Hydroxyurea adherence and associated factors among children aged 12-59 months attending the Mulago hospital sickle cellclinic, Kampala, Uganda
Abstract
Background: In 2014, hydroxyurea (HU) treatment was approved for use for children with sickle cell anaemia (SCA) in Uganda. Currently, HU is prescribed for children with SCA attending Mulago Hospital Sickle Cell Clinic (MHSCC). Presently, there is no data on HU adherence and factors associated among children at MHSCC. Objectives: To determine the level of HU adherence and associated factors among children age 12-59 months attending MHSCC. Methodology: This was a cross-sectional, sequential mixed methods study done at the MHSCC. A total of 268 children aged12-59 months were enrolled. Quantitative data was collected using a semi-structured questionnaire. Qualitative data was collected from 6 healthcare workers (HCWs) using key informant interviews and two focused group discussions (FGDs) with caregivers, who participated in quantitative study. One FGD of caregivers had good adherence while the other had poor adherence. Informed consent was sought from the study participants before enrollment into the study. HU adherence was calculated as the percentage of doses taken out of the total prescribed medications, and the self-reported score of the 8-item Modified Morisky Medication Adherence Scale (MMAS-8) in the previous 2 weeks. Good adherence was defined as taking ≥95% of the prescribed doses and a MMAS-8 score of 8. Quantitative data was analyzed using logistic regression and p value of < 0.05 was considered significant. Qualitative data was analyzed using content thematic approach.
Results: Of the 268 children, 97(36.2%) had good adherence to HU. A child having a caregiver who received HU counselling was likely to have good adherence (AOR 2.73, 95%CI 1.20-6.70, p=0.021) while missing clinic appointments twice in 3 months (AOR 0.06, 95% CI 0.00-0.69, p=0.036) and having a mother as the primary caregiver (AOR 0.33, 95% CI 0.13-0.82, p=0.018) were associated with poor adherence to HU. Good outcomes and improved quality of health, access to financial services, positive attitudes of HCW and teamwork among HCW were facilitators of HU adherence while stockouts and distance to MHSCC, inadequate financial and social support and dysfunctional laboratories impeded HU adherence.Conclusion and recommendations: Only 36.2%of children aged 12- 59 months attending MHSCC have good adherence to HU. Having a caregiver who received HU counselling improved HU adherence. Continuous HU counselling and education to caregivers, especially mothers, and availing of HU at MHSCC should be strengthened to improve HU adherence. Further studies should be done in mothers as a primary caregiver to identify the specific factors affecting HU adherence.