Adherence to Clinic Appointments and Medication Amomg Patients Accessing Static and Outreach Mental Health Clinics, Lilongwe, Malawi

Abstract

It is reported that individuals who are non-adherent to medication and other treatment modalities have higher rates symptom recurrence, higher hospital readmission and poor quality of life. Few studies have been conducted on prevalence for non-adherence to clinic appointment and medication as most of them have concentrated on other conditions, for example, hypertension, Diabetes and HIV/AIDS. Although a few studies have been undertaken in Low and Middle Income Countries (LMICs), such as Nigeria and South Africa, poor mental health service organization, missed planned visits, and their consequences may have serious ramifications in Malawi. Nkhoma Mission Hospital (NMH) has been integrating mental health within the existing services to ensure that the services are accessible to people. A cross-sectional analytical hospital and community based study was conducted from June, July 2021 at NMH, Lilongwe, Malawi. The study used a survey/census approach to enroll all the participants into the study. Adherence to clinic appointments and medication was assessed through interviewer administered questionnaires consisting of measures assessing adherence to clinic appointments and medication. Medication Adherence Rating Scale (MARS) was used to assess adherence to medication. Association of alcohol use, insight, and stigma with medication adherence was established using AUDIT scale, BIRCHWOOD Scale and Internalized Stigma of Mental Illness (ISMI) Scale. There were Ninety-one (91) participants who took part in this study. There were 51 (56%) males and 40 (44%) females in the study. The prevalence of non-adherence to medication and clinic appointment was 64% (n=58) and 46.2% respectively. A multivariate logistic regression analysis found different factors associated with non-adherence to clinic appointments and medication. Females were 4.7 times more likely to miss clinic appointments than males (B =-1.555, Exp (B)=0.221, p=0.029), Protestant Christians were 5 times more likely than Christians from other denominations and non-Christians participants to miss clinic appointments (B = 5.176, p=0.034), clients not married were 15 times more likely not to adhere to clinic appointments (B=2.722, Exp(B)=25.12, p=0.002) and clients who visited a mobile clinic were more likely than those who visited a static clinic to miss appointments (B =-1.762, Exp (B)=0.172, p=0.020). Clients who had been on medication for less than 2 years had significantly lower adherence to medication than those who had been on medication for more than 2 years (B=-1.631, t=-2.053, p=0.043), patients who occupation was farming had lower adherence to medication (B= -1.541, t=- 2.057, p=0.043), Psychotic patients had a higher adherence to medication than nonpsychotic patients (B=1.753, t=2.041, p=0.044). The prevalence of non-adherence to clinic appointments and medication in this study was high. It is important to address factors that influence non-adherence to clinic appointments and medication in order to avoid relapse.