title: Prevalence and predictors of sub-optimal medication adherence among patients with severe mental illnesses in a tertiary psychiatric facility in Maiduguri, North-eastern Nigeria.
abstract: BACKGROUND
  Sub-optimal adherence constitutes a significant impediment to the management of severe mental illnesses (SMIs) as it negatively impacts on the course of the illness and the treatment outcome. In this study, the levels of adherence, prevalence and the predictors of sub-optimal adherence were assessed in a sub-Saharan African setting.
  
  
  METHODS
  Three hundred and seventy (370) respondents with diagnoses of schizophrenia, bipolar disorder or severe depression were randomly enrolled and interviewed at the out-patient department of the Federal Neuropsychiatric Hospital, Maiduguri in northeastern Nigeria. An anonymous sociodemographic questionnaire and a clinical proforma designed by the authors, Oslo social support scale and the 8-item Morisky Medication Adherence Scale (MMAS-8) were used for data collection.
  
  
  RESULTS
  The prevalence of sub-optimal adherence was 55.7%. The independent predictors of sub-optimal adherence were; seeking for traditional/ spiritual treatment (Odds Ratio (O.R.) = 6.523, 95% C.I. = 3.773 - 11.279, P = < 0.001), male gender (O.R. = 3.307, 95% C.I. = 1.907 - 5.737, P = < 0.001), low levels of insight (O.R. = 1.753, 95 C.I. = 1.220 - 2.519, P = 0.002), and low social support levels (O.R. = 1.528, 95% C.I. = 1.097 - 2.129, P = 0.012).
  
  
  CONCLUSIONS
  Based on the outcome of the study, we recommend the development of psycho-educational programmes on adherence and the active involvement of the relations and significant others in the management of patients with SMIs in sub-Saharan Africa.
authors.affiliation: Department of Mental Health, College of Medical Sciences, University of Maiduguri, Borno State, Nigeria.
authors.forename: Abdu Wakawa
authors.initials: AW
authors.lastname: Ibrahim
authors.affiliation: Department of Community Medicine, College of Medical Sciences, University of Maiduguri, Borno State, Nigeria.
authors.forename: Shuaibu
authors.initials: S
authors.lastname: Yahya
authors.affiliation: Department of Mental Health, College of Medical Sciences, University of Maiduguri, Borno State, Nigeria.
authors.forename: Sadique Kwajafa
authors.initials: SK
authors.lastname: Pindar
authors.affiliation: Department of Mental Health, College of Medical Sciences, University of Maiduguri, Borno State, Nigeria.
authors.forename: Musa Abba
authors.initials: MA
authors.lastname: Wakil
authors.affiliation: Department of Clinical Services, Abubakar Tafawa Balewa University Teaching Hospital, Bauchi, Bauchi state, Nigeria.
authors.forename: Adamu
authors.initials: A
authors.lastname: Garkuwa
authors.affiliation: Department of Psychiatry, Bayero University Kano, Kano State, Nigeria.
authors.forename: Shehu
authors.initials: S
authors.lastname: Sale
mesh_terms: D000293:Adolescent; D000328:Adult; D001714:Bipolar Disorder / Q000188:drug therapy*; D003430:Cross-Sectional Studies; D003866:Depressive Disorder / Q000188:drug therapy*; D005260:Female; D006778:Hospitals, Psychiatric; D006801:Humans; D008297:Male; D008875:Middle Aged; D009549:Nigeria; D015995:Prevalence; D012559:Schizophrenia / Q000188:drug therapy*; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D055815:Young Adult; D016903:Drug Monitoring
keywords: Maiduguri; Mental illnesses; Nigeria; Sub-optimal adherence