title: Adherence to medication: A nation-wide study from the Children's Cancer Hospital, Egypt.
abstract: OBJECTIVE
  To investigate adherence to medical regimen and predictors for non-adherence among children with cancer in Egypt.
  
  
  METHODS
  We administered two study specific questionnaires to 304 parents of children diagnosed with cancer at the Children's Cancer Hospital in Cairo, Egypt, one before the first chemotherapy treatment and the other before the third. The questionnaires were translated to colloquial Egyptian Arabic, and due, to the high illiteracy level in Egypt an interviewer read the questions in Arabic to each parent and registered the answers. Both questionnaires consisted of almost 90 questions each. In addition, a Case Report Form was filled in from the child's medical journal. The study period consisted of 7 mo (February until September 2008) and we had a participation rate of 97%. Descriptive statistics are presented and Fisher's exact test was used to check for possible differences between the adherent and non-adherent groups. A P-value below 0.05 was considered significant. Software used was SAS version 9.3 for Windows (SAS Institute Inc., Cary, NC, United States).
  
  
  RESULTS
  Two hundred and eighty-one (90%) parents answered the second questionnaire, regarding their child's adherence behaviour. Approximately two thirds of the children admitted to their third chemotherapy treatment had received medical recommendations upon discharge from the first or second chemotherapy treatment (181/281, 64%). Sixty-eight percent (123/181) of the parents who were given medical recommendations reported that their child did not follow the recommendations. Two main predictors were found for non-adherence: child resistance (111/123, 90%) and inadequate information (100/123, 81%). In the adherent group, 20% of the parents (n = 12/58) reported trust in their child's doctor while 14 percent 8/58 reported trust in the other health-care professionals. Corresponding numbers for the non-adherent group are 8/123 (7%) for both their child's doctor and other health-care professionals. Almost all of the parents expressed a lack of optimism towards the treatment (116/121, 96%), yet they reported an intention to continue with the treatment for two main reasons, for the sake of their child's life (70%) (P = 0.005) and worry that their child would die if they discontinued the treatment (81%) (P < 0.0001).
  
  
  CONCLUSIONS
  Non-adherence to medical regimen is common among children diagnosed with cancer in Egypt, the main reasons being child resistance and inadequate information.
authors.affiliation: Hanan El Malla, Nathalie Ylitalo Helm, Ulrica Wilderäng, Gunnar Steineck, Division of Clinical Cancer Epidemiology, Department of Oncology, Sahlgrenska University Hospital, 413 45 Gothenburg, Sweden.
authors.forename: Hanan
authors.initials: H
authors.lastname: El Malla
authors.forename: Nathalie
authors.initials: N
authors.lastname: Ylitalo Helm
authors.forename: Ulrica
authors.initials: U
authors.lastname: Wilderäng
authors.forename: Yasser
authors.initials: Y
authors.lastname: El Sayed Elborai
authors.forename: Gunnar
authors.initials: G
authors.lastname: Steineck
authors.forename: Ulrika
authors.initials: U
authors.lastname: Kreicbergs
keywords: Adherence to medical regimen; Cancer; Non-compliance; Paediatric oncology; Patient-physician communication; Psycho-oncology; Psychosocial