Empowering Local Primary Health Care to Improve Antiepileptic Drugs (AEDs) Adherence among Children with Epilepsy in Outreach District of Pakistan

Abstract

Introduction: There is a dearth of data on effectiveness-assessment of community interventions regarding the adherence improvement among children with epilepsy (CWE) in outreach financially-poor settings. This study was therefore designed to determine impact of integration of childhood epilepsy into primary care to improve the level of adherence to antiepileptic drugs and the factors that are associated with non adherence. Objectives: This study was designed to determine the effectiveness of interventions through free community childhood epilepsy center aimed at improving adherence to antiepileptic medication in CWE in an outreach financially constrained district. Methods: During this interventional study, 240 children (160 children being treated and followed in the free community primary care childhood epilepsy center and 80 children not being treated at this center) aged 4 months to 18years, diagnosed with epilepsy and treatment initiated with at least 1 AED for the past 3 months, were selected for data collection. The childhood epilepsy camps were held at local community centres provided open access, and no user fees or charges for medication were made. Local physicians, who were provided with special training and visiting paediatric neurology fellows carried out screening to help the three visiting paediatric neurologists confirming the diagnoses for data collection. Data was collected by a questionnaire divided into three parts: 1) demographical information about patients 2) information about medication adherence profile using the Morisky Medication Adherence Scale-8 (MMAS-8), and 3) data on intervention-effectiveness of the community childhood epilepsy center (CCEC) on antiepileptic drug adherence. Ethical approval was obtained from the institutional ethics committee. Results: Among the 240 children and adolescents with epilepsy who fulfilled the inclusion criteria, 160 (66.6%) reported seeking treatment from TDBUCEC and 80 (33.4%) were seeking AED(s) from other sources. Age range was 04 months – 18 years while male to female ratio was 1.26:1. Adherence to antiepileptic drugs by self-report was found to be 85% (was 42% in 2014 without community intervention) among the children being treated, provided free AEDs with consultations and followed at the epilepsy center, whereas adherence was 37.5% among the children not being intervened by this center. There was no statistical difference in age and gender among these two groups. Conclusion: Majority of children had good adherence levels when supported and given free treatment in their own community. The best intervention strategy to improve adherence to antiepileptic medication among CWE is integration and implementation of childhood epilepsy in primary health care to provide free uninterrupted anti-epilepsy drugs (AEDs) and pediatric epilepsy consultations in outreach resource-constrained districts in Pakistan.