Assessment of Health-Related Quality of Life, Treatment Outcome, Medication Adherence, and Associated Factors among Epileptic Patients at Meklle City Hospitals: A Multicentre Observational Study.
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Date
2024-07
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Publisher
Addis Ababa University
Abstract
Background: Epilepsy is a chronic brain disorder with unpredictable treatment responses and
a substantial impact on the patient's health-related quality of life (HRQoL). Understanding the
treatment response and its determinants, patient's HRQoL, and medication adherence is crucial
for designing an optimal treatment strategy for individuals living with epilepsy. However, there
is no/limited data about HRQoL, treatment outcomes, and medication adherence in people
living with epilepsy in the study settings.
Objective: This study aimed to assess the HRQoL, treatment outcome, medication adherence,
and associated factors among epileptic patients; at three selected hospitals in Mekelle City,
Tigray, Ethiopia.
Methodology: A multicenter observational study was conducted from May 10 to September
27 2023 G.C. Study participants were selected through stratified systematic random sampling.
The HRQoL and medication adherence were evaluated using the Euro Quality of Life (Euro-
QoL) questionnaire and the 8-item Morisk medication adherence scale (MMAS-8). Data
analysis was done through STATA version 14. Mann-Whitney U test, Kruskal Wallis H test,
tobit regression model, and logistic regression were used to analyze the data. Statistical
significance was declared at a 95% Confidence Interval (CI) and p-value of <0.05.
Results: A total of 351 study participants with a mean (±SD) age of 37.98 ±14.27 years were
involved. More than half (179,51%) of the study participants had poor HRQoL, and the median
(IQR) values for EQ-5D-5L utility and EQ-VAS of the study participants were 0.774 (0.56-
0.85) and 65 (50-80), respectively. Age over 60 years (β = -0.21, 95% CI = -0.402, -0.017), and
frequent seizure episodes before treatment (β =-0.0054, 95% CI: -0.0102- 0.006) were
negatively associated with HRQoL. On the other hand, the absence of co-morbidities (β =
0.095, 95% CI: 0.012 -0.178) and not experiencing seizure remitting-relapsing (β = 0.062, 95%
CI: -0.0007- 0.125) were positively associated with HRQoL. More than one-third (39%) of the
study participants had poorly controlled seizures with one out of five epileptic patients having
seizure relapse. Living in urban areas (AOR=3.36, 95% CI; 1.1-10.4, p=0.037), being
government-employed (AOR= 4.0, 95% CI; 1.1-14.5, p=0.035), and a student (AOR=4.0, 95%
CI; 1.1-14.5, p=0.035) were factors significantly associated with good seizure control. In
addition, half (50.6%) of the study participants were non-adherent to their medications, and
being a farmer (AOR=4.2, 95% CI: 1.5-11.3, p=0.005), housewife (AOR=4.9, 95% CI: 1.4-
17.2, p=0.012), absence of co-morbidities (AOR=1.8, 95% CI: 1.11-11.28, p=0.008), and good
seizure control (AOR=2.38, 95% CI: 1.55-3.71, p<0.001) were factors significantly associated
with AED treatment adherence.
Conclusion: More than half of the study participants had poor HRQoL, with
anxiety/depression being the most frequently reported health problem. More than one-third of
the study participants had poorly controlled seizures, and one out of five epileptic patients
experienced seizure remission-relapse. In addition, half of the study participants were non-
adherent to their medications.
Description
Keywords
Antiepileptic drugs, Morisk Medication Adherence Scale, Health-related Quality of Life, seizure control, Euro-Qol, utility.