Adherence to anti-seizure medications among pediatric epilepsy patients during the Sudan armed conflict

Poor adherence to antiseizure medications (ASMs) is responsible for 26–79% of breakthrough seizures. This study was conducted to evaluate the adherence of pediatric patients with epilepsy to their medications during armed conflict in Sudan. An observational, analytical cross-sectional study was conducted among pediatric patients (aged ≤18 years) diagnosed with epilepsy. A systematic random sampling technique was employed, and data were collected through structured phone interviews using the Medication Adherence Rating Scale (MAR-20) and the Pediatric Epilepsy Side Effects Questionnaire (PESQ). Associations between categorical variables were analyzed via the chi-square test or Fisher’s exact test. For continuous variables, the Mann‒Whitney U test was used. A total of 161 patients were included in this study. 60.9% of the study participants were males, and 39.1% were females. A total of 70.2% of the participants still resided in Sudan during the armed conflict. The mean total score on the MAR scale (MAR-20) was 28.16 (SD = 13.5). Only 31.1% (n= 50) of patients achieved complete adherence to ASMs, whereas 68.9% (n= 111) were nonadherent. The most common challenges cited by caregivers were the unavailability of medications at pharmacies (39.1%) and the lack of transportation (32.9%). Complete adherence was significantly greater among children whose fathers had university degrees or higher (p value = 0.007) and among children who relocated outside Sudan during this armed conflict than among those residing in Sudan (p value = 0.027). Nonadherence was significantly associated with increased seizure frequency (p = 0.001). The mean total PESQ score and the cognitive domain score were significantly greater in nonadherent patients than in adherent patients (p value of 0.026 and 0.026, respectively). This study revealed a low rate of adherence to antiseizure medications (ASMs) among pediatric epilepsy patients in Sudan during ongoing conflict. Economic hardship, displacement, and disrupted medical services significantly hinder effective epilepsy management. There is an urgent need for multifaceted interventions that address both healthcare system barriers and caregiver support.