Prevalence and predictors of sub-optimal medication adherence among patients with severe mental illnesses in a tertiary psychiatric facility in Maiduguri, North-eastern Nigeria.

Abdu Wakawa Ibrahim,Shuaibu Yahya,Shehu Sale,Sadique Kwajafa Pindar,Adamu Garkuwa,Musa Abba Wakil

doi:10.11604/pamj.2015.21.39.6664

Abstract

IntroductionSub-optimal adherence constitutes a significant impediment to the management of severe mental illnesses (SMIs) as it negatively impacts on the course of the illness and the treatment outcome. In this study, the levels of adherence, prevalence and the predictors of sub-optimal adherence were assessed in a sub-Saharan African setting.MethodsThree hundred and seventy (370) respondents with diagnoses of schizophrenia, bipolar disorder or severe depression were randomly enrolled and interviewed at the out-patient department of the Federal Neuropsychiatric Hospital, Maiduguri in northeastern Nigeria. An anonymous sociodemographic questionnaire and a clinical proforma designed by the authors, Oslo social support scale and the 8-item Morisky Medication Adherence Scale (MMAS-8) were used for data collection.ResultsThe prevalence of sub-optimal adherence was 55.7%. The independent predictors of sub-optimal adherence were; seeking for traditional/ spiritual treatment (Odds Ratio (O.R.) = 6.523, 95% C.I. = 3.773 - 11.279, P = < 0.001), male gender (O.R. = 3.307, 95% C.I. = 1.907 - 5.737, P = < 0.001), low levels of insight (O.R. = 1.753, 95 C.I. = 1.220 - 2.519, P = 0.002), and low social support levels (O.R. = 1.528, 95% C.I. = 1.097 - 2.129, P = 0.012).ConclusionBased on the outcome of the study, we recommend the development of psycho-educational programmes on adherence and the active involvement of the relations and significant others in the management of patients with SMIs in sub-Saharan Africa.

Highlights

Sub-optimal adherence constitutes a significant impediment to the management of severe mental illnesses (SMIs) as it negatively impacts on the course of the illness and the treatment outcome
The data of 20 respondents were not analyzed due to: refusal to grant informed consent (n=8), comorbid psychoactive substance use (n=5), presence of florid psychopathology, auditory hallucinations and delusions (n=5), and those whose questionnaires could not be analyzed due to missing data (n=2)
Semi-skilled and unskilled workers as well as the unemployed constituted over 60% of the respondents and about 51% were unmarried

Summary

Introduction

Sub-optimal adherence constitutes a significant impediment to the management of severe mental illnesses (SMIs) as it negatively impacts on the course of the illness and the treatment outcome. Conclusion: Based on the outcome of the study, we recommend the development of psycho-educational programmes on adherence and the active involvement of the relations and significant others in the management of patients with SMIs in sub-Saharan Africa. The severe mental illnesses (SMIs) are characterized by a chronic, and sometimes, fluctuating course as well as their association with significant functional impairments/disabilities [1,2,3,4]. Non-adherence to medications is a complex and multidimensional healthcare problem as it constitutes a major obstacle to translating treatment efficacy in research settings into effectiveness in clinical practice [11,12,13]. There can be a profound impact on the cost of care, as well as significant impediments to the patientslong term adaptations, including the social, vocational and academic functioning [17,18]

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Results

Conclusion