Epilepsy is a common neurological disorder with multiple and often curable causes 1. Epilepsy affects approximately 50 million people worldwide making it the most common neurological disorder globally 2. Most people living with epilepsy (PWE) live in low and middle income countries 3. The prevalence of epilepsy in Africa is greater than 10‰ 4. In Sub-Saharan Africa (SSA), the prevalence of active convulsive epilepsy is high and range from 2.2 to 58 per 1000 affecting an estimated 4.4 million people 5.

In Ivory Coast, the prevalence of epilepsy has been estimated at 7‰ by Kouassi and al. 6. The PWE are still too often stigmatized because of the lack of knowledge about this disease and supernatural beliefs in the population 7. In Ivory Coast, several studies have focused on the sociocultural aspects of the epilepsy in different population groups. Assi and al. carried out a study in a population of students in Abidjan 8. Boa and al. assessed the knowledges and beliefs on epilepsy in next of kin of PWE hospitalised in neurology 9. Akani and al. conducted a study on the knowledges of medical traditional health practitioners on epilepsy 10.

Increased attention is currently scope to the quality of life, that is to say to the psychological and social problems faced by PWE, including access to education. Doumbia and al. have found 35.2‰ epilepsy in the preparatory course (C.P.1) students in their study carried out in one commune of abidjan in Ivory Coast 11. Schools should offer some useful information and assistance in health issues, such as epilepsy. Therefore, teachers should have sufficient knowledge for this purpose. Our study aims at assessing the level of knowledge of primary school teacher in the city of Bouake in Ivory Coast.

That was a two-month descriptive observational study in the city of Bouake. Bouake, the second largest city, is located in the central part of Ivory Coast about , 355 km of Abidjan wich is the economic capital. The study was carried out based on the anonymous questionnaire on the socio-demographic characteristics, knowledge, beliefs and practical attitudes of respondents regarding epilepsy. It included both open and closed questions. The questionnaire was distributed to the respondents during the break and retrieved at the end of the same day for each school identified. It was validated after two pre-tests with two different groups of teachers from Bouake. This study was done in 3 Primary School Inspections (PSI) which were randomly chosen among 5 PSI of the city in Bouake. We founded the maximum size of the sample with EPI Info 7.2 software. As a result, 310 teachers were recruited from 10 primary schools.

Most of the respondents were men (73.87%) and the average age was 43.08 years. Muslims were predominant (46.45%), followed by Christians (33.87%) and animists (19.68%). 59.03% of the respondents had a high school level and (40.97%) had university level. Table 1 show the demographic characteristics of the respondents.

This study has been done in a young and high educatied population. We found that the majority of primary school teachers, who have completed higher education, indicated that they were not informed enough about the epilepsy. This finding was also reported by Maïga (58.7% of the teachers) in Mali 7, Kiwanuka in Uganda 3 and Owolabi in a study conducted in a school teachers population in Nigeria 12. Despite this fact, they knew that epilepsy was a brain disorder from a medical origin. In contrast, some teachers considered it as a supernatural disease due to the deep-rooted beliefs in population. This finding agrees with the studies in Abidjan 8, in Benin 1, in Nigeria 1213, in Ouganda 3, in Zimbabwe 14 and in Brazil 15. The confusion between epilepsy and mental illness remains, since 32.9% of the respondents admitted that the epilepsy was related to madness.

Many teachers have recognized the spectacular tonic-clonic seizure, associated with stiffness, convulsion, loss of consciousness, tongue biting and urinary incontinence. The tonic-clonic seizure, generally known as the "great evil" seizure, is considered as the major symptom of the epilepsy, which is well described by our participants 8. This finding agrees with other reports 1216. None of the respondents knew the absence seizure. It rarely helps to diagnose the epilepsy since it highly unseen 10. This finding reported by Owolabi has great implication for in-school recognition of non convulsive seizure 12. The « absence » seizure mostly occurs in school-aged children, with poor school performance implications. Hereby, it is relevant for teachers to be aware of this disease so that they will contribute to diagnose it early. Futher more, they should be aware of the factors favouring the occurrence of seizures. The concept of contagiousness still remains. 79.68% of teachers identified the foamy drooling as a clinical sign of epilepsy, and 39.14% believed that epilepsy could be spread by touching with the patient during the seizure. This fact was also identified by Owolabi 12 and increases the attitudes of fear and rejection of the patient 1012. The conceptions including "avoid touching PWE in seizure" and "avoid his drool" are strongly indicated by the teachers despite their high education level and explain the high rate of accidents occurring within PWE during seizures 8.

The daily life of PWE is characterized by these misconceptions and thus, leading to social, professional, and family prohibitions as also described by Assi and al 8. All teachers have admitted that the PWE can maintain normal schooling. Objectively, education of epileptic children, can be hindered by several problems, including psychomotor disorder, fear of discrimination, fear of falling in the crowd, and family guilt 17. 56% of teachers have revealed that the PWE should not have a position of responsibility. Assi and al. have made the same observation in a student population in Abidjan in Ivory Coast and have linke dit it with the suddenness and disabling nature of epileptic seizures 8. The professional environment of PWE should not be informed according to 51.94% of the teachers because of the fear of exclusion or dismissal 8. Therefore the awareness of the occupational community may help to take actions during seizures or to obtain a job adaptation 8.

The lack of knowledge about epilepsy will perpetuate the misconceptions. In addition, the PWE must not only have leisure, such as disco and video games but also eat on the same plates as other members of the family. This fact is a major factor of exclusion in traditional African settings7818. In some cultures, the epilepsy is still considered as a reason to prohibit or cancel a wedding among 16.45% of our study respondents 19 due to the risk of transmission to offspring. All respondents would like to get more information about epilepsy through flyers or audiovisual media. The Ivoirian Association against Epilepsy (A.I.L.E) should implement a social marketing strategy on epilepsy awareness flyers and increase the sensibility campaign for teachers in Bouake so that they would eliminate the misconceptions about epilepsy. This awareness activity could be done in collaboration with the association "stop epilepsie", an Ivorian association of PWE and PWE family.

This study has some limitations which should be considered in the interpretation of our findings. Explanations were provided to the participant on some questions and this might have affected their responses. The study took place over two months and some teachers interviewed could have given information to their colleagues or read documents. This might have affected their spontaneous responses. Despite these limitations, the benefit of this study is that it provides responses that can be considered as a baseline for the A.I.L.E social marketing strategy, and considered as base line for comparison with the next studies.

Primary school teachers play a vital role in educational and psychosocial development of student as an important part of their life is spent at school. The epilepsy is still, an unknown neurological disorder due to several misconceptions and the lack of knowledge in view of this study. Primary school teachers have erroneous knowledge about epilepsy. Hereby, this study should carefully suggest to enhance the understanding or perception of this disease among the populations, particularly in primary school teachers under the management of the Ivoirian Association against Epilepsy (A.I.L.E).