Nonadherence to Antiepileptic Medications and Its Determinants among Epileptic Patients at the University of Gondar Referral Hospital, Gondar, Ethiopia, 2019: An Institutional-Based Cross-Sectional Study

Abstract

Introduction. Nonadherence to antiepileptic medication is the extent of a patient’s passive failure to follow the prescribed therapeutic regimen. The prevalence and impact of nonadherence to antiepileptic medication are high globally. The main purpose of this study was to assess nonadherence to antiepileptic medications and its associated factors among epileptic patients at the University of Gondar Referral Hospital, Gondar, Ethiopia, 2019. Methods. An institutional-based cross-sectional study was conducted among 365 epileptic patients at the University of Gondar Referral Hospital, who were selected by a systematic random sampling technique. Data were collected by face to face interviews using a structured pretested questionnaire. Data were entered into EPI Info version 7 and then exported to SPSS version 22 for analysis. The data were described by descriptive statistics. Binary logistic regression analysis was used as a model, and variables with a p value of less than 0.05 were considered as statistically significant with nonadherence to antiepileptic medications. Results. A total of 356 epileptic patients participated in the study yielding a response rate of 97.5%. The overall prevalence of nonadherence to antiepileptic medications among epileptic patients attending at the University of Gondar Referral Hospital was 38.5% (95% CI: 33.1–43.8). Divorced and/or widowed marital status (AOR: 3.38 (95% CI: 1.54, 7.44)), treatment duration of 3–5 years (AOR = 3.58 (95% CI: 1.38, 9.29)), treatment duration of 5 and above years (AOR: 3.49 (95% CI: 1.53, 7.95)), comorbidity (AOR: 2.42 (95% CI: 1.08, 5.43)), side effects of antiepileptic medications (AOR: 3.36 (95% CI: 1.67, 6.74)), absence of health information (AOR: 1.98 (95% CI: 1.11, 3.52)), epilepsy-related stigma (AOR: 2.81 (95% CI: 1.57, 5.02)), and negative attitude towards antiepileptic medications (AOR: 2.46 (95% CI: 1.36, 4.45)) were significantly associated with nonadherence to antiepileptic medications. Conclusions. Prevalence of nonadherence to antiepileptic medications among epileptic patients at the University of Gondar Referral Hospital was found to be high. Hence, giving health information about epilepsy and its management will help to reduce antiepileptic medications’ nonadherence.

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

“…The present study showed that duration of epilepsy was significantly associated with medication adherence. This finding is in agreement with results of studies from Ethiopia [ 22 ], Kenya [ 19 ] and Jordan [ 18 ]. This could be due to provision of inadequate information about the course of the illness and its possible prognosis at key points during the course of epilepsy treatment [ 40 ], the side effects of antiepileptic drugs taken for a prolonged period of time [ 21 ], or simply adherence fatigue from several years of drug administration [ 41 ].…”

“…Although stigma has been reported in previous studies as an important factor associated with treatment non adherence [ 20 , 22 ], this study has not demonstrated the association. Moreover, our study did not show an association between adherence and the presence of comorbidity in contrast to earlier findings [ 10 , 21 – 23 ].…”

“…Adherence is influenced by several factors that include socioeconomic factors, the health care system, the characteristics of the disease, the treatment the patient receives, and patient-related factors [ 16 ]. Some of the predictors of adherence identified in previous studies include duration of treatment [ 8 , 18 , 19 ], seizure type and parental depressed mood [ 17 ], seizure frequency [ 20 ], pill burden and drug costs [ 16 ], comorbidities [ 10 , 21 – 23 ], stigma [ 20 , 22 ], parent and child satisfaction with medical care [ 24 ], and medication adverse effects [ 21 , 22 , 25 ]. There is scarcity of data on treatment adherence and associated factors among children with epilepsy in Ethiopia.…”

Measuring of Non-Adherence of Epilepsy Patients to their Medication and its Relationship to their Beliefs about the Disease, and the Frequency of Seizures: A Comparative Study between Epilepsy Patients in Saudi Arabia and Egypt

“…Our study agreed with other studies 33,40 who found that partial epilepsy (52%) and generalized (48%). But other study showed that 79.2% were of generalized epilepsy and 20.8% of focal epilepsy, 45 other showed that 23.1% were of generalized epilepsy and 67.5% of focal epilepsy 9.3% with uncertain epilepsy. 31 Concerning the number of medications received, our patients received AED as monotherapy (60.4% & 48.7%) more than polypharmacy (39.6% & 51.3%) among Egyptian and Saudi patients respectively.…”

“…42,43 Employers or students were less likely to adhere to their treatment regimen compared to those who were unemployed, 43 and this may be justified by working or academic schedules that prevent patients from following their prescribed regimen, or may be due to the side effects, especially drowsiness that affect job or academic performance. 44 Studies carried out in Ethiopia found that divorced and widowed patients were significantly poor adherent when compared with single patients in their marital status, 11,45 which might be due to no support from their partners in adhering to the prescribed medication(s) and instructions given by health care professionals. 11 Regarding types of epilepsy, 54.8% & 39.2% of patients with focal epilepsy versus 29.5% & 49 with generalized epilepsy among Saudis and Egyptians respectively.…”