Prevalence and factors associated with behavioural problems in children with epilepsy attending Mulago hospital,
Kasereka Songya Josias1, Paul Bangirana2, Joseph Rujumba3
1Paediatric Resident, Department of Paediatrics and Child Health, College of Health Sciences, School of Medicine, Makerere University, Kampala, Uganda..
Insights
Behavioral problems affect over a third of children with epilepsy (CWE), with internalizing behaviors more common. High stigma and recent seizure control increase risks, while adolescence offers protection.
Area of Science:
- Pediatric Neurology
- Child Psychiatry
- Epileptology
Background:
- Epilepsy is a common neurological disorder in children.
- Behavioral problems are frequently observed in children with epilepsy (CWE).
- Understanding associated factors is crucial for effective management.
Purpose of the Study:
- To determine the prevalence of behavioral problems in CWE.
- To identify factors associated with behavioral problems in CWE.
Main Methods:
- Cross-sectional study of 300 children with epilepsy (aged 6-17) in Uganda.
- Behavioral problems assessed using the Strengths and Difficulties Questionnaire.
- Associated factors evaluated using validated scales for stigma, self-esteem, adherence, and disabilities.
Main Results:
- 36% of CWE exhibited behavioral problems, with internalizing behaviors more prevalent than externalizing.
- Co-occurring neurodevelopmental disorders or childhood disabilities significantly increased the odds of behavioral problems (cOR: 5.42).
- High stigma perception (aOR: 4.06) and being seizure-free for six months (aOR: 3.43) were associated with increased risk, while adolescence reduced risk (aOR: 0.33).
Conclusions:
- Behavioral problems are common in children with epilepsy, affecting over a third.
- Internalizing behaviors are more frequent than externalizing behaviors.
- High perceived stigma and the initial period of seizure control are key factors associated with behavioral problems in CWE.
Purpose:
To determine the prevalence of behavioural problems and the associated factors in children with epilepsy (CWE).
Methods:
This was a cross-sectional study conducted at Mulago National Referral Hospital, Kampala, Uganda, from December 2019 to May 2020. A total of 300 CWE aged 6 to 17 years were consecutively enrolled and assessed for behavioural problems using the Strengths and Difficulties Questionnaire. We obtained data on the associated factors by using pretested structured questionnaires, the Rosenberg Self-Esteem Scale, the Kilifi Stigma Scale of Epilepsy, the Morisky medication adherence scale and the Tumaini Child Health Screener for childhood disabilities. Simple logistic regression and multivariate analysis was done to determine the associated factors while adjusting for the presence of neurodevelopmental disorders and childhood disabilities.
Results:
Behavioural problems were detected in 108/300 CWE (36%) with more internalizing (28%) than externalizing (21%) behaviour scores noted. The odds of behavioural problems increased with the presence of co-morbid neurodevelopmental disorders or childhood disabilities (cOR: 5.42, p-value < 0.001). Factors associated with occurrence of behavioural problems were high stigma perception (aOR: 4.06, p-value < 0.001) and being seizure-free in the last six months (aOR: 3.43, p-value =0.031) while being an adolescent (aOR: 0.33, p=0.001) lessened the risk.
Conclusions:
Behavioural problems occur in more than a third of CWE. They are more in the internalizing domain than in the externalizing domain. Their odds increase with high perceived stigma and in the first six months of seizure control.
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