Determinants of Adherence to Anticonvulsants Therapy among Outpatient Epileptic Children in a Kenyan Referral Hospital

Abstract

Background: Epilepsy is a chronic disease requiring prolonged adherence to treatment. Adherence to anticonvulsants by epileptic children is important as studies have shown that about two-thirds of epileptic children can be completely freed from seizure if they persistently adhere to treatment for a period of 2-5 years.  Conversely, non-adherence to anticonvulsants may lead to increased frequencies of status epilepticus and sudden unexplained death from epilepsy. There is scant literature on factors impacting on the adherence to anticonvulsants among children.

Objectives: To determine rate of adherence and parents/caregivers’ factors influencing adherence to anticonvulsants among outpatient epileptic children attending neurology clinic.

Methods: Cross-sectional study design was carried out at Kenyatta National Hospital from May to July 2014. Systematic sampling was used to recruit a sample of 176 parents/guardians of children with epilepsy. Predesigned questionnaires and Morisky tool for assessing medication adherence were used to capture participant’s socio-demographics and factors impacting on adherence to antiepileptics.  Data were analysed using STATA software version 10.  Discrete variables were summarized with frequencies and percentages while continuous variables were summarized using measures of central tendency and dispersion.

Results: The rates of adherence, when classified in terms of high, medium and low, were 36.9 %, 39.8 % and 23.3 %, respectively.  Adherence rate was associated with parents/guardian marital status (Adjusted OR= 5.72, 95% CI= (1.50, 21.78), p=0.01) and education level (Adjusted OR=5.16, 95% CI= (1.88, 14.02), p< 0.01). Unavailability and inaccessibility of drugs were also shown to influence adherence.

Conclusion: Adherence to antiepileptic medication was poor.  This was partly due to parents/guardian’s related factors.  Health care workers should explore ways and means of minimising these factors to improve on adherence.

Key words: Adherence, anticonvulsants, epilepsy, children.