Antiepileptic drug adherence in children in southern Ethiopia: A cross sectional study

Abstract

Background Epilepsy is one of the commonest chronic neurological disorders with serious health consequences. Treatment adherence is one of the determinants of seizure control. This study was designed to determine factors affecting antiepileptic drug adherence among children with epilepsy. Methods A cross sectional study was conducted on 192 children with epilepsy (≤14 years of age) on follow-up at a pediatric neurology clinic in Southern Ethiopia from January 1st to August 30th, 2019. Medication Adherence was measured using the eight-item Morisky’s medication adherence scale. Logistic regression analysis was done to determine factors associated with antiepileptic drug adherence. Result One hundred twenty-five (65%) of the study subjects were adherent to their medication. On multivariable analysis, factors predictive of good adherence included family size of ≤5 [AOR = 2.34, (95% CI: 1.07, 5.10); P = 0.03] and duration of epilepsy (<1year [AOR = 5.83, (95% CI: 1.48, 22.92); P = 0.012] and 1-2year [AOR = 4.58, (95% CI: 1.12, 18.77); P = 0.035]). Monthly family income of <1000 Ethiopian Birr [AOR = 0.18, (95% CI: 0.06, 0.61); P = 0.005] and presence of seizure attack in the past 3months [AOR = 0.23, 95% (CI: 0.10, 0.55); P = 0.001] predicted poor antiepileptic drug adherence. Conclusion Adherence to antiepileptic drugs in children is low in our setting; low family income and occurrence of seizures while on treatment predicted poor adherence. Supplying free antiepileptic drugs to poor children and regular provision of information about expected treatment response to children with epilepsy and their caretakers may help improve adherence.

Antiepileptic drug adherence among children with epilepsy attending a tertiary hospital in Rivers state, Nigeria

“…18,19 Similarly poor family income affected adherence significantly in this present study. This finding is similar to finding by Dima et al 8 This could be due to the out-of-pocket payment done by most families in our setting and the high cost of the anti-epileptic drugs as parents or caregivers may not be able to sustain these drugs. Abebaw et al had reported that people living with epilepsy who paid for AEDs were more likely to have poor adherence compared to those who got theirs for free.…”

“…Though, Dima and Shibeshi study population were children, they however made use of children who were 14 years and below whose parents may be responsible for administering the drug to them unlike this present study whose study population extended to children up to 18 years, and probably the older the patient the more likely they will take the drugs unsupervised. 8 Although Nazziwa et al by self-reporting had an adherence level as high as 79.5% among children this did not correspond to their serum AED levels as the latter was as low as 22.1%. 7 This further highlights the need for serum AEDs levels as relying on only self-reporting may not be reliable.…”

“…Predictors of anti-epileptic drug adherence among the study participant is as shown in Table 3. Age, sex, social class of the patients, the number of drugs the patient is 7,8 This finding indicates that more needs to be done to ensure adherence to AEDs, as lack of adherence is a major cause of unresponsiveness to treatment while on AEDs. Though, Dima and Shibeshi study population were children, they however made use of children who were 14 years and below whose parents may be responsible for administering the drug to them unlike this present study whose study population extended to children up to 18 years, and probably the older the patient the more likely they will take the drugs unsupervised.…”

“…7 In Ethiopia, Dima and Shibeshi recently reported a 65% adherence of AED among children with epilepsy and this poor adherence was related to low family income among other factors. 8 The differences in the adherence rate reported depends on the study population and the methods used. Due to high cost and unavailability of serum AEDs level estimation, self-report has been the main method of assessing adherence in developing countries as it is affordable and adaptable to the populace, however, it has been reported to overestimate adherence.…”

“…9,10 Factors that determine adherence to medications among children on treatment includes socioeconomic factors, age, sex, the availability of drugs, ignorance and the level of education of care givers. 8,10 Out of pocket payment for health related conditions and negligible subscription to health insurance services as obtained in most developing countries contributes to poor health seeking behaviours and poor adherence to prescribed treatment. 10 The extent to which these factors contribute to the adherence to AEDs have not been documented among children with epilepsy in Port Harcourt.…”