Perceived Stigma in Epilepsy Patients in a Low Income Country; Ethiopia: A Review and Meta-Analysis of the Prevalence and Related Factors.

Abstract Background: The presence of perceived stigma hinders epilepsy patients from help-seeking behavior and diminishes adherence to medical follow up. Despite this, the limitation of aggregate evidence regarding the prevalence and associated factors of perceived stigma existed in Ethiopia. Methods: Our search for eligible articles was accompanied in the databases of PubMed, Scopus, EMBASE, and African Index Medicus. An additional manual search by the enumeration of the reference list of other articles was done. We used stata-11 and random-effects models to obtain the average prevalence of perceived stigma. Heterogeneity was assured with the Higgs I2 test and Cochran's Q- statistic. Sensitivity analysis and sub-grouping analyses were done. Qualitative checks for symmetry in funnel plot and quantitative description of Egger's test were done to check a publication bias.Results: Of 1524 articles identified by the electronic and manual search, only 10 articles fulfilled the eligibility criteria and included in the analysis. The average prevalence of perceived stigma was found to be 43.79% (95% CI: 31.84, 55.75). The prevalence of perceived stigma varies across the measurement tool used, study location, and year of publication. The average prevalence of perceived stigma in studies measured with the modified FIS scale was 76.3%; higher than those studies measured with the Kilifi stigma scale; 33.63% and three-item stigma scale; 39.5%. Besides, the average prevalence of stigma was higher in Amhara (53.2 %) and the Oromia region (52.2%). Studies published before 2016 provide higher perceived stigma (56.26 %) than studies published after 2016 (35.47%). Our qualitative analysis revealed that rural residence, low level of education and income, age groups of 18 to 24 years, frequent seizure occurrence, contagion believe regarding epilepsy, duration of epilepsy from 1-10 years, depression and anxiety co-morbidity were among the associated factors with perceived stigma in people with epilepsy.Conclusion: The average prevalence of perceived stigma in people with epilepsy was high and varies across study location, measurement tool, and study's publication year. Management of epilepsy should focus on the stigma component besides the biological intervention.