsibility of the p arents to arrange the marriage of a daughter. Influence of education i ndicates that people with epilepsy who have higher education, as compa red with those with less education, had fewer children, were less ofte n avoided by their classmates and neighbors, had fewer problems with p lans for education, less frequently encouraged others to avoid them, w ere more frequently married, and believed that they were more dangerou s to others. Most people believed that their conditions had a physical basis; only 3.1% attributed their epilepsy to supernatural causes. Co nclusions: Stigmatization regarding epilepsy has not been proven to be an important feature in the culture of Pakistan because none of the o bservations are statistically significant as per P-value.