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Adherence to anti-seizure medications among pediatric epilepsy patients during the Sudan armed conflict
Aseel Adil Ahmed Abdelhafiz1, Alag Adil Ahmed Abdelhafiz2, Khalid Osman Mohamed3
1Faculty of Medicine, University of Khartoum, Khartoum, Sudan. aseeladelahmed1@gmail.com.
Insights
Pediatric epilepsy patients in Sudan show low adherence to antiseizure medications (ASMs) during conflict, with medication unavailability and transport issues being major barriers. Interventions are urgently needed to improve epilepsy management.
Area of Science:
- Neurology
- Public Health
- Pediatrics
Background:
- Poor adherence to antiseizure medications (ASMs) contributes significantly to breakthrough seizures in epilepsy.
- Evaluating ASM adherence in pediatric epilepsy patients during armed conflict in Sudan is crucial for understanding management challenges.
Purpose of the Study:
- To assess the adherence rates of pediatric epilepsy patients to ASMs amidst armed conflict in Sudan.
- To identify factors influencing medication adherence and challenges faced by caregivers.
Main Methods:
- An observational, analytical cross-sectional study involving pediatric epilepsy patients (≤18 years) in Sudan.
- Data collected via phone interviews using the Medication Adherence Rating Scale (MAR-20) and Pediatric Epilepsy Side Effects Questionnaire (PESQ).
- Statistical analysis included chi-square, Fisher's exact, and Mann-Whitney U tests.
Main Results:
- Only 31.1% of 161 pediatric patients achieved complete ASM adherence; 68.9% were nonadherent.
- Key barriers included medication unavailability (39.1%) and lack of transportation (32.9%).
- Nonadherence was linked to increased seizure frequency and higher reported side effects, particularly cognitive issues.
Conclusions:
- Low ASM adherence rates among pediatric epilepsy patients in Sudan during conflict highlight significant healthcare challenges.
- Economic hardship, displacement, and disrupted medical services impede effective epilepsy management.
- Multifaceted interventions addressing healthcare system barriers and caregiver support are essential.
Background:
Poor adherence to antiseizure medications (ASMs) is responsible for 26-79% of breakthrough seizures. This study was conducted to evaluate the adherence of pediatric patients with epilepsy to their medications during armed conflict in Sudan.
Methods:
An observational, analytical cross-sectional study was conducted among pediatric patients (aged ≤18 years) diagnosed with epilepsy. A systematic random sampling technique was employed, and data were collected through structured phone interviews using the Medication Adherence Rating Scale (MAR-20) and the Pediatric Epilepsy Side Effects Questionnaire (PESQ). Associations between categorical variables were analyzed via the chi-square test or Fisher's exact test. For continuous variables, the Mann‒Whitney U test was used.
Results:
A total of 161 patients were included in this study. 60.9% of the study participants were males, and 39.1% were females. A total of 70.2% of the participants still resided in Sudan during the armed conflict. The mean total score on the MAR scale (MAR-20) was 28.16 (SD = 13.5). Only 31.1% (n= 50) of patients achieved complete adherence to ASMs, whereas 68.9% (n= 111) were nonadherent. The most common challenges cited by caregivers were the unavailability of medications at pharmacies (39.1%) and the lack of transportation (32.9%). Complete adherence was significantly greater among children whose fathers had university degrees or higher (p value = 0.007) and among children who relocated outside Sudan during this armed conflict than among those residing in Sudan (p value = 0.027). Nonadherence was significantly associated with increased seizure frequency (p = 0.001). The mean total PESQ score and the cognitive domain score were significantly greater in nonadherent patients than in adherent patients (p value of 0.026 and 0.026, respectively).
Conclusions:
This study revealed a low rate of adherence to antiseizure medications (ASMs) among pediatric epilepsy patients in Sudan during ongoing conflict. Economic hardship, displacement, and disrupted medical services significantly hinder effective epilepsy management. There is an urgent need for multifaceted interventions that address both healthcare system barriers and caregiver support.
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