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Adherence to Iron Chelation Therapy Among Children with Beta Thalassemia Major: A Multicenter Cross-Sectional Study
Thamron Keowmani1, Siew Chin Teo1, Kuan Chau Yap2
1Pharmacy Department, Hospital Wanita Dan Kanak-Kanak Sabah, Sabah, Malaysia.
Insights
Non-adherence to iron chelation therapy (ICT) is prevalent in Malaysian children with beta-thalassemia major, particularly those on subcutaneous medications. Improving patient knowledge and considering administration routes can enhance adherence to ICT.
Area of Science:
- Hematology
- Pharmacology
- Public Health
Background:
- Adherence to iron chelation therapy (ICT) is critical for managing thalassemia but remains a significant challenge.
- Beta-thalassemia major requires lifelong ICT to prevent iron overload complications.
Purpose of the Study:
- To determine the prevalence of non-adherence to ICT among children with beta-thalassemia major in Malaysia.
- To identify factors associated with non-adherence to ICT in this patient population.
Main Methods:
- A cross-sectional study was conducted from November 2019 to November 2021 in seven Malaysian tertiary hospitals.
- Adherence was assessed using pill counts and self-reported data, alongside a knowledge questionnaire.
- A decision tree analysis was employed to identify predictors of non-adherence.
Main Results:
- The prevalence of non-adherence to ICT was 47.5% for patients on subcutaneous ± oral medications and 21.1% for those on oral medications only.
- The median knowledge score regarding thalassemia and ICT was 67.5%.
- Key factors associated with non-adherence included the route of ICT administration and the patient's knowledge score.
Conclusions:
- Non-adherence to ICT is higher in children receiving subcutaneous ± oral medications compared to oral medications alone.
- Patient knowledge about thalassemia and ICT significantly influences adherence rates.
- Interventions should focus on improving patient education and optimizing ICT administration routes.
Background:
Adherence to iron chelation therapy (ICT) remains an issue among thalassemia patients. This study aimed to determine the prevalence of non-adherence to ICT among children with beta thalassemia major in Malaysia and the factors associated with it.
Methods:
This was a cross-sectional study conducted between November 2019 and November 2021 at seven tertiary hospitals in Malaysia. Participants registered with Malaysian Thalassemia Registry were recruited by convenience sampling. Adherence was measured via pill count and self-reported adherence. Knowledge about thalassemia and ICT was measured using a questionnaire from Modul Thalassemia by Ministry of Health of Malaysia. A decision tree was used to identify predictors of non-adherence.
Results:
A total of 135 patients were recruited. The prevalence of non-adherence to ICT in those who took subcutaneous ± oral medications was 47.5% (95% CI: 31.5%, 63.9%) and the prevalence of non-adherence to ICT in those who took oral medications only was 21.1% (95% CI: 13.4%, 30.6%). The median knowledge score was 67.5% (IQR 15%). A decision tree has identified two factors associated with non-adherence. They were ICT's route of administration and knowledge score. Out of 100 patients who were on oral medications only, 79 were expected to adhere. Out of 100 patients who were on subcutaneous ± oral medications and scored less than 56.25% in knowledge questionnaire, 86 were expected to non-adhere. Based on the logistic regression, the odds of non-adherence in patients who took oral medications only was 71% lower than the odds of non-adherence in patients who took subcutaneous ± oral medications (OR = 0.29; 95% CI = 0.13, 0.65; p = .002).
Conclusion:
The prevalence of non-adherence to ICT among children with beta thalassemia major in Malaysia was 20/95 (21.1%) in those who took oral medications only and the prevalence of non-adherence was 19/40 (47.5%) in those who took subcutaneous ± oral medications. The factors associated with non-adherence were ICT's route of administration and knowledge score.
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