In an endeavor to assess the effect of seizure on school absenteeism in school age children and adolescents between the ages of 7 and 18 years who were attending follow up at the PNC in Tikur Anbessa Specialized Hospital (TASH), 183 children with epilepsy were recruited. To our knowledge this study is the first of its kind in Ethiopia which is set to determine the extent of epilepsy among school aged children and to identify factors affecting school attendance among children with epilepsy. In order to design future interventions to improve school attendance, identifying the factors affecting school absenteeism in children with epilepsy is very important
In this study, school absenteeism among children aged 7-18 years at PNC follow up were 69.4%. Poor attendance is less in this study compared to the research in Brazil (88%) but higher than the study in Sera lion (50%) and a study by CDC (36%)(5, 9, 10). The differences in estimates poor school attendance could be attributed to the difference in sample size, the demographic characteristics, seizure duration, and the varying definition of poor attendance.
More children with epilepsy within the age group of 13-18 years (82%) missed school. The higher proportion of absenteeism in this age group may reflect the difficulty of coping with epilepsy among older children due to possible longer duration of the disease since onset and fear of dealing with the stigma associated with the illness.
Similar to the other studies, this study finding show that the major reason for missed school days was due to seizure (20, 22). Totally four children (3.2 %) ceased attending school in our study is fewer than reported in a study done in Serra lion which was about 20%. Education is very important for all children and especially for children with epilepsy as it could facilitate adaptive functionality and better integration in the society. Therefore, cessation of education should not an option in children with epilepsy rather allowing children to come to clinic after school after medical appointments and improved seizure control might help children decrease absenteeism.
The proportion of the two sexes in this study was similar to the proportion reported in a study that determined the incidence of epilepsy in rural central Ethiopia(11).In this study, there were statistically significant association between female sex and missed school days. More female (79%) than male (63%) children with epilepsy missed school days. Female children with epilepsy were 2.2 times more likely to miss school days than their male counterparts. In developing countries like Ethiopia where enrollment and retention of female children at school is poor, this result is expected. In addition, female children with epilepsy are at increased risk of developing depression due to the illness which could perhaps affect school attendance negatively. Our finding, however, contradicts the finding of a study that showed higher proportion of school attendance among female than male children(12). The finding of this study shows the need to reach out for female children with epilepsy even more than the male children. Stronger social support to boost the confidence and better function of children with epilepsy are required.
More number of care givers has disclosed the condition of the children to the teachers (86.9%). As teachers could support children with epilepsy, it is encouraging to know that most of the careers willingly disclose the status of the children to their teachers. Unfortunately, more number of the children whose status is known by the teachers missed school day as opposed to children whose status was not disclosed to their teacher. The preference of the teachers to let the children stay at home till their seizure is cured before coming to school can be the reason for poor attendance(7). Therefore, it is important to equip teachers with the knowledge and resources required to handle children with epilepsy to avoid more number of missing days. Furthermore, teachers and care takers could plan ways to make up for missed days of school to improve attendance of the children.
Having symptomatic seizure and longer duration of seizure identified as the independent determinants of missing school. This could be associated with the illness and potential fear of stigma associated with having the illness. Children who experienced seizure at school are less likely to miss school than those who never had seizure at school. This could perhaps be due to a good collaboration of the care takers and teachers in reassuring the children with seizure.
Greater proportions of the primary caregivers of the children were married (80.9%) and more than half of had attended high school or higher education (59.6%) and have a secured monthly income (68.2%). These characteristics of careers are expected to affect school attendance of children with epilepsy positively. Though, more proportion of children raised by parents of lower education level missed school than those raised by parents of higher education level, our findings fail to demonstrate a statistically significant association between family size, marital status of parents, socioeconomic status and educational status of parent’s with school absenteeism.
As shown in our results despite the absence of any illness the parents allowed 19.2% of their children to miss school days. Excessive fear and concerns of care takers of children with epilepsy need to be tackled through reassurance and education to improve school attendance.
In this study, though not statistically significant, children with more than one seizure per month have missed school more than those who had less frequent seizure but other studies suggest the negative impact of seizure frequency on intellectual performance resulting in low academic performance and difficulty in learning(13). Direct effect of seizure on wellness of the children and its indirect effect on cognition may both result in poor attendance among children with epilepsy (13-16).
More children who repeated grade (78.6%) missed more school days than those who never repeated their grade (61.6%). There is a statistically significant association between repeating grade and poor attendance. A possible inference from this is that repeating a grade could negatively affect school attendance. Children with epilepsy are likely to have associated learning difficulties, therefore each child learning abilities need to be assessed before commencement and during the learning process. Therefore, the schools need to identify trained personnel who could identify learning challenges of the child and who could suggest potential measures to be taken to improve progress of learning of the children with epilepsy to avoid repeating classes.