Adherence to antiepileptic drugs among children attending a tertiary health unit in a low resource setting

Interventions to promote medication adherence among children with epilepsy: An integrative review

PROBLEM

Many children with epilepsy face challenges in adhering to their medication, leading to inadequate seizure control. However, the most effective intervention is still unclear. This integrative review's main goal was to examine and synthesize the existing literature on interventions for promoting medication adherence in children with epilepsy.

ELIGIBILITY CRITERIA

This integrative review followed Whittemore and Knafl's five-stage framework. Four electronic databases (PubMed, ScienceDirect, Scopus, and CINAHL Complete) were systematically searched from 2013 until 2024 to identify eligible studies published in the English language. The key search terms included "Children with epilepsy" AND "medication adherence" AND "intervention." Studies reporting on the implementation and evaluation of medication adherence interventions in children with epilepsy were eligible. Quality assessment and narrative synthesis were subsequently undertaken.

SAMPLE

A total of 17 studies were included in the review.

RESULTS

Five interventions were found, including educational, behavioral, and mixed intervention types, using technology and family involvement. Promoting medication adherence is crucial, but tailored interventions for different age groups and sustained support are needed.

CONCLUSIONS

Promoting medication adherence is of utmost importance to enhance the knowledge of children who have epilepsy and their families, and to increase medication adherence. However, there is still a need to develop interventions that are appropriate for children of different ages and their families, which should be suitable and sustainable during treatment.

IMPLICATIONS

Pediatric nurses should consider socioeconomic factors, ethnicity, family functioning, and parental distress. Strategies include monitoring adherence, continuous communication, and technology support for children with epilepsy during treatment.

Prevalence of anti-seizure medication nonadherence and its associated factors, among people with epilepsy in North Shewa, Ethiopia, 2021

BACKGROUND

Epilepsy is a worldwide neurologic illness, characterized by recurrent unprovoked epileptic seizures and can affect people of all age groups. Patients who are receiving drug therapy for chronic diseases, such as epilepsy, must fit complex medication regimens into their everyday routines. Managing medication schedules may pose a significant burden on patients' lives. Anti-seizure medication choices should therefore be tailored to patients' factors that may limit medication use. The study aimed to determine the prevalence and Predictors of anti-seizure medication nonadherence among patients with epilepsy.

METHODOLOGY

An institutional-based cross-sectional study was conducted among 352 people with epilepsy who were selected by systematic random sampling method at government hospitals in North Shewa Ethiopia. Data were collected by reviewing patients' charts and interviewing people with epilepsy by using structured and pretested questionnaires. Data obtained were encoded into EPI-INFO software and exported to SPSS version 25 for analysis. Logistic regression was employed to assess independent factors associated with medication non-adherence.

RESULT

The prevalence of anti-seizure medication non-adherence was 40%. Being female [AOR = 3.37, 95%, CI: 1.84, 6.18], Divorced [AOR = 9.13, 95%, CI: 1.80, 46.34], Being jobless [AOR = 7.33, 95%, CI: 3.24, 16.56], Perceived poor social support [AOR = 2.73, 95%, CI: 1.28, 5.82], perceived stigma [AOR = 5.07, 95%, CI: 2.40, 10.68], polytherapy [AOR = 2.23, 95%, CI: 1.06, 4.71], drug side effects[AOR = 6.03, 95%, CI: 3.17, 11.45], buying medications [AOR = 5.81, 95%, CI: 3.63,16.79] and duration of stay on treatment [AOR = 4.31, 95%, CI: 1.863, 9.97] were significant predictors of anti-seizure medication non-adherence.

CONCLUSION

Non-adherence to anti-seizure medication among people with epilepsy in the study area was relatively higher as compared with study reports from different parts of the country. Health and clinical, socio-economy, and patients' psychological mindset were among the determinant factors affecting the consistency of epilepsy treatment adherence. Enhanced professional, health education for patients as well as for society and financial support, are basic pillars to reduce the constraints of effective treatment.

Adherence to anti-seizure medications and associated factors among children with epilepsy at tertiary Hospital in Southwest Ethiopia: a cross-sectional study

BACKGROUND

Childhood epilepsy causes a tremendous burden for the child, the family, society as well as the healthcare system. Adherence to anti-seizure medications (ASMs) is a key to treatment success. Poor adherence has been considered as one of the main causes of unsuccessful treatment for epilepsy and presents a potential ongoing challenge for achieving a key therapeutic goal of seizure control.

METHODS

A facility-based cross-sectional study design was conducted among children with epilepsy attending the Pediatrics neurology follow up clinic of Jimma Medical Center from June- 21 to September- 20, 2021. Data were collected by using a semi-structured pre-tested questionnaire. Epidata version 3.1 and SPSS version 26.0 were used for data entry and analysis respectively. Descriptive statistics and binary logistic regression analysis were employed. Adjusted odds ratios were used to ascertain effect sizes for any association between the dependent and associated variables while significance level at p-value of < 0.05 was determined using 95% confidence intervals.

RESULT

A total of 170 children with epilepsy were included in this study. About 54.7% were male and 44.7% were in age range of 10-17 years. The overall adherence to anti-seizure medications was 54.1%. Those caregivers who were married [AOR = 7.46 (95% CI = 1.46, 38.20)], those children with controlled seizure status [AOR = 3.64 (95% CI = 1.51, 8.78)], those who got appropriate health care [AOR = 7.08(95% CI = 2.91, 17.24)], those caregivers who had good knowledge [AOR = 5.20(95% CI = 2.60,14.83)]; and positive attitude [AOR = 2.57 (95% CI = 1.06, 6.28)] towards epilepsy were significantly associated with adherence to anti-seizure medications.

CONCLUSIONS

More than half of the children/adolescents having epilepsy were adherent to their anti-seizure medication(s). Children's adherence to anti- seizure medications was influenced by current marital status of the parents/caregivers, controlled seizure status, getting appropriate healthcare in the hospital, caregiver's knowledge; and attitude towards epilepsy. More efforts are required to scale up the provision of client-centered service (provision of appropriate health care delivery, focus on quality of treatment and providing health education/counseling to improve caregivers' knowledge and attitude towards epilepsy) to improve children's adherence status to their medication(s) and seizure control status.

The Influence of Parents on Medication Adherence of Their Children in China: A Cross-Sectional Online Investigation Based on Health Belief Model

Objective

To explore the influence of parents on the medication adherence of their children.

Study Design

A cross-sectional online investigation.

Methods

A questionnaire with 41 questions was designed based on the health belief model (HBM) distributed and collected online in 28 cities around China through multi-stage stratified sampling. The reliability of the questionnaire was assessed with Cronbach's α coefficient and split-half reliability, and its validity was evaluated with exploratory factor analysis and content validity index. The structural equation model (SEM) was constructed to explore the relationship between the parents' health beliefs and their children's medication adherence. Subgroup analysis was conducted to study the differences between parents with different demographic characteristics (male and female, rural and urban).

Results

573 questionnaires were included for analysis, with an effective rate of 62.97%. The Cronbach'α coefficient of the questionnaire was 0.821 > 0.6, the split-half reliability was 0.651 > 0.6, the I-CVI of each dimension were >0.78, and the S-CVI/AVE (I-CVI average) was 0.95 > 0.9. The result of the questionnaire exploratory factor analysis met the standard. According to the SEM, self-efficacy (λ = 0.177), perceived susceptibility (λ = −0.244), and perceived severity (λ = 0.243) were direct influencing factors of children's medication adherence. In the subgroup analysis, the model established by each subgroup was consistent with the model established by the overall sample. The absolute values of females' perceived susceptibility, severity, and self-efficacy for their children's medication adherence path coefficients were higher than males'.

Conclusion

Parents' perceived severity and self-efficacy may positively impact on their children's medication adherence, while parents' susceptibility to children's medication non-adherence may negatively impact on children's medication adherence. Objective constraints, perceived barriers, and benefits may in directly impact on children's medication adherence. Women's health beliefs appear to have a more significant impact on their children's medication adherence than men's. It may be an effective strategy to increase their children's medication adherence by improving parents' health beliefs. Medical staff should explain medication adherence knowledge to the parents of children, and inform the children of the possible consequences of non-adherence with medication, to improve the subjective perception of parents on the severity of children's non-adherence with medication, and improve parents' self-efficacy in rational medication for children. In addition, attention should be paid to the mental health of the parents, and more social and psychological support.

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

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 1^st to August 30^th, 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.

The prevalence and major determinants of non-compliance with anti-seizure medication among children

Background: A wide range of adherence to the use of anti-seizure medications has been reported among children with the disease, and accordingly, various factors on the degree of adherence to the drug have been reported. But in our society, there is no clear picture of drug adherence and related factors among children with seizures. We evaluated the frequency of adherence to anti-seizure medication as well as related factors. Methods: This cross-sectional study was conducted on 120 children with epilepsy who referred to Ali Asghar Hospital in Tehran, Iran, during 2019 and 2020. Along with demographic characteristics, adherence to antiepileptic medications was assessed by the Modified Morisky Scale (MMS). Results: The overall frequency of adherence to anti-seizure medications among children was reported to be about 41.7%. Among all baseline characteristics, much higher adherence was revealed in patients with educated parents. The rate of drug adherence in children with a history of perinatal morbidities was much lower than in other patients. The type of seizure could also affect the rate of drug adherence as the highest and the lowest adherence was found concerning focal impaired awareness seizure (57.1%) and atonic seizures (11.1%) indicating a significant difference (P = 0.022). The most common causes of non-adherence to treatment were expressing inability to treat the patient (23.0%), parents' forgetfulness to give medicine to the child (18.3%), and not taking medication when traveling or leaving home (16.7%). Conclusion: The lower level of education of the parents, type of seizure, as well as the presence ofunderlying perinatal morbidity in the child can predict non-compliance with anticonvulsant medication regimens among affected children.

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.

Barriers to biomedical care for people with epilepsy in Uganda: A cross-sectional study

OBJECTIVE

Epilepsy, a neurological disorder with effective biomedical treatment, remains largely untreated in Uganda. Potential reasons for this treatment gap (TG) include limited access to trained providers and clinics, social stigmata of seizures, cultural beliefs, or lack of public understanding of epilepsy as a treatable condition. The current study aimed to formally evaluate barriers faced by people with epilepsy (PWE) in Uganda when seeking biomedical care.

METHODS

In a cross-sectional study, 435 participants drawn from a community prevalence study were enrolled. We included participants reporting a history of recurrent seizures suggestive of epilepsy, who completed a survey about barriers to obtaining care for their symptoms. Principal axis factor analysis (PFA) using a promax rotation was conducted for data reduction. Frequencies of barrier factors were compared across those who did not seek care for epilepsy (n = 228), those who sought care from biomedical facilities (n = 166), and those who sought care from a traditional or pastoral healer (n = 41).

RESULTS

The PFA yielded a five-factor solution: 1) logistical and actual costs; 2) treatment effectiveness; 3) influence of the opinion of others; 4) doctors' care; and 5) contextual factors impacting decision-making. Variables related to logistical and actual costs were most endorsed. Comparison of groups by care sought did not reveal a difference in endorsement of factors, with the exception that those who sought biomedical care were more likely to endorse factors related to doctors' care compared with those that sought care from traditional or pastoral healers (P = .005).

CONCLUSIONS

People with repetitive seizures in Uganda report several barriers to obtaining biomedical care in Uganda, with those related to practical and actual costs endorsed the most. It is imperative that interventions developed to reduce the TG in Uganda consider these practical issues to improve access to effective epilepsy care. This article is part of the Special Issue "The Intersection of Culture, Resources, and Disease: Epilepsy Care in Uganda.

Prevalence of medication adherence and factors influencing adherence to antiepileptic drugs in children with epilepsy from western China: A cross-sectional survey

PURPOSE

The purpose of the study was to evaluate adherence to prescribed antiepileptic drugs (AEDs) and influencing factors in children with epilepsy from western China.

METHODS

In this cross-sectional study, children with epilepsy were recruited from Western China Second Hospital. Questionnaires were used to collect baseline patient data and medication adherence, which was assessed using the Morisky scale. An ordinal logistic regression model was used to examine the factors affecting medication adherence.

RESULTS

In total, 399 children were included. The age of participants ranged from 0.3 to 17.8 years, with a male-to-female ratio of 1.36:1. Overall, 57.1% (228/399) had generalized seizures. Further, 21.3% (85/399) patients showed good adherence, 51.4% (205/399) moderate adherence, and 27.3% (109/399) poor adherence. Ordered multiclassification logistic regression analysis showed that the age of patient, type of epilepsy, total household income, and source of drug information were associated with adherence.

CONCLUSIONS

Medication adherence is not high in children with epilepsy from western China. Medication adherence is affected by many factors, and we suggest that efforts are focused on tailored approaches to epilepsy education and behavioral interventions for better adherence.

The prevalence rates of medication adherence and factors influencing adherence to antiepileptic drugs in children with epilepsy: A systematic review and meta analysis

OBJECTIVE

We conducted a systematic review to assess antiepileptic drug (AED) adherence rates, and to identify the characteristics associated with nonadherence in children.

METHODS

We searched PubMed, EMBASE, and the Cochrane Library from inception to June 2017. Observational studies addressing medication adherence or examining factors influencing AED adherence were included.

RESULTS

We included 22 studies, involving 3955 participants. The general quality of included studies were rated as high quality. Adherence rates were reported in 18 studies, varying between 22.1% and 96.5%. Meta analysis of 13 studies (n = 2051) revealed a pooled adherence rate assessed by objective methods of 58% (95% CI [0.46, 0.74]). Meta analysis of nine studies (n = 1217) revealed a pooled adherence rate assessed by subjective Methods of 73%, (95% CI [0.63, 0.85]). Family support, smaller family size, stable parental marriage status, support from healthcare providers and higher family socioeconomic status were associated with better medication adherence. However, contradictory results were found regarding the effects of age, the frequency of seizure, type of seizures, type of medication and the number of administered drugs.

CONCLUSIONS

Adherence to AEDs is challenging for pediatric patients with epilepsy. Few factors which influence adherence can be drawn because of differing variables and results. Future prospective research should be designed with longer study periods and larger samples in naturalistic settings.

Health service provision for people with epilepsy in sub-Saharan Africa: A situational review

BACKGROUND

Epilepsy is a public health issue in sub-Saharan Africa (SSA) where many people with the condition receive no treatment. Health-care services for epilepsy in this region have not been comprehensively assessed. We examined key features of epilepsy health services provided in SSA.

METHODOLOGY

This was a scoping review conducted using pre-specified protocols. We implemented an electronic search strategy to identify relevant citations using PUBMED, EMBASE, Web of Science, Scopus, Cumulative Index to Nursing and Allied Health Literature (CINAHL), African Index Medicus (AIM), Open Grey, Cochrane database, and Google Scholar. Articles eligible for full-text review were screened and data of interest were reported.

RESULT

The search identified 81 eligible articles, forty-nine from East Africa, 19 from West Africa, 8 from South Africa, and 5 from Central Africa. A variety of care services were identified, with reporting of rural epilepsy care in 75% of retrieved articles mainly from East and South African countries. The majority of the rural epilepsy clinics were health worker- or nurse-led, reporting good seizure control in about two-thirds of patients using phenobarbital as the most commonly prescribed antiepileptic drug. Funding for rural epilepsy care came mainly from external donor agencies.

CONCLUSION

We attempted to provide a 'snapshot' of epilepsy care services in SSA. The successes achieved in some of the centers are due to the use of existing primary health-care systems and employing non-physician health-care personnel. The true picture of epilepsy care coverage is not apparent due to the lack of data and proper health system structure in most parts of SSA. As more individuals begin to receive care, the long-term funding for epilepsy care in African countries will depend on the commitment of their respective governments.

Interviewing and Urine Drug Toxicology Screening in a Pediatric Pain Management Center: An Analysis of Analgesic Nonadherence and Aberrant Behaviors in Adolescents and Young Adults

OBJECTIVES

Many adolescents and young adults report having chronic pain. Urine drug toxicology (UDT) is not routinely used in the pediatric pain management population, despite more routine use in adults with pain, particularly those prescribed opioids. As a first step toward establishing monitoring practices in pediatric and adolescent pain management, the present study evaluated the role of UDT in conjunction with a standard clinical interview in identifying the rate of adherence to an established analgesic regimen. The study also aimed to assess the use of UDT in identifying possible aberrant behaviors in this population.

METHODS

Data were acquired from a convenience sample of 50 pediatric and adolescent pain management initial consultations, during which a clinical interview and UDT were conducted. Data were analyzed to determine adherence to an established analgesic prescription regimen, and for identification of aberrant behaviors including concurrent use of illicit substances and prescription medication misuse. Other pertinent demographic and clinical factors were examined as factors in adherence.

RESULTS

Opioid medications were prescribed for 42% of the sample receiving pain medications, and 22% of the sample was nonadherent to their prescription analgesic regimen. Factors associated with a higher likelihood of nonadherence were an older age and having an opioid prescription. The majority (90%) of those nonadherent to their analgesic regimen displayed some form of aberrant behavior. Among the nonadherent patients, 50% were identified by UDT alone, and 50% were identified by self-report during the clinical encounter.

CONCLUSIONS

These results highlight the challenges of identifying nonadherence to a prescription regimen among adolescents with chronic pain. In addition, this preliminary work suggests that UDT could be used in conjunction with careful clinical interviewing to substantiate patient report and increase the likelihood of detecting analgesic nonadherence and aberrant behaviors.