THE CHALLENGES FACED BY PARENTS IN THE MANAGEMENT OF SEIZURES AMONGST CHILDREN (0-5 YEARS) IN MOLYKO COMMUNITY

Abstract

Seizure is a sudden attack (as of a disease) especially the physical manifestations as convulsions, sensory disturbances, or loss of consciousness) resulting from abnormal electrical discharges in the brain. Seizures can be life-threatening especially when the patient is at risk of severe injuries resulting from falls and severe hemorrhage can occur due to biting of the tongue.

The main aim of this study was to investigate the challenges faced by parents in the management of seizures amongst children (0-5 years) in Molyko community. The research design was the cross-sectional design which is a type of research design in which you collect data from many different individuals at a single point in time.

Data were obtained using a questionnaire and analyzed with Microsoft excel. The majority of parents in the Molyko community have knowledge of seizures/convulsions in children (0-5 years). Most parents in Molyko community can manage seizures at home adequately before appropriate medical help arrives. the main challenges parents of children aged 0-5 years in Molyko community face during home seizure management are; Fear of the unknown, Lack of understanding of the condition. More research should be done on seizures in order to provide answer seekers with adequate knowledge on seizures. People should attend workshops for first aid measures generally in order to learn practical solutions to minor and major problems at home before going to the hospital.

CHAPTER ONE

GENERAL INTRODUCTION

1.1 Background

Seizure is a sudden attack (as of a disease) especially the physical manifestations as convulsions, sensory disturbances, or loss of consciousness) resulting from abnormal electrical discharges in the brain. (Merriam., 2019). A seizure can also be defined as an abnormal discharge in the brain (Halle., 2018). It can cause changes in your behavior, movements, or feelings and in levels of consciousness.  Seizures usually occur in young people aged 5-20, although it can affect anyone. Seizures and epilepsy are not the same, seizures are the main symptom of epilepsy (Bogne et al., 2009).

Seizures are common in the pediatric age group and occur in approximately 10% of children. Parents often experience anxiety and fear if seizures in the child occur in their presence at home. Parental response is mostly determined by their knowledge on seizures (Chiabi et al., 2016).

New-onset seizures causes include febrile seizures (children under 5 years), idiopathic, congenital, birth injury, head trauma (including due to child abuse), gastroenteritis (Rotavirus, shigella), metabolic disorder e.g hypoglycemia, hyponatremia (most common cause in afebrile children under age 2 years).  Most adult seizure causes include; Brain infection, including meningitis and encephalitis, drug abuse, electric shock, epilepsy, fever, heart disease, stroke, withdrawal from alcohol or certain medicines, venomous bites, and stings (such as a snake bite) (Adam., 2019).

Most seizures only last for a few minutes or even just a few seconds. If you’ve had a seizure, it may take you an hour or so to feel normal again. And you may not have any memory of having had a seizure or remember what was happening as the seizure started. Some symptoms of seizures include; slight twitching of all parts of the body including arms, hands, and legs, convulsions that affect the entire body, loss of consciousness, twitching of the face, affected speech, sudden stillness with a blank stare, temporary loss of control of your bladder or bowels. (Kamgno et al., 2003)

In a study conducted, the older children had an overall seizure rate of 18%, and previous seizures were the only significant risk factor. In contrast, the younger children had an overall seizure rate of 45%, and the seizures were significantly associated with hypoxic-ischemic encephalopathy, intracranial hemorrhage and central nervous system infection. (Gutierrez et al., 2011). About 70% of people with epilepsy are able to successfully manage epilepsy seizures with medications and certain types of surgery, but it’s important to remember that epilepsy can’t be cured and that there’s always a risk of having another seizure. (International League Against Epilepsy., 2017)

Seizure management must occur simultaneously with the diagnostic assessment, which should include addressing life-threatening causes (e.g hypoglycemia, malaria) and with attention given to the most likely aetiology in a particular region or setting. For ongoing seizures, initial treatment with benzodiazepines is indicated. There is evidence of efficacy for several agents and delivery modes. Longer-acting antiepileptic drugs should be on hand if acute seizures fail to respond to two doses of benzodiazepines.  (Ornella., 2017).

Some devices can monitor seizures and alert caregivers, potentially benefiting treatment and helping prevent sudden unexpected death in epilepsy. In a small study in 2018 involving 28 participants, the results of which appeared in the journal Neurology, compared one such multimodality device, the Nightwatch, to an Emfit bed sensor. The Nightwatch detected 85% of all severe seizures compared with 21% for the bed sensor. It also only missed one serious attack every 25 nights. Nearly 70% of Sudden Unexpected Death in Epilepsy cases occur during sleep, according to one study carried out in 2017. This indicates that there may be potential benefits of using accurate nighttime warning systems. (Liu and Aungsuroch., 2018)

According to Baskind., (2015), challenges to managing seizures include; health care facilities are often long distances for patients to reach, supply of Antiepileptic Drugs (AED’s) tends unreliable and compliance is often poor based on a combination of limited access to AED’s, cost and lack of understanding of the nature of the disease.

Mortality appears to be increased in Africa based on the recent data from China and Kenya, which suggest that premature mortality is very high in these settings, particularly affecting older children and adults. In Africa, the mortality is particularly related to poorly controlled epilepsy, with a greater proportion of children dying with status epilepticus, drowning, and burns caused by seizures compared with other continents. (Chomba et al., 2019).

1.2 Rationale

The aim of this was to investigate the challenges faced by parents in the Management of Seizures Amongst Children (0-5 Years) in the Molyko Community and to propose ways of improving management strategies of seizures at home.

1.3 Problem Statement

Seizures can be life-threatening especially when the patient is at risk of severe injuries resulting from falls and severe hemorrhage can occur due to biting of the tongue.

Home management or first aid of seizures include; staying with the child till they’re alert, keeping the child safe from harm, turning the head to one side if they are not awake to keep the airway clear (International League Against Epilepsy., 2017).

During an internship in Molyko Health center, the researcher observed that most patients especially children brought to the hospital with seizures were poorly managed at home by their parents/guardians and were even brought to the hospital in the state of seizures with no home management done and some patients had already bitten their tongue. This motivated the researcher to carry out this study to investigate the challenges faced by parents in the Management of Seizures Amongst Children (0-5 years) in Molyko Community.

1.4 Research Questions

1. What knowledge do parents have on seizures amongst children (0-5 years) in Molyko Community?
2. What are the management strategies used by parents in seizures amongst children (0-5 years) in Molyko Community?
3. What are the challenges faced by parents in the management of seizures amongst children (0-5 years) in the Molyko Community?

1.5 Research Objectives

1.5.1    General Objective

To investigate the challenges faced by parents in the Management of Seizures Amongst Children (0-5 Years) in Molyko Community.

1.5.2 Specific Objectives

1. To assess parents knowledge on seizures amongst children (0-5 years) Molyko Community
2. To identify the management strategies used by parents in seizures amongst children (0-5 years) in Molyko Community
3. To describe challenges faced by parents in the management of seizures amongst children (0-5 years) in Molyko Community