SCHIZOPHRENIA IN EASTERN ETHIOPIA: TREND, DETERMINANTS, MEDICATION ADHERENCE AND QUALITY OF LIFE

Abstract

Background: Schizophrenia is a chronic and severe mental disorder which causes a significant impact on the quality of life of the patients and their families, the social environment, and the healthcare system. In Ethiopia, there is a scarcity of data related to schizophrenia trends over time, determinants, ant-psychotic medication adherence, and quality of life among patients with schizophrenia. Objective: This study aimed to assess schizophrenia trends, determinant, anti-psychotic medication non-adherence, quality of life and their associated factors among patients with schizophrenia in public hospital, eastern Ethiopia. Methods: Quantitative institution-based cross-sectional study was conducted in in two public hospitals (Hiwot Fana Comprehensive Specialized University Hospital and Dill-Chora Referral Hospital) in eastern Ethiopia. Five- years of data were retrieved from medical records of 2016 to 2020 using data abstraction tool, and structured questionnaires were utilized to obtain data from people suffering from schizophrenia. To assess anti-psychotic medication adherence and quality of life, the MOrisky medication adherence rating scale questionnaire and the WHOQoL-BREF, a 26- item self-administered generic questionnaire were utilized. Further, the extended Mantel-Haenszel Chi-square test was used to examine the proportion and to identify any linear trend between 2016 and 2020. In addition, conditional logistic regression model was used to analyze the association between schizophrenia and its determinants. Moreover, multiple Stepwise Logistic Regression Model was used to assess the association between independent variables and nonadherence. Adjusted odds ratios along with 95 % CIs were estimated to assess the strength of the association. Multiple linear regression was used to determine the quality of life and associated factors, while standardized Beta-coefficients with 95 % confidence intervals were computed to assess the variables that were significantly associated with quality of life and, a P-value < 0.05 was considered to declare the levels of statistical significance. Results: Schizophrenia has shown an increased trend over the five years, from 2732 (57%) in 2016 to 5079 (65%) in 2020 (χ2=9.67 (p = 0.0018)). Being unemployed (AOR:4.60; 95 % CI:1.80 - 11.71), family history of mental illness (AOR: 12.21; 95 % CI: 4.83 - 30.00), family history of xvi substance use (AOR: 2.13; 95 % CI: 1.07 - 4.29), and poly-substance users (AOR: 4.45; 95% CI: 1.28 - 15.45) were associated schizophrenia. About half, 44.57 % (95 % CI: 0.413 - 0.478) of schizophrenia patients were non-adhered to their antipsychotic medications. Being single (AOR: 2.47; 95 % CI:1.71 - 3.85), Khat Chewers (AOR: 2.83; 95 % CI:2.06 - 3.90), on first-generation antipsychotics (AOR: 1.76; 95% CI:1.20 - 2.57), and taking poly drugs (AOR: 1.95; 95% CI: 1.267 - 3.00) were factors associated with non-adherence, likewise those with no insight because of their illness (AOR: 2.10:95 % CI (1.52 - 2.91), and those who experience medication side effect were 1.6 times (AOR: 1.65; 95 % CI (1.10 - 2.48) were more likely non-adhere to their antipsychotic medications. In the same line, the overall quality of life in schizophrenia patients was low with mean (SD) of 71.09 (9.14), which was significant among those with low social support (β =- 2.51, p=0.0001), poor adherence to antipsychotic medications (β = -2.11, p-value=0.002), poly-substance users (β=-2.84, p=0.0001), and those who experienced perceived self-stigma (β=-2.24, p=0.0001). Conclusions: Schizophrenia has increased over time, and being unemployed, having a family history of mental illness, and poly-substance use were found to be determinants of schizophrenia. Non-adherence to their antipathetic medication was high, and those single in marital status, current khat chewers, treated with first-generation antipsychotics or medications, had poor insight into the illness, and experienced medication side effects had higher non-adherence. A low quality of life was revealed among the patients with schizophrenia, which was prevalent among those with poor social support, perceived stigma, and non-adherence to antipsychotics. Providing early intervention and treatment, raising awareness about the condition, and targeting the determinants are required. Furthermore, priority and tailored interventions are needed to improve medication adherence and quality of life among affected patients, possibly done at individual or group levels.