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ASSESMENT OF FACTORS ASSOCIATED TO POOR TREATMENT OUTCOMES AMONG EPILEPTIC PATIENTS TAKING ANTI EPILEPTIC MEDICATIONS AT SHAMBU GENERAL HOSPITAL, NORTH WEST ETHIOPIA
Dinka Dugassa*, Dawit Simegnew and Dr Gemechis Melaku
Background: Epilepsy is one of the most prevalent neurological disorders that can be effectively prevented and treated at an affordable cost. Adherence to AED therapy is critical for effective disease management, yet adherence and persistence rates are low due to several barriers. No adherence to treatment is one factor, which affect treatment outcome. A significant association was seen among some of the commonly reported triggering factors for epileptic patients. Objective: To assess treatment outcomes and associated factors for poor treatment outcomes among patients taking AEDs at Shambu General Hospital, North West Ethiopia Methods and patients: A hospital based retrospective cross – sectional study was conducted from October 24 to December 9, 2016, through patient interview and patient chart review to assess the level of poor treatment outcome and influencing factors in epilepsy patients on AEDs attending at Shambu General Hospital. Samples of 132 patients were selected to gather a required data and convenient sampling technique was used. Structured standard interview questionnaires were prepared to collect data and data analysis was done using tally, pen, pencil and papers manually. Pre-testing of the questionnaire was done on 10 patients. Verbal consent from participants was taken before the interview. Result: One hundred fourteen (86.4%) were reported one or more triggering factors that can increase their seizure attacks. The most common triggering factors were emotional stress (97.4%), sleep deprivation (78.1%), missing meal (29.8%), missing medication (21.9%), and noise (15.5%) as reported by the patients. Fifty-nine patients (44.7%) had poor seizure control. Seventy one patients (53.8%) were classified as non-adherent to medication. The major reasons for non-adherence were as a result of forgetfulness (73.2%), Feeling sick/side effects (60.6%), being away from home (The schedule of their work makes it impossible) (26.8%), and Poly-pharmacy (Drugs are too many) (22.5%).Therefore there is significant association between level of adherence (P=0.001), number of seizure attacks before AEDs initiation (p=0.028), EEG (neurologic abnormality) (p=0.04) and age at onset of seizure (diagnosis) (p=0.026). There is no significant association between brain injury (p=0.61) and epilepsy treatment outcome. Conclusion: Assessment of adherence should be a routine part of management of epilepsy to identify modifiable factors that could be acted on to improve seizure treatment outcome. Poor adherence to prescribed medication is considered to be the main cause of unsuccessful drug treatment for epilepsy. The major reasons for non-adherence with their descending order were as a result of forgetfulness, Feeling sick/side effects, being away from home (The schedule of their work makes it impossible), Poly-pharmacy (Drugs are too many). The most common triggering factors were: emotional stress, sleep deprivation, missing meal, missing medication, and noise. There is significant association between level of adherence, number of seizure attacks before AEDs initiation, EEG (neurologic abnormality) and age at onset of seizure (diagnosis). There is no significant association between brain injury and epilepsy treatment outcome. Recommendation: The health professionals working at Shambu Hospital should prepare some interventions to improve adherence to anti-epilepsy medications. There should be assessment of seizure triggering factors and inform the patient so that they can avoid those triggering factors to increase their quality of life by reducing/eliminating seizure. Since there is no research done on this topic in the country specifically in Shambu Hospital, further studies are needed.[Full Text Article]