The prevalence and predictors of antipsychotic medication non-adherence among clients with psychotic disorders in Mzimba, Malawi

Master Thesis


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University of Cape Town

Background: Mental, neurological and substance use (MNS) disorders significantly contribute to the burden of diseases worldwide. Schizophrenia is one of the severe forms of MNS disorders. Antipsychotic medications play a significant role in the treatment and management of schizophrenia. However, non-adherence to antipsychotic medication is a recognized problem. At the present time, a majority of the research investigating non-adherence to medication in this population has been conducted in high income countries, with only a few studies available from low and middle income countries such as Malawi. This study aimed at determining the prevalence and predictors of antipsychotic non-adherence among clients with psychosis in Mzimba district, Malawi. The factors were categorized into patient-related, medication related and environmental related. Methodology: This was a hospital based quantitative study conducted in Mzimba, Malawi. 150 patients attending outpatient treatment facilities from three mental health clinics were recruited in the study. All recruited participants had a diagnosis of psychosis. The recruitment process targeted every potential participant during a clinic day. Potential participants were approached by the research assistant after their appointment with the healthcare provider to participate in the study. The following measures were included in the interview administered survey: 1) the Morisky Medication Adherence Scale-8; the Birchwood Insight Scale; the Drug Attitude Inventory-10; the Glasgow Antipsychotic Side-effects Scale; a Social Support questionnaire, and the Alcohol Use Disorder Identification Test. A logistic regression model was developed to investigate the associations between socio demographic and illness related factors and non-adherence to medication. Ethical approval to conduct the study was obtained from the Faculty of Health Sciences Research Ethics Committee at the University of Cape Town before the beginning of the study. Ethical approval was also obtained from National Health Sciences Research Ethics Committee in Malawi. Results: More than half of the participants were male (n=84). The average age of all participants was 34 years of age (sd=9.40). 43.9% of the respondents were identified as non-adherent (n=66). In the unadjusted logistic regression model, the amount of insight a client had about their mental illness, the side effects of antipsychotic medication, and the form or type of medication, were all found to be significantly associated with antipsychotic medication non-adherence. For example, participants with poor insight were less likely to adhere to antipsychotic medication (OR=0.48, 95% CI 0.24-0.95). When these three variables were adjusted for age and gender, they all predicted non-adherence to antipsychotic medication; insight (OR=0.42, 95% CI 0.20-0.90); side effects (OR=1.10. 95% CI 1.03-1.17); and medication type or form (OR=0.30, 95% CI 0.15-0.91). Conclusion: The study was the first study conducted in Mzimba, Malawi to investigate nonadherence rates among patients with psychosis. Similar to other studies conducted globally, the non-adherence rates to antipsychotic medication reported in the present study was high. The risk factors predicting non-adherence have the potential to assist in the development and delivery of interventions to address among this population.