Prevalence, knowledge, attitude, and practice of epilepsy in Kerala, SouthIndia

Purpose: To ascertain the prevalence and pattern of epilepsy and to charact erize and quantify knowledge, attitude, and practice (KAP) toward epilepsy among the people of the state of Kerala, which is distinguished from the re st of India by a high level of literacy and health awareness of its populat ion. Methods: We conducted a door-to-door survey covering the entire population of 238,102 people residing in 43,681 households in a semiurban area of cent ral Kerala. The screening questionnaire administered by medical social work ers had a sensitivity of 100% for identifying persons with epilepsy. Neurol ogists examined all the individuals suspected or having epilepsy. We evalua ted KAP toward epilepsy among 1,118 subjects (439 males and 679 females; me an age, 33.3 years; age range, 15-85 years) from households without epileps y in the study area. Results: Through a three-phased survey, we ascertained 1,175 cases (616 mal es acid 559 females) with active epilepsy, providing a crude point prevalen ce ratio of 4.9 cases per 1,000 people and an age-adjusted prevalence ratio of 4.7 cases per 1,000 population. The highest age-specific prevalence rat e of 6.5 per 1,000 occurred in the 10- to 19-year-old age group. Sex-specif ic prevalence rates did not significantly differ. The proportion of general ized and localization-related epilepsies was 58.8% and 30.6%, respectively. Ninety-nine percent of the KAP respondents had read or heard about epileps y. Thirty-one percent and 27% thought epilepsy was a hereditary disorder an d a form of insanity, respectively. About 40% of the respondents felt that individuals with epilepsy could not be properly educated or employed. Eleve n percent would object to their children having contact with epileptic chil dren. Conclusions: The prevalence and pattern of epilepsy in central Kerala, Sout h India, do not differ from that of developed countries. Although the aware ness of epilepsy among the people of Kerala was comparable to that of devel oped countries, the attitudes were much more negative. The need for educati ng the people of Kerala on epilepsy and for incorporating an adequate knowl edge of epilepsy in the school curricula cannot be overemphasized.