Determinants of adherence to anticonvulsant therapy among outpatient epileptic children aged two to twelve years at Kenyatta National Hospital

Abstract

Background: Epilepsy is a chronic disease requiring prolonged treatment with anticonvulsants to control seizures. Adherence to anticonvulsants by epileptic children is crucial but studies from developed countries have shown that adherence of patients to anticonvulsants is averaging at 50 %. Parents/guardians and prescribers of anticonvulsants have a big role in the enhancement of adherence to anticonvulsants among children. Study objective: To evaluate the determinants of adherence to anticonvulsants in outpatient epileptic children aged two to twelve years at neurology clinic in Kenyatta National Hospital. Methods: This study involved 176 epileptic children aged two to twelve years attending neurology clinic, their parents/guardians and 10 attending prescribers. A cross-sectional study design was used. Systematic random and convenience sampling was used to enrol parents/guardians and prescribers respectively. Predesigned questionnaires were used to identify determinants among the participants whereas Morisky tool was used for assessing medication adherence. Results: Among the study patients, there was male predominance at 62.5 %. Rates of adherence to anticonvulsant by epileptic children were found to be 36.9 % for high adherence, 39.8 % medium adherence and 23.3 % low adherence. Adherence was shown to be statistically significantly associated with parents/guardian marital status (p= 0.01, OR= 5.72, CI= 1.5, 21.78), education level (p= 0.001, OR= 5.16, CI= 1.88, 14.02). Lack of time by prescribers due to patient load, assumptions that the patient will adhere and lack of knowledge on the importance of adherence were the major prescriber’s related factors impacting on adherence. Unavailability and inaccessibility of anticonvulsants impacted on adherence because majority of patients could not obtain their medications from Kenyatta National Hospital pharmacy facility at affordable cost. Conclusion: Adherence to anticonvulsants therapy among children was poor due to parents/guardians and prescriber related factors. We recommend these factors to be minimized. Identifying appropriate means so that adherence may be improved