Study design and setting
An institutional based cross-sectional study was conducted from June-July, 2020, at selected central Gondar zone primary public hospitals. Central Gondar zone primary public hospitals are located in northwest Ethiopia and in this zone there are eight primary public hospitals. Among this hospitals this study was conducted at four selected hospitals which are named, ”Wogera”, ”Dembia”, ”Aykel” and “Delgi” primary hospitals.
Systematically selected adult Patients (age greater than eighty (18) years), who had been clinically diagnosed with epilepsy and those attended an out-patient department at, Dembia, Aykel, Delagi and Wogera primary hospitals were study population. Patients who were incapable to communicate and seriously sick at the time of the data collection were excluded.
The adequate sample size was calculated by using a single population proportion formula (n= (Zα/2)2p(1-p)/d2 with assumption of, 50% magnitude of anxiety since there is no study done on the magnitude and associated factors of anxiety among people with epilepsy in our country, 5% tolerable margin of error and 95% confidence interval with 10% non-response rate. Therefore a minimum 422 number of participants were required to conduct this study. A systematic random sampling method was used to select adequate number of study participants from selected hospitals during the study period. Sampling interval was determined by dividing the total study population who to follow up during the data collection period approximately 1002 by total sample size 589.The sampling fraction or k=x/y=1002/422=2.37≈2. The first study participant was selected by a lottery method from each hospital independently, and the next study participants were selected at a regular interval (every 2) individual as shown in (Figure 1).
Data collection instruments
Hospital anxiety and depression scale (HADS) were used to assess depression and anxiety. Hospital anxiety and depression scale was used and validated in Ethiopia with internal consistence of 0.78, for anxiety sub-scale 0.76, for depression sub-scale and 0.87 for the full hospital anxiety and depression scale. It is commonly used to screen anxiety and depression symptoms and it has 14 item questions which are divided into two parts, which is a 7- item sub-scale for each depression and anxiety symptoms. The items are rated on a four-point Likert scale which is ranging from 0 to 3 giving maximum and minimum score of 0 and 21 receptively. If the participants scores ≥8 for each depression and anxiety sub-scale questions were considered as the participant has anxiety and depression respectively (16) .The internal consistence by Cronbach’s alpha of hospital and depression scale in this study was 0.84,0.82,for depression and anxiety respectively.
Hazardous alcohol use was assessed by Fast Alcohol Screening Tools, which was a 4-items brief screening questionnaire. FAST (Fast Alcohol Screening Tools), was extracted from AUDIT (alcohol use disorder identification test) which used to measures hazardous alcohol use. FAST five different item questions, each item was scored from 1 to 4, whose total score was considered weather the participants has as hazardous alcohol use or not hazardous alcohol use. A mean score of ≥3 was indicated hazardous alcohol use (17) . It was utilized to think about alcohol used within the east-Africa setting, including Ethiopia (18) . FAST was illustrated with sensitivity of 91% and specificity of 93% (17) .The FAST internal consistence in Cronbach’s alpha of the current study was 0.81.
Social support was collected by Oslo-3 item of social support scale. It is 3 item questionnaires, commonly used to assess social support and it has been used in several studies. The sum score scale ranging from 3-14, which had 3 categories: poor support 3-8, moderate support 9-11 and strong support 12-14 (19) .The internal consistence ,Cronbach’s alpha of Olso-3 items in the current study was 0.85.
Perceived stigma was assessed by kilifi stigma scale (KSS) which was developed and validated in kilifi, Kenya, with high internal consistence Cronbach’s alpha of 0.91 and excellent test- retest reliability with gamma 0.92. It is a simple three-point likert scoring system scored as not at all (0), sometimes (1) and always (2). A total of score was calculated by adding of all item scores. A patient who score above 66th percentile of the data measured by kilifi stigma scale of epilepsy indicate presence of perceived stigma (20) .The Cronbach’s alpha, of kilifi stigma scale in the current study was 0.94.
Data collection procedures
Data were collected by face-to-face interviews using a semi-structured and a structured questionnaire and reviewed the patient chart by six trained bachelors of Science in psychiatric nurse by Amharic version questioners. The questionnaire was translated to Amharic language as to be understandable by all participants and translated back to English again to ensure its consistency. Training was given for data collectors about ethical principle, confidentiality, and how to interview and data management.
Data processing and analysis
The data was checked for completeness, consistency and entered to Epi-Data version 18.104.22.168 and was exported to SPSS (Statistical Package for Social Science) version 20 for analysis. Bivariate and multivariate logistic regression analysis was performed to identify factors associated with outcome variable. All variables with a p-value less than 0.20 in bivariate analysis were entered into the multivariate logistic regression analysis. A p-value of < 0.05 was considered as statistically significant, and the adjusted odds ratio (AOR) with 95% confidence interval (CI) was calculated. Goodness of model fitness was checked by using Hosmer-lemshow test.
The study was carried out under consideration of the Helsinki Declaration of medical research ethics (34). Ethical clearance for this study was obtained from an Institutional Health Research Ethics Review Committee of College of Health and Medical Sciences, Haramaya University. The permission letter was obtained from the head of neurology unit. Confidentiality (Secrecy) of the information was kept and utilized for the study reason only. Oral consents were taken from participants before real data collection began.