Adherence to anti-seizure medications among persons living with epilepsy attending a community- based epilepsy clinic in Buikwe and Mukono Districts-Uganda: A mixed methods study

Background: Epilepsy is a common neurological disease especially in Sub-Saharan Africa. Medication adherence is essential in seizure control; however, majority of patients living with epilepsy have poor adherence to anti- seizure medications. The purpose of this study was to determine the prevalence, the factors associated with, and the experiences with adherence to anti-seizure medications among people living with epilepsy attending a community- based epilepsy clinic in Buikwe District and Mukono General Hospital in Mukono District, central-Uganda. Methods and material: In this cross-sectional mixed methods study, 277 participants were enrolled and 20 in-depth interviews were conducted from April to July 2024. Socio-demographics and treatment related information were collected using structured questionnaires. Medication adherence was measured using the standardized 8- item Morisky Medication Adherence Scale. Modified Poisson regression was done to determine factors associated with adherence to anti-seizure medications. Thematic analysis was conducted to explore participant’s experiences with adherence to anti-seizure medications. Results: The overall prevalence of adherence to anti-seizure medications was 66.5%. Factors significantly associated with adherence to Anti-seizure medications were earning a modest monthly income, adjusted prevalence ratios [aPR], (aPR 1.29; CI 1.13-1.53), receiving an inadequate treatment dosage (aPR 0.80; 95% CI 0.64-0.92), waiting for three or more hours at the facility (aPR 0.79: 95% CI 0.61-0.91), and being aged 30 to 34 years (aPR 0.71: CI 0.53-0.95). Key themes describing experiences with adherence to anti-seizure medications included fear of stigmatization, fear of injury and loss of life, social support, financial burden, individual motivation, misconceptions about anti-seizure medications, and limited awareness about their effectiveness. Conclusion: This study revealed that about two- thirds of people living with epilepsy were adherent to anti-seizure medications. There is a need to implement strategies such as incorporating a medication adherence tool into routine patient care to improve adherence in our settings.