This ambidirectional cross-sectional study involved a total of 168 eligible epilepsy patients. Of the total participants, 132 (78.6%) patients were adherent to their ASMs. Similarly, a high adherence level was reported in studies done by Gizachew Kassahun (65.9%) [12], Tefera Abula (70%) [17], and Melak Gedamu [4] in Ethiopia. Collin A. Hovinga et al. from United States (71%) [18], and Sunday O. Ogundele from Lagos (64.7%) [11], had also reported similar finding. However, other studies from Ethiopia (36.5.4%) [19], and Nigeria (32.6%) [20], reported a relatively lower proportion of adherence. This variation of the result may be due to difference in the data collection method or sample size employed.
Among factors assessed for association with the level of ASM adherence in this study, age, occupation, educational level, history of brain injury, presence of seizure triggering factor(s), multiple ASM use, complaint of ASM-related undesirable effects, and presence of seizure recurrence were significantly associated with adherence. Similar studies from Ethiopia [4, 12, 13], and a study by Sunday O. Ogundele from Lagos [11], reported educational level as one of the factors associated with the level of ASM adherence. The reason why educational status was associated with adherence might be due to the fact that 63.1% of the patients in this study had no formal education. The association of adherence with complaint of ASM-associated undesirable effects may also be explained by the fact that 70.8% of participant were not complained the effect. Similar finding was reported by studies from Ethiopia [4, 12], and other study from Sudan [10].
The other significant association was observed between adherence and multiple ASM use. This finding is corroborated by results of the studies from Ethiopia [3, 4], and other study conducted in Sudan [10]. This association could be explained in terms of reluctance to take drugs properly as the number of drugs increased. Moreover, patients may experience more adverse drug events with increased number of medications which can also negatively affect the adherence rate.
In patients with epilepsy, proper diagnoses and treatment can make an estimated 70% of them seizure-free. Despite this, about three-quarters of epilepsy people in low-income countries do not get the treatment needed [1]. In our study, seizure recurrence was identified in 71.4% of the epilepsy patients. Similar previous studies from Tikur Anbessa Specialized Hospital [3], Mizan-Tepi University Teaching Hospital [7], Ambo hospital [6], and Ayder comprehensive specialized hospital [5] reported seizure recurrence in 65.6%, 60.8%, 44.7%, and 53.4% of patients, respectively. The higher proportion of seizure recurrence seen in the region could be due to poor community knowledge and awareness [21], lack of health care professionals training to recognize, diagnose and treat epilepsy, and problems with the availability of ASMs in the region [1].
In the management of epilepsy, ASM-associated undesirable events frequently hinder adequate seizure control and cause other disastrous impacts on the patient [22]. This had also been corroborated by the findings of our study in which higher probability of seizure recurrence was seen in those epilepsy patients complained ASM-associated undesirable events than those who didn`t complain. This could potentially be related to the patients’ tendency to stop taking ASMs because of the undesirable effects they experience. The presence of seizure triggering factors is also another reason affecting seizure threshold in epilepsy [23, 24]. Avoiding or modifying these factors could allow ASM therapy to work better resulting in seizure control.
On the contrary, our study identified a lower likelihood of seizure recurrence in those epilepsy patients with triggering factors as compared to their counterparts. This could be related to potential underreporting of triggering factors in those who didn`t reported due to fear of being blamed or could be due to other factors raising the seizure threshold in those epilepsy who reported and vice versa in those who didn`t report. Furthermore, the increased probability of seizure recurrence identified in those epilepsy patients from rural residence as compared to the urban in our study may be associated with poor access to health care facility and no ready access to ASM [25]. The increased probability of seizure recurrence seen in those epilepsy patients who were on ASM for more than five years observed in the study may be due to chronic therapy associated potential miss of ASM dose with time.