Infantile epileptic spasms syndrome, historically known as West syndrome, is a developmental and epileptic encephalopathy that typically emerges in the first year of life. Its signature manifestation is the epileptic spasm: a sudden, brief contraction of the trunk and limb muscles that can resemble a startle reflex, colic, or reflux. Clusters of these spasms often occur on waking, and because they are so easily mistaken for benign infant behaviors, the condition is notorious for slipping past the first clinician who sees it. The electroencephalographic hallmark, hypsarrhythmia, is a chaotic, disorganized pattern of very high-voltage waves that reflects profound cerebral dysfunction. Treatment with adrenocorticotropic hormone, oral corticosteroids, or vigabatrin is time-sensitive, and international guidance emphasizes that prompt initiation of therapy substantially improves developmental outcomes.

The stakes are amplified in settings where pediatric neurologists are scarce. In Palestine, access to subspecialty neurology services is limited, which means frontline physicians, including general practitioners, family medicine specialists, and pediatricians working in district hospitals and clinics, effectively serve as the diagnostic gatekeepers. If they fail to recognize spasms, order an urgent electroencephalogram, and escalate the case, the window for effective treatment can close before the child ever reaches a specialist. This structural reality is precisely what motivated the research team, led by investigators at Al-Quds University and collaborating institutions including An-Najah National University and Palestine Polytechnic University, to measure how prepared the frontline actually is.

Between March and June 2026, the team administered a structured, self-administered questionnaire to pediatricians, general practitioners, family medicine specialists, and residents in pediatrics or family medicine practicing across the West Bank. The instrument was designed around the established knowledge, attitudes, and practices framework, a standard tool in health-services research for diagnosing gaps that can be targeted by training. Knowledge was assessed with twenty items scored from zero to twenty, attitudes with twelve Likert-scale items ranging from twelve to sixty, and clinical practices with ten scenario-based items scored from zero to twenty-eight. Knowledge was then categorized as poor at or below fifty percent, fair between fifty and seventy percent, and good above seventy percent, a threshold the authors treated as the adequacy benchmark for safe practice.

The headline numbers are sobering. Overall, 48.7 percent of participants demonstrated good knowledge, 53.0 percent held positive attitudes, and 52.5 percent exhibited good clinical practices. The mean knowledge score was 13.5 out of 20, equivalent to 67.4 percent, which fell statistically significantly below the 70 percent adequacy benchmark. In other words, the average physician in the sample sat just under the line that the investigators considered minimally acceptable, and nearly half of the cohort fell clearly below it. The authors report that the most pronounced deficits concerned the etiology and prognosis of the syndrome, domains that determine whether a clinician understands why urgent action matters and what the child’s future looks like without it.

The stratified analysis revealed a steep gradient across specialties. Pediatricians scored 15.8 on knowledge, compared with 11.6 for primary care physicians and 13.3 for residents, a difference that was highly significant. The same pattern held for attitudes, with mean scores of 44.5, 40.7, and 41.2 respectively, and for practices, where pediatricians averaged 20.4 against 15.9 for primary care physicians and 17.4 for residents. This hierarchy is clinically consequential because primary care physicians are often the first, and sometimes the only, medical professionals a worried parent consults when a baby begins exhibiting unusual movements. The group least equipped to recognize the syndrome is, in this system, positioned at the front door.

The statistical architecture of the study went beyond simple group comparisons. The team used independent samples t-tests and one-way analysis of variance to compare subgroups, Pearson correlations to probe relationships between the three domains, and multiple linear regression to identify independent predictors while controlling for confounders. The correlations were telling: knowledge tracked strongly with practices, with a correlation coefficient of 0.645, and moderately with attitudes at 0.380. This suggests that what doctors know about infantile spasms is tightly coupled to what they actually do when confronted with a suspected case, and that attitudinal readiness alone cannot compensate for missing factual knowledge. In the regression models, specialty group and male gender emerged as the strongest independent predictors of all three scores, indicating that the knowledge gap is not evenly distributed and that training interventions should be targeted rather than generic.

Perhaps the most actionable finding concerns perceived barriers. When asked what most impedes early diagnosis, 37.7 percent of respondents identified lack of provider awareness as the leading obstacle. That figure is striking because it comes from the physicians themselves: the frontline workforce recognizes that its own awareness is the bottleneck. Unlike resource constraints or referral bottlenecks, which require systemic investment, provider awareness is a problem that continuing medical education can, in principle, address directly. The authors conclude that targeted continuing medical education programs, particularly for primary care physicians and residents, have the potential to improve early recognition and management of the syndrome in Palestine.

The study’s design carries both strengths and limitations worth noting. The sample of 419 participants is large for a survey of this kind, and the scenario-based practice items move beyond self-report by asking clinicians to respond to realistic clinical vignettes. The instrument’s content validity was assessed using the scale-level content validity index, and the analysis included checks for multicollinearity using variance inflation factors. However, as a cross-sectional survey, it captures a snapshot rather than a trajectory, and self-administered questionnaires are inherently vulnerable to response bias. The authors also note that the findings apply to the West Bank and may not generalize to other health systems, although the pattern of specialty-dependent knowledge gaps echoes concerns raised in studies from other resource-limited settings.

For the global child-neurology community, the Palestinian data sharpen a broader message. Infantile epileptic spasms syndrome is among the most time-critical diagnoses in medicine, yet its presentation mimics ordinary infant behaviors, and its victims cannot describe their symptoms. Where pediatric neurologists are plentiful, the frontline still matters; where they are scarce, the frontline is everything. The Palestinian study suggests that a modest, well-aimed educational intervention, focused on the primary care physicians and residents who see these babies first, could shift outcomes for a condition in which the difference between prompt and delayed treatment is measured in a child’s lifelong cognitive trajectory. The research was approved by the Al-Quds University Research Ethics Committee and conducted in accordance with the Declaration of Helsinki, with informed consent from all participants, and it appears in the open-access literature so that clinicians and educators elsewhere can build on it.

Subject of Research: Physician knowledge, attitudes, and practices regarding infantile epileptic spasms syndrome in Palestine

Article Title: Infantile spasms in Palestine: knowledge, attitudes, and practices among pediatric and primary care physicians and residents

Article References: Alhaddar, M., Darawsheh, R., Shalalfa, N., Ewidat, S., Abu-Hanieh, D., Abdallah, N., Mohsen, M., Almahdi, A., Alhouseini, M., Nasser, A., Elbaou, B., Alwawi, A., & Zrineh, A. (2026). Infantile spasms in Palestine: knowledge, attitudes, and practices among pediatric and primary care physicians and residents. BMC Pediatrics. https://doi.org/10.1186/s12887-026-07816-0

Image Credits: AI Generated

DOI: 10.1186/s12887-026-07816-0

Keywords: infantile spasms, infantile epileptic spasms syndrome, West syndrome, pediatric epilepsy, primary care, Palestine, West Bank, knowledge attitudes practices, continuing medical education, neurodevelopmental disorders, EEG, diagnostic delay

The research team interviewed 133 cattle farmers and farm workers across Kwara State between March 2024 and May 2025, using a validated semi-structured questionnaire delivered through an open data kit mobile tool. Respondents were drawn from the three senatorial districts of the state, which covers roughly 35,705 square kilometres between latitudes 8.05°N and 10.15°N. To determine how many participants to recruit, the team applied a standard veterinary epidemiological formula based on an expected prevalence of Dicrocoelium dendriticum infection among local cattle, calculating a minimum sample of 38 farmers and ultimately enrolling well over three times that number. Eligible participants were farm owners or workers over eighteen years of age who were directly involved in the daily feeding, watering, rearing or care of cattle and who gave verbal consent.

The questionnaire itself was built through a rigorous multi-stage process: identifying the topic, selecting the target population, formulating knowledge, attitude and practice questions with scored answer options, and validating the instrument by calculating Cronbach’s alpha coefficients, which came out at 0.78 for knowledge, 0.76 for attitudes and 0.92 for practices—figures indicating good internal consistency. Each respondent answered twenty questions: seven on knowledge of helminths, seven on attitudes towards the infections, and six on practices. Scoring was weighted so that fully correct answers, strongly positive attitudes and completely good practices earned two points, with partial responses earning one and poor responses zero. Respondents scoring above the calculated mean thresholds—5.59 for knowledge, 7.67 for attitudes and 7.61 for practices—were classified as satisfactory.

The headline finding was a striking asymmetry. Overall, the survey recorded a satisfactory level of knowledge, attitudes and practices regarding helminth infections themselves. About 69 percent of farmers knew about helminth infections and more than 81 percent could recognise the clinical signs, which range from anemia, diarrhea and emaciation to reduced milk yield, infertility and poor carcass quality. The most important culprits are gastrointestinal nematodes, lungworms and liver fluke, parasites whose damage translates directly into lost income and, at the national scale, lost contributions to Nigeria’s GDP. Yet when the questions turned to anthelmintic resistance, the picture darkened dramatically: 67.67 percent of farmers had no knowledge of the phenomenon at all, and 81.95 percent were ignorant of how it could be managed.

The knowledge gaps extended into other critical territory. Nearly half of respondents—48.87 percent—could not name or identify the types of helminths affecting their cattle, and only 8.27 percent knew how the parasites are transmitted. Even more striking, 93.23 percent of farmers were unaware that vaccines could play any role in helminth control, and on the practice side, every single farmer recorded a poor score regarding vaccine use, reflecting in part the scarcity of commercially available vaccines for most veterinary helminths. Attitudinal results were similarly mixed: while majorities held positive views about consulting veterinarians, the necessity of treating infections and the preventability of helminthosis, 77.44 percent failed to recognise the economic importance of the disease, and 57.14 percent held negative attitudes towards the role of hygiene in control.

Not all the practical news was discouraging. Solid majorities of farmers demonstrated good practices in the fundamentals of anthelmintic deployment: 79.70 percent scored well on the age at which they begin deworming, 71.43 percent on the frequency of administration, 77.44 percent on the route of administration and the same proportion on herd-level treatment, and 71.43 percent showed good practice in their choice of drugs. These fundamentals matter because the way anthelmintics are used—treatment frequency, dosing accuracy and the tendency towards mass medication and under-dosing—are among the key drivers of resistance development. Recommended countermeasures include combining drugs from different anthelmintic classes and adopting ‘refugia’ strategies, which deliberately leave a proportion of the parasite population unexposed to treatment so that susceptible genes dilute the resistant ones in the parasite population.

Statistical analysis using binary logistic regression revealed that five factors significantly shaped farmers’ knowledge, attitudes and practices: age, educational status, role on the farm, herd size and farming experience. Older farmers, more educated farmers, farm owners, those with larger herds and those with longer farming experience all recorded higher satisfactory levels. The pattern is interpretable through economic and cognitive lenses: larger herds represent bigger capital investments that incentivise knowledge-seeking, farm owners bear the financial consequences of disease directly, and accumulated years of livestock experience build practical disease literacy. The findings echo earlier studies from Iran, Rwanda, Ethiopia and elsewhere, which similarly linked education, ownership and herd size to better parasite and drug-resistance awareness.

Perhaps most significant for intervention design was the demonstration that the three dimensions of the survey move together. Spearman’s rank correlation analysis showed a positive, moderate association between knowledge and attitudes (rs = 0.538), a moderate positive link between knowledge and practices (rs = 0.639) and a strong positive correlation between attitudes and practices (rs = 0.830), all statistically significant at P = 0.01. In plain terms, farmers who understand helminths tend to view them more seriously and manage them better—which suggests that education campaigns targeting knowledge gaps, particularly around anthelmintic resistance, could cascade into improved behaviour across the whole chain from belief to action.

The authors caution that their results should be generalised cautiously across Nigeria’s ethnically and educationally diverse farming population, and they acknowledge the limitations inherent in self-reported questionnaires, including potential social desirability bias, and the inability of a cross-sectional design to establish causation. Nevertheless, the message is clear and urgent. Anthelmintic drugs remain the foundation of helminth control worldwide and are likely to remain so given the dearth of vaccines, yet intensive use has already produced dramatic resistance in cattle, goats, sheep and horses across the globe, escalating production costs and threatening livestock sustainability. The team’s recommendation is straightforward: cattle farmers in Kwara State—and by extension comparable settings across sub-Saharan Africa—need targeted enlightenment about anthelmintic resistance, its management and the true economic weight of helminth infections, before the region’s limited arsenal of effective dewormers is quietly lost.Subject of Research: Knowledge, attitudes and practices of cattle farmers regarding helminth infections and anthelmintic resistance in Kwara State, Nigeria.

Subject of Research: Cattle farmers' knowledge, attitudes and practices regarding helminth infections and anthelmintic resistance in Kwara State, Nigeria

Article Title: Appraisal of knowledge, attitudes and practices regarding helminth infections and anthelmintic resistance among cattle farmers in Kwara State, Nigeria

Article References: Appraisal of knowledge, attitudes and practices regarding helminth infections and anthelmintic resistance among cattle farmers in Kwara State, Nigeria. (n.d.). https://doi.org/10.1186/s44399-026-00034-0

Image Credits: AI Generated

DOI: 10.1186/s44399-026-00034-0

Keywords: anthelmintic resistance, cattle, helminth infections, Kwara State, Nigeria, knowledge attitudes practices, livestock farmers, gastrointestinal nematodes, refugia, veterinary parasitology, helminthosis, cross-sectional survey