Factors Associated with Poor Antiepileptic Drugs Adherence in Below Poverty Line Persons with Epilepsy: A Cross-Sectional Study

Quality of life and associated factors among patients with epilepsy at selected public hospitals of Somali region, Eastern Ethiopia

BACKGROUND

Epilepsy in low- and middle-income countries is linked to lower quality of life and premature death. Limited healthcare access and stigma in regions like Somali hinder effective management and lead to social isolation, affecting family relationships, education, and employment opportunities. Even though determining the status and factors affecting epileptic patients' quality of life is an initial step toward enhancing treatment outcomes, there is a scarcity of evidence-based information on epileptic patients' quality of life in the study area.

OBJECTIVE

To assess the quality of life and its associated factors among patients with epilepsy at selected public hospitals of the Somali region, Eastern Ethiopia, from June 30 to July 30, 2023.

METHOD

An institution-based cross-sectional study was undertaken on 422 epileptic patients in five public hospitals in the Somali region. A simple random sampling procedure was utilized to choose study participants. Face-to-face interviews were conducted with a pretested structured questionnaire, and data was analyzed using SPSS version 26. A multivariable logistic regression analysis with 95% confidence intervals was used to investigate the relationships between the dependent and independent variables. A P-value of less than 0.05 was used to declare the statistical significance of the observed relationships.

RESULTS

Overall, 56.4 % of epileptic patients had good quality of life (95 % CI = 51.5-59.2 %) with 98.8 % response rate. Age in year ≥ 35 (AOR = 0.28; 95 %CI: 0.11, 0.71), family size (four to six, and greater than or equal to seven) (AOR = 0.12; 95 %CI: 0.04,0.33) and (AOR = 0.23; 95 %CI: 0.08, 0.68), poor drug adherence (AOR = 14.42; 95 %CI: 3.93, 52.95), lack physical activities (AOR = 0.33; 95 %CI: 0.17, 0.66), smoking (AOR = 0.41; 95 %CI: 0.18, 0.91), alcohol Consumption (AOR = 0.06; 95 %CI: 0.02), and absence of depression (AOR = 3.32;95 %CI: 1.35, 8.17) were significant association with quality of life among epileptic patients.

CONCLUSIONS AND RECOMMENDATION

The magnitude of good quality of life among epileptic patients is lower, implying that poor quality of life among epileptic patients remains a public health concern in the study area. Drug adherence, physical activity, smoking, alcohol consumption, anxiety, and depression status were all modifiable factors that influenced quality of life. As a result, it would be ideal if all health practitioners prioritized health education and counseling on treatment adherence, comorbidity, and drug abuse prevention. Furthermore, screening for, identifying, and treating psychological illnesses on a regular basis would greatly benefit epilepsy sufferers' quality of life.

Nonadherence to antiepileptic medication and associated factors among persons with epilepsy in India: A systematic review and meta-analysis

BACKGROUND

Nonadherence to antiepileptic drugs (AEDs) is a prevalent issue in India, contributing to suboptimal seizure control, higher morbidity and mortality, increased hospitalization rates, and a substantial effect on the overall quality of life for individuals with epilepsy.

OBJECTIVES

This study aimed to measure the prevalence of medication adherence among individuals with epilepsy in India and to identify factors associated with nonadherence.

METHODS

Following PRISMA guidelines, we searched PubMed, Scopus, Embase, and Google Scholar for studies on AED adherence in India. Quality assessment employed Newcastle Ottawa Scale adapted for cross-sectional studies. Pooled prevalence was ascertained using a random-effects model in R software (version 4.2.2), with a 95% confidence interval. Heterogeneity was estimated with the I2 statistic, and publication bias was appraised via a funnel plot. Subgroup analyses, based on study region and adherence measurement tool, were done to investigate heterogeneity.

RESULTS

Nine cross-sectional studies with 1772 participants were analyzed. The pooled prevalence of adherence to AEDs in India stood at 49.9% (95% CI: 39.8%-60.1%). Subgroup analyses showed comparable adherence rates in the South (50.9%) and North (46.5%) regions of India. However, adherence rates varied substantially based on the measurement tool: Morisky Medication Adherence Scale-4 (MMAS-4) reported 71.3%, MMAS-8 indicated 45.9%, and Morisky Green Levine (MGL) adherence scale exhibited 42.0%. Factors contributing to non-adherence to antiepileptic therapies involved poor socioeconomic status, lower education levels, polytherapy, drug-related side effects, and substance abuse.

CONCLUSIONS

Almost half of persons with epilepsy in India were non-adherent to their AEDs. This underscores the importance for healthcare professionals to pay greater attention to improving the adherence rate to AEDs within the healthcare service.

The relationship between stress, anxiety, depression and medication adherence behavior in patients with epilepsy: A cross-sectional study

OBJECTIVE

To investigate the relationships between stress, anxiety, and depression and medication adherence behavior in patients with epilepsy (PEW).

METHODS

A cross-sectional study design was conducted on 235 PEW in the Qazvin's Boo Ali Sian Hospital. Data collection tools included socio demographic and clinical data form, morisky medication adherence scale (MMAS-8), depression anxiety stress scales -21(DASS-21). We used adjusted multivariate logistic regression model for statistical analysis.

RESULTS

A considerable proportion of patients reported mild, moderate, severe and extremely severe symptoms of depression (177 [75/3%]), anxiety (169 [71.9 %]), and stress (158 [67.2 %]). However, 61/8% of the participant had proper medication adherence and 38/3% had poor medication adherence. The results of adjusted multivariate logistic regression showed that in patients who had severe and extremely severe depression and anxiety, the probability of poor medication adherence was higher (P < 0.05). The levels of stress were not significant predictors for medication adherence behavior (P > 0.05).

CONCLUSION

According to this study, severe and extremely severe depression and anxiety can be considered as an important predicting factor in the lack of adherence to antiepileptic medication.

PRACTICE IMPLICATIONS

Healthcare professionals can improve care of patients with PEW by considering patients' mental and psychological health problems in educational, counseling and supportive programs.

Case report: KETOLAND the psychoeducation program for ketogenic diet

Glucose transporter type 1 deficiency syndrome (GLUT1DS) is a rare neurological disorder characterized by a wide spectrum of symptoms: epilepsy, movement disorders and neurocognitive impairment. The gold standard treatment for GLUT1DS are ketogenic dietary therapies (KDTs), specifically classical ketogenic diet (CKD). Despite the benefits, CKD often represents a challenge for patients and their families since meal preparation is extremely demanding and deviates a lot from normal diet. To assure an optimal compliance to CKD a psychological support for parents and patients with GLUT1DS is highly recommended. Specifically, a psychoeducational intervention that ameliorates the knowledge about the illness and its therapy improves treatment' s adherence and efficacy. The aim of this case report is to investigate the effectiveness of a psychoeducational program, partially implemented through telepsychology, based on the theoretical model of Cognitive Behavioral Play Therapy (CBPT) to support KDT knowledge and adherence in a patient with GLUT1DS who presented a worsening of her clinical picture due to a sparse knowledge of KDTs principles which determined a low adherence. Thus, with this case report we propose a model of intervention with psychoeducation in a patient with a complex chronic disease.

Non-Adherence to Antiepileptic Drugs and Associated Factors among Epileptic Patients at Ambulatory Clinic of Southwestern Ethiopian Hospital: A Cross-Sectional Study

BACKGROUND

Non-adherence to anti-epileptic drugs (AEDs) was the most common drug therapy issue that hampered epileptic patients' treatment success. As a result, the barriers to patients adhering to their treatment should be investigated in depth in order to prevent poor treatment outcomes.

METHODS

A hospital-based cross-sectional study was conducted on epileptic patients who had followed up at Mettu Karl Comprehensive Specialized Hospital (MKCSH). Data collection was done through patient interview and medical charts review. Hill-Bone Compliance to High Blood Pressure Therapy Scale was used to measure medication adherence. The data were analyzed using SPSS version 23 after data were entered by Epi Info7.2.1. The multivariable logistic regressions were utilized and P < 0.05 was used to declare association.

RESULTS

Over the study period, more than half of the participants 172 (57.7%) were males, and the median age of participants was 29 years. The magnitude of non-adherence to ant-epileptic drugs (AEDs) was 120 (40.27%). The results of multivariable analysis revealed that patients who had experienced the medication side effects, adjusted odds ratio (AOR) = 2.199; 95% CI: 1.21, 4.00, P = 0.010, a poly-pharmacy, adjusted odds ratio (AOR) = 5.166; 95% CI: 2.63, 10.14, P = <0.001 and the presence of a co-morbidity, adjusted odds ratio (AOR) =3.70; 95% CI: 2.058, 6.65, P = <0.001 were the predictors of medication non-adherence.

CONCLUSION

The magnitude of non-adherences to AEDs was found to be high. Phenobarbitone was the most prescribed AEDs. The number of medications taken by the patients, the presence of co-morbidity and the occurrence of medication side effects had a significant association with non-adherence to AEDs. Therefore, the pharmaceutical care in general and drug information services in particular should be established to enhance medication adherence in our study area.