Ibinda Fredrick, Odermatt Peter, Kariuki Symon M, Kakooza-Mwesige Angelina, Wagner Ryan G, Owusu-Agyei Seth, Masanja Honorati, Ngugi Anthony K, Mbuba Caroline K, Doku Victor C K, Neville Brian G, Sander Josemir W, Newton Charles R J C
Centre for Geographic Medicine Research (Coast) Kenya Medical Research Institute Kilifi Kenya.
Studies of Epidemiology of Epilepsy in Demographic Surveillance Systems (SEEDS)-INDEPTH Network Accra Ghana.
Epilepsia Open. 2017 Mar 30;2(2):226-235. doi: 10.1002/epi4.12052. eCollection 2017 Jun.
The epilepsy treatment gap is large in low- and middle-income countries, but the reasons behind nonadherence to treatment with antiepileptic drugs (AEDs) across African countries remain unclear. We investigated the extent to which AEDs are not taken and associated factors in people with active convulsive epilepsy (ACE) identified in cross-sectional studies conducted in five African countries.
We approached 2,192 people with a confirmed diagnosis of ACE for consent to give blood voluntarily. Participants were asked if they were taking AEDs, and plasma drug concentrations were measured using a fluorescence polarization immunoassay analyzer. Information about possible risk factors was collected using questionnaire-based clinical interviews. We determined factors associated with nonadherence to AED treatment in children and adults, as measured by detectable and optimal levels, using multilevel logistic regression.
In 1,303 samples assayed (43.7% were children), AEDs were detected in 482, but only 287 had optimal levels. Of the 1,303 samples, 532 (40.8%) were from people who had reported they were on AEDs. The overall prevalence of nonadherence to treatment was 63.1% (95% confidence interval [CI] 60.5-65.6%) as measured by detectable AED levels and 79.1% (95% CI 73.3-84.3%) as measured by optimal AED levels; self-reported nonadherence was 65.1% (95% CI 45.0-79.5%). Nonadherence was significantly (p < 0.001) more common among the children than among adults for optimal and detectable levels of AEDs, as was the self-reported nonadherence. In children, lack of previous hospitalization and learning difficulties were independently associated with nonadherence to treatment. In adults, history of delivery at home, absence of burn marks, and not seeking traditional medicine were independently associated with the nonadherence to AED treatment.
Only about 20% of people with epilepsy benefit fully from antiepileptic drugs in sub-Saharan Africa, according to optimum AEDs levels. Children taking AEDs should be supervised to promote compliance.
低收入和中等收入国家的癫痫治疗缺口很大，但非洲各国抗癫痫药物（AED）治疗依从性差的原因尚不清楚。我们调查了在五个非洲国家进行的横断面研究中确诊的活动性惊厥性癫痫（ACE）患者未服用AED的程度及相关因素。
我们联系了2192名确诊为ACE的患者，征得他们自愿献血的同意。询问参与者是否正在服用AED，并使用荧光偏振免疫分析仪测量血浆药物浓度。通过基于问卷的临床访谈收集有关可能风险因素的信息。我们使用多水平逻辑回归确定了儿童和成人中与AED治疗不依从相关的因素，以可检测水平和最佳水平衡量。
在检测的1303份样本中（43.7%为儿童），482份检测到AED，但只有287份达到最佳水平。在这1303份样本中，532份（4
