Pluralistic and singular causal attributions for epilepsy in Uganda

• Published in: Epilepsy & behavior 2021-01, Vol.114 (Pt B), p.107334-107334, Article 107334
• Main Authors: Smith, Caleigh E., Kajumba, Mayanja, Bobholz, Samuel, Smith, Patrick J., Kaddumukasa, Mark, Kakooza-Mwesige, Angelina, Chakraborty, Payal, Sinha, Drishti D., Kaddumukasa, Martin N., Gualtieri, Alex, Nakasujja, Noeline, Onuoha, Erica, Nakku, Juliet, Muhumuza, Christine, Sanchez, Nadine, Fuller, Anthony T., Haglund, Michael M., Koltai, Deborah C.
• Format: Article
• Language: English
• Subjects: Causality; Causes; Epilepsy; Epilepsy - epidemiology; Epilepsy - etiology; Humans; Patient Acceptance of Health Care; Pluralism; Social Stigma; Uganda; Uganda - epidemiology
• ISSN: 1525-5050; 1525-5069
• DOI: 10.1016/j.yebeh.2020.107334

In Uganda, causal attributions for epilepsy reflect a variety of beliefs and impact care-seeking behavior, perpetuate stigma, and undermine the effectiveness of interventions to narrow the epilepsy treatment gap. The objective of this study was to characterize beliefs about seizure etiology to gain a better understanding of how epilepsy is conceptualized in the community in order to inform culturally appropriate educational policies and interventions. In a community-based study, 15,383 participants were surveyed about beliefs related to 15 potential causes for epilepsy. Principal axis factor analysis (PFA) was performed to identify causative factors and then utilized to classify singular versus pluralistic belief systems related to epilepsy etiology. Analysis of variance (ANOVA) and Mann–Whitney U-tests were conducted to examine the differences in background characteristics across the etiology belief groups. Three main causative factors emerged from the PFA: biological, sociospiritual, and biospiritual. Among those endorsing at least one factor (n = 13,036), the biological factor was endorsed most frequently as a potential cause for epilepsy (88.0%), followed by the sociospiritual (63.4%), then biospiritual (47.6%). Review of the patterns of endorsement found that only 22.2% endorsed the biological factor alone, 6.7% the sociospiritual factor alone, and 2.8% the biospiritual factor alone (total 31.7%). The remainder endorsed a combination of two or all three factors as being potentially causal, and most (65.7%) endorsed a pluralistic combination inclusive of a biological etiology. Group comparisons showed that endorsing only the biological factor was associated with the highest levels of education (p