Factors affecting adherence to antiepileptic medications among Sudanese individuals with epilepsy: A cross-sectional survey

Abstract

Background: Nonadherence to medication is widespread in epilepsy and other chronic diseases. Studies reporting adherence to antiepileptic medications are very limited in African countries. Adherence reports from low income African countries are few in contrast to multiple studies from high-income countries. Therefore, the aim of this study is to measure the level of adherence to antiepileptic medication in Sudanese population. Methods: A descriptive cross-sectional study of 96 individuals with epilepsy recruited from neurology outpatient clinics in three tertiary centers in Sudan. Data were collected by using a structured questionnaire containing Morisky Medication Adherence Scale-4 (MMAS-4) and Belief about Medication Questionnaire and analyzed by statistical package of social sciences. Results: About 35% of patients were estimated to be nonadherent. Most of the patients (93%) acknowledged their need for antiepileptic drugs. However, 35% had high concern score. Adherence is affected by attitude toward antiepileptic drugs (AEDs) and presence of side effects to AEDs. The relation between side effects and adherence was significant ( P value 0.000). Furthermore, there was a statistically insignificant relation between the number of drugs used and adherence ( P value 0.002). There was a significant relation between adherence, necessity mean score, concern mean score, and necessity concern differential P value 0.000 for all. Conclusion: Nonadherence to antiepileptic medication was reported in almost in one third of individuals in this cohort. There were statistically significant associations between nonadherence and both side effects and number of medications used in the treatment of epilepsy. Therefore, family physician should always check compliance with antiepileptic medication. Patient's education about adherence to medication through family physician may in part decrease the recurrence of epileptic seizures. Further research is needed to explore ways to increase adherence with AEDs in a low resource country like Sudan.

Clinical Characteristics and Current Medical Practice in a Group of Sudanese Patients with Epilepsy: A Cross Sectional Hospital Based-Study

“…However, in the later study all patients have EEG while in our patients only 55% had EEG access. The focal epilepsy partially matched the previous study as it was 26% versus 29% [20].…”

“…Our findings in semiology of generalized seizures (84%) was higher than a hospital based study in Iran (78%) [17] and also higher than the French and Spain studies (31% & 13.8%), in hospital and primary care setting respectively [18] [19]. The tonic clonic seizures here was 75% which was partially matching a previous study in the same hospital which was 72.3% [20]. The differences in design and methodologies had affected our hospital based results.…”

Identifying Patterns of Self-Reported Nonadherence Using Network Analysis in a Mixed German Cohort

“…This identifies the listed items as putative network hubs, which is in line with previous research as both high number of drugs (eg, polypharmacy) and adverse effects have been repeatedly identified as influential factors contributing to nonadherence. 2 , 5 , 30 , 31 Additionally, the expected influence, which assesses the cumulative influence within the network, indicates that items 13, 12 and 2 are highly influential nodes in the network. 32 Therefore, our network analysis was able to detect commonly identified influential factors for nonadherence, namely taking too many medications, adverse effects and lack of knowledge.…”

Epilepsi Hastalarının Tedaviye Uyumları Ve Etkileyen Faktörler

“…[7] Eğitim düzeyi yüksek bireylerde yapılan birçok çalışmada, hasta ve hasta yakınlarının epilepsi hakkında bilgilerinin eksik olduğu ve verilen antiepileptik tedavilere yeterince uyum göstermedikleri bildirilmiştir. [11,[17][18][19][20] Bu çalışmada da hastaların epilepsiyi tanımlarken zorlandıkları ve kendilerini tam olarak ifade edemedikleri gözlendi. Yapılan birebir görüşmelerde bazı hastaların epilepsiyi beyindeki sinir bozukluğu olarak tanımlarken, aynı zamanda ruh hastalığı olarak da kabul ettikleri belirlendi.…”

“…Ayrıca bu durum tedaviye uyum sağlamalarına da yardımcı olabilir. [20,22,23] İlaç dışı tedavi uygulamalarında, kişinin bulunduğu toplum ve dini inançlarının etkisinin olduğu, Müslüman olan toplumlarda epilepsi hastalarının hocaya ve türbeye gitmeyi tercih ettikleri, muska taktıkları, şifalı sular içtikleri, batı ülkelerinde yoga yaptıkları, vitamin kullandıkları; Tayvan'da ise geleneksel Çin tıbbını kullandıkları belirlenmiştir. [24][25][26] Bu çalışmada da hastaların %27.1 gibi oldukça yüksek bir oranının da tıbbi tedavi dışında yöntemlere başvurdukları, en çok hocaya/türbeye (%73.6) gittikleri ve şifalı suları denedikleri saptandı.…”