Regularne przyjmowanie leków i przerwy w leczeniu epilepsji u sudańskich dzieci podczas konfliktu zbrojnego: badanie retrospektywne w jednym ośrodku
Medication adherence and treatment gap in Sudanese children with epilepsy during armed conflict: a one-unit retrospective clinical audit
W skrócie
Badanie wykazało, że podczas konfliktu zbrojnego w Sudanie większość chorych dzieci (78%) nie przyjmowała regularnie leków przeciwpadaczkowych, a 70% miało przerwy w leczeniu trwające co najmniej miesiąc. Glównymi przeszkodami dla regularnego leczenia były braki leków w aptkach, wypędzenie z domów i utrata dokumentacji medycznej. W wyniku przerw w leczeniu u dzieci obserwowano wzrost liczby napadów, a niektóre trafiały do szpitala lub doświadczały niebezpiecznego stanu zwanego status epilepticus.
Oryginalny abstract (angielski)
BACKGROUND: Armed conflict disrupts health systems and disproportionately affects children with chronic neurological conditions such as epilepsy. Evidence on medication adherence during conflicts is limited. The audit aimed to assess antiseizure medication adherence, treatment continuity, and epilepsy-related outcomes among children attending a paediatric neurology clinic during a period of armed conflict. METHODS: A retrospective, single-centre, hospital-based clinical audit was conducted. Children with epilepsy who attended a paediatric neurology clinic during the conflict period were included. Medication adherence was assessed using the Proportion of Days Covered over the preceding 90 days, with adherence defined as Proportion of Days Covered over ≥ 80%. The treatment gap was defined as ≥ 30 consecutive days without antiseizure medication. Epilepsy-related clinical outcomes and caregiver-reported barriers to care were also recorded. Descriptive statistics with 95% confidence intervals (CI) were used. RESULTS: Of the 64 children included, 14/64 (21.9%) met the predefined criterion for medication adherence (PDC ≥ 80%), while 50/64 (78.1%) were non-adherent. A treatment gap of ≥ 30 consecutive days without antiseizure medication within the preceding 90 days was identified in the majority of participants 45/64(70.3%). Epilepsy-related complications during the conflict period included 38/64 (59.4%) with increased seizure frequency, 20/64 (31.3%) requiring hospital admission, and 12/64 (18.8%) experiencing status epilepticus. Caregivers frequently reported multiple barriers to adherence, most commonly medication stock-outs (40/64; 62.5%), displacement relocation (35/64; 54.7%), and loss of medical records (28/64; 43.8%). CONCLUSIONS: Medication non-adherence and treatment interruptions were highly prevalent among children with epilepsy during armed conflict. These findings highlight the vulnerability of epilepsy care to health system disruptions and underscore the need for conflict-adapted strategies to maintain access to essential antiseizure medications.