Background: Antiepileptic drugs are effective in the treatment of epilepsy, but poor adherence to medication is major problem to sustained remission and to functional restoration. Poor adherence to treatment is one of many reasons for pharmacological treatment failure and seizure recurrence. Even though there were studies on the magnitude and associated factors of Antiepileptic drugs non-adherence, there is a shortage of published information regarding the prevalence and associated factors of Antiepileptic drugs none-adherence in Ethiopia.
Objective: To assess prevalence and associated factors of antiepileptic drug none-adherence among epileptic patients attending at Dilla University Referral Hospital.
Methods: Institutional based cross sectional study design was conducted at Dilla University Referral Hospital from March to May, 2016. A total of 265 individuals wasselected by simplerandom sampling method and interviewed by using structured questionnaire 8-itemMorisky Medication Adherence Scalewas used to assess the prevalence of antiepileptic drug non adherence. Data was coded and exported to SPSS version 20 for analysis.
Results:The prevalence of Antiepileptic’s drug none-adherence in this study was 38.1% and getting medication by payment [AOR009,95%,CI:1.044,3.868], Patients who did not got health information about(their illness, duration of treatment and drug side effect], [AOR=0.319,95%,CI:0.184,0.534], poor social support [AOR=3.06, 95%, CI: 1.47-6.37], skip dose [AOR=2.462,95%,CI:1.375,4.407], patients who were on treatment for 2-5 years [AOR=1.48, 95%, CI: 0.722,3.035]were found to besignificantly associated (p.
Conclusion: The prevalence of antiepileptic drug none-adherence among patients with epilepsy disorder was found 38.1%. Getting medication by payment, did not receive health information about [the illness, duration of treatment, medication side effect], skip dose, on treatment for 2-5 years, and poor social support were found to be the independent predictor of antiepileptic drug none-adherence.
Key words: Antiepileptic Drugs; prevalence; epileptic patients; Ethiopia
Epilepsy is a chronic disorder of the brain and is one of the most common serious neurological disorders worldwide with noboundary to age, race, social class, nationality or geographical location. Worldwide aroundOne billion peopleare affected by neurological disorders, including 50 million who had epilepsy, 24 million with Alzheimer disease & other dementias, and an estimated 6.8 million die each year due to neurological disorders. Among patients who had epilepsy; 85% of them found in developing countries andestimated 40 million people do not receive appropriate treatment [1,3]. The overall mortality rate due to epilepsy increased by two to three fold as compared with the general population.
Medication none-adherence is defined as a voluntary or involuntary behavior of medication intake which includes: failing initially filling or refilling a prescription, discontinuing a medication before the course of therapy is complete, inability to cross pond with agreed recommendations from health care provider, taking more or less of a medication than prescribed and taking a dose at wrong time[5,6].
Antiepileptic drugs (AEDs) are effective in the treatment of epilepsy ,but poor adherence to medication is major problem to sustained remission and functional restoration. Poor adherence to treatment is one ofmanyreasonsfor pharmacologicaltreatmentfailure andseizurerecurrence. Themortality rate in non -adherent patients was more than three times higher than that of adherent patients .Even though around 70% of people who had epilepsy may expect to become seizure free with optimum antiepileptic drug (AED) treatment, patients didn’t take their antiepileptic drugs appropriately.
A twenty review study indicated that one third of epileptic patients report negative experiences which may lead to poor adherence due to drug substitution. The consequence of AEDs non-adherence behavior has been associated with: poor seizure control, increased morbidity and mortality along with increased time of hospitalization, worsened patient outcome, increased health care cost and death[12-14].
Themortality of untreated epilepsy become increase due to status epileptics and falling accident. Recurrence seizure will result in poor quality of life, decreased productivity, seizure related joblessness and motor vehicle accident.AEDs non adherent patients had significant negative consequences like dropout from school and workas compared to those who were adherent to AEDs.
AEDs non – adherence will also lead to increase burden of inpatient and emergency department services [17, 18]. There was a negative relation between medication adherence and frequency of seizures. Patients who had poor seizure control are more likely to be anxious and feel as they are helpless due to their illness . Moreover AEDs non-adherence also affects family members socially, economically and psychologically [3,20]. A review study revealed that a number of factors like patient centered, therapy related factors, social and economic factors, and health care system and disease factors were contributed to therapeutic non adherence.Problem of non adherence to therapeutic regimen has been a matter of concern not only to the professionals and attendants but also to the country.Approximately 70% of people with epilepsy could lead normal lives if properly treated.
Even though there was a study done on the magnitude and associated factors of AEDs non-adherence, there is a shortage of published information regarding the prevalence and associated factors of AEDs none-adherence in Ethiopia. Therefore, assessing and showing the significance of antiepileptic non -adherence might be important to enforce policy makers and different stakeholdersand to manage antiepileptic non -adherence.
Study Area and Period
The study was conducted at Dilla University Referral Hospital (DURH) from March to May, 2016 which is found in Dilla town, Gedeo zone, SNNPR, Ethiopia. DURH is established in 1977 E.C /1985 G.C as zonalhospital in Gedeo zone with the former name ofDilla Hospital until June 11/2001 E.C that changed in to DURH. It is located 360 km from Addis Ababa, the capital city of Ethiopia, and 90 km from Hawassa, the capital city of SNNPRE. It provides curative and rehabilitative services for about 2 million catchment populations. At the time of its establishment, about 154 staffs were recruited, of them 104 are health professionals and the remaining are supportive staffs.Now the
hospital has five wards, namely Medical (39 bed], surgical (26 beds), oby/gyn(9 beds), Pediatrics (18 beds] and psychiatry (12 beds). Currently the hospital serves around 3 million peoples from which 95% belongs to Gedeoethnic group. There are around 725 epileptic patients who are taking antiepileptic drugs annually.
Sample Size Determination and Technique
It was determined by Level of significance (0.05), Power (0.50) withz= 95% confidence internal andThe value of ‘’p’’( p= proportion of prevalence)was taken as 36.8% of antiepileptic drug non – adherence from a study conducted in Jimma University specialized hospital, Southwest Ethiopia to estimate the sample size , total sample size for this study is 359. Then the total source of population are 725 that means less than 10,000; therefore it was used correction formula and by considering 10% non response rate, so final sample size 265.
A systematic sampling method was used to select study participants visiting Dilla University Referral Hospital during the study period from a total of 725 epileptic’s patients.
Data Collection and Analyses Procedures
Data collection instruments
The instrument has five sections: it includes socio-demographic, clinical and treatment related factors, health care related factors, patient related factors and Morisky 8-item medication adherence questionnaire. A structured questionnaire wasused to collect socio-demographic characteristics and antiepileptic drug non – adherence related factors. Data regardingthe regimen of drugs and presence of co morbidillness was collected by asking the patient and reviewing patients’ charts. Drug non -adherence was assessed by using 8 item version of self reporting questionnaire of Morisky Medication Adherence Scale (MMAS).
Social support was assessed by using the Oslo 3 item social support scales: the sum score scale ranging from 3-14, which is categorized into poor support 3-8, moderate support 9-11 and strong support 12-14 .
Felt stigma was measured by using kilifi stigma scale of epilepsy. It is a simple three pointlikert scoring system scored as not at all (0), sometimes (1) and always (2). A total of score wascalculated by adding of all item scores. The score above 66th percentile of the data indicated presence of perceived stigma.
Data Collection Technique and Data Quality Control
Data was collected through interview by administering structured questionnaire and by reviewing patients chart.Training was given for data collectors and supervisors about the use of questionnaire, the ethical principle of confidentiality and data management prior to their involvement of data collection for two days was given.
Pre-test was done on 5% of the sample size, at wonago Health centre. Based on the finding of the pre test, the questioner was revised. Data collectors were supervised daily and the filled questionnaires were checked daily by the supervisors and principal investigator for completeness.
Data Processing and Analysis
The coded Data was checked, cleaned andenteredinto exported into Statistical Package for the Social Sciences (SPSS window version 20).
TheDescriptive summary using frequencies, percentage and median were used to present study results.
A Bivariate analysis was performed to determine the effect each of factors on the outcome variable. Only factors with p.value<0.2 on Bivariate analyses were kept for multivariate analyses and a p value of < 0.05onmultivariate analyses was considered as statistically significant.
Ethical clearance was obtained from ethical review board of Dilla University. Formal permission was taken for the hospital. All participants were well informed about the aims and purpose of the study, its contribution to the future development of health system in the country. The right was given to the study participants to refuse or withdraw from participation at any time during data collection without loss of any entitlement.
A total of 265 patients were included in the study and making the response rate of 100% because all of them consented and completed the interview. The study subject was comprised of 140 (52.8%) male and 125 (47.2%) female. The majority [122 (46%)] of the patients were in the age group between years 26-44 of age. The majority of the study subjects 119 (44.9%) were orthodox, and 93 (35.1%) were farmers. Majority [116 (43.8%)] of the patients participated in the study were married and only 27 (10.2%) had Collage and above education
Clinical/Treatment/ Related Factors
More than half of the respondents 210 (79.2%) were on monotherapy and Phenobarbital was the most common prescribed drug. Among the respondents 217 (81.9%) had no any co morbid illness and 48 (18.1%) had co morbid illness.Depression disorder, HIV, dyspepsia, schizophrenia, and asthma are the type of co morbid illness.Medications which were prescribed concomitantly with AEDs were fluoxetine, haloperidol, cotrimoxazole and amitriptyline. Of 114(43%) were on treatment for 2-5 years and among the participants 10439.2) reported that they experience side effect and the most reported experienced side effect was sedation. Regarding skip dose 128(48.3) participants were reported missing their dose due to different reasons and the most reason was forgetting 87[32.8%], run out off drug 42(15.8%)(See table 2).
Health Care And Patient Related Factors
Among the participants 78(29.4%) had free access to AEDs drugs. Regarding health information about 160(60.4%) participants stated that they did not get health information from their health care provider concerning their illness, drug side effect and duration of treatment. About 90(34%) respondents had perceived stigma and 76(28.7%) had poor social support (see table 3)
Prevalence of Antiepileptic Drug None-Adherence
As measured by the 8-item MMAS, 101(38.1%) of the respondents scored two and more .The overall prevalence of antiepileptic drug non – adherence among the study participants were found to be 38.1%.
Factors Associated with Drug None-adherence
From the bivariate analysis of antiepileptic drug non adherence in relation to each variable, way of getting medication, received health information from their health care provider, ever skip dose, social support, duration on treatment were variables that fulfilled the minimum requirement (p) and for further analysis entered to multivariate logistic regression. On the other hand sex, age, occupation, marital status, number of AEDs medication,residence, and current substance use, experienced side effect, substance use since starting medication, perceived stigma did not fulfill the minimum requirements and were exclude from further analysis.
During the multivariate analysis of antiepileptic drug non adherence in relation to all independent variables, getting medication by payment [AOR2.099, 95%,CI:1.044, 3.868], Patients who did not get health information about[their illness, duration of treatment and drug side effect] [AOR=0.319,95%,CI:0.184,0.554],poor social support [AOR=3.06, 95%, CI: 1.47-6.37], skip dose [AOR=2.462,95%,CI:1.375,4.407] and patients who were on treatment for 2-5 years [AOR=1.48, 95%, CI: 0.722,3.035]were found to be significantly associated (p.
Non adherence to treatment is one of many reasons for pharmacological treatment failure and seizure recurrence. In this study the prevalence of antiepileptic drug non adherence among patients with epilepsy disorder was 38.1% with [95%, CI: 32.3, 44.9].
It was greater than in studies done in USA 26% . The probable explanation for this difference may be due to: the study design used, the medication prescribed, methods used to measure the non adherence and as well as difference in socio-demographic characteristics of the study participant or due to study area. But the non – adherence was smaller than those studies in Brazil, Nigeria and Palestine which were 66.2%, 67.4% and 64% respectively [28,31, 40] The difference from Brazil study might be due to duration of treatment and prescribed AEDs which were 71.1% of the respondents were on two to five AEDs and the mean duration of treatment was 21.5year. In this study the participants who were on two medications was 18.1% and the mean of treatment duration was 1.9 years and the difference in Nigeria might be due to socio-demographic characteristics and poly-therapy which was 85%of the participant took three and above AEDs. The difference in Palestine might to be due to sample size, chronic illness and prescribed medication: the sample size in Palestine was small, 13.7% had other chronic diseases and more than half of the patients 63.2% were on poly-therapy but in this study 37% the respondent had co morbid illness and 18.1% were on two medications.
From the study participants who were buyingAEDs medications, the odds of being non adherence was about 2 times more likely to be non adherence as compared with patients who were getting their AEDs medication free of charge [AOR2.009, 95%,CI:1.044, 3.868]. From all patients who were buying their medication 104(55.6%) were known to be non adherent. This study was in line with a study done in Kenya .
From all patients who did not get health information 160(60.3%) were known to be non adherent. This finding was not in line with Egypt’s study in which all patients include in the study (100%) did not get any health education about epilepsy from nurses but 6% received health education from physician .The possible reasons might be health care providers may not have adequate time, poor doctor-patient relationship, negligence and might feel fatigue to explain related conditions with the disease and the treatment for their patients.
Concerning social support ,participants who had poor social support were three times more likely to be non – adherence as compared with patients who had strong social support [AOR=3.06, 95%, CI:1.47-6.37]. The study was in line with a study done in Egypt. Among participants 210(46.7%) were skipped their medication dose at least once during their treatment. They have different reasons for skipping.Forgetting 87(32.8%) was the most reported reason for skipping dose.
Regarding the duration of treatment for those patients who were on treatment 2-5 years,the odds of being non adherencewere about 1.488 times more likely to be non adherence compared with patients who were on treatment 3 month to 1 year [AOR=1.488, 95%, CI: 0.722,3.035]. As the study illustrated while treatment duration increases, the respondents more likely to be non adherent. The study was not similar with studies done in Kenya and Egypt [33,34]. This could be due to decreased the willingness to follow their treatmentas well as forgetfulness to follow the treatment for long period of time by patients and also the treatment duration increases the patient might feel better and more likely to be non-adherent to their treatment given.
The prevalence of antiepileptic drug non-adherence among patients with epilepsy disorder was found to be 38.1%
Getting medication by payment, did not receive health information about (the illness, duration of treatment, medication side effect), skip dose, on treatment for 6 years and above, and poor social support were found to be the independent predictor of AEDs non adherence.
Based on the findings and the conclusions, the following recommendations were forwarded for respective bodies.
To Ministry of Health
In order to improve adherence, it is better to design and implement programs that address getting medication free of charge
To Dilla University Referral Hospital
The hospital should develop standard protocol for the management of epileptic patients and manuals which describe strategies of drug selection, dosing, frequency of drug and duration of treatment.
To Health Care Providers
The health care providers should give time to provide the appropriate health information about disease condition, drug side effect, duration of treatment and the consequence of dose missing.
The researchers better to further study with other study design to provide strong evidence regarding the prevalence and associated factors of epileptic drug non adherence among patients with epilepsy disorder.
All authors declare that they have no conflict of interest associated with the publication of this manuscript.
MareguShegaw conceived and designed the study and collected data in the field, performed analysis, interpretation of data, and draft the manuscript. Reta kassa, Yigrem Ali and NegatuAddisualso involved in the design, analysis, andinterpretation of data andthe critical review of the manuscript. All authors approved and read the final manuscript.
This study was not funded by any organization, and notcovered by any financials.
- Organization WH (2006) Neurological Disorders: Public Health Challenges. World Health Organization.
- Stump E(2007) WHO Report: Millions Have Neurological Disorders Worldwide. Neurology Today 7: 25.
- Organization WHO,others ( 2005) Atlas: epilepsy care in the world.
- O’Donoghue MFO, Sander JWAS(1997) The mortality associated with epilepsy, with particular reference to sudden unexpected death: a review. Epilepsia 38: S15-S19.
- Osterberg L, Blaschke T (2005) Adherence to medication. New Engl J Med 353: 487-497.
- Hugtenburg JG, Timmers L, Elders PJM, Vervloet M, van Dijk L ( 2013) Definitions, variants, and causes of nonadherence with medication: a challenge for tailored interventions. Patient Prefer Adherence 7:675-682.
- Dekker PA, Organization WHO, others (2002) Epilepsy a manual for medical and clinical officers in Africa.
- Sabaté E (2003)Adherence to Long-term Therapies: Evidence for Action. World Health Organization 228.
- Kwan P, Schachter SC, Brodie MJ (2011)Drug-resistant epilepsy. New England Journal of Medicine 365:919-926.
- Sander JW(2004) The Use of Antiepileptic Drugs—Principles and Practice. Epilepsia 45:28-34.
- Hakonsen H, Toverud EL A review of patient perspectives on generics substitution: what are the challenges for optimal drug use. GaBI Journal 1:28-32.
- Neligan A, Bell GS, Johnson AL, Goodridge DM, Shorvon SD,et al.(2011) The long-term risk of premature mortality in people with epilepsy. Brain 134:388-395.
- Kaddumukasa M, Kaddumukasa M, Matovu S, Katabira E (2013) The frequency and precipitating factors for breakthrough seizures among patients with epilepsy in Uganda. BMC neurology.13: 182.
- Cramer JA, Wang ZJ, Chang E, Powers A, Copher R, et al. (2014) Healthcare utilization and costs in adults with stable and uncontrolled epilepsy. Epilepsy & Behavior 31:356-362.
- Newton CR, Garcia HH (2012) Epilepsy in poor regions of the world. The Lancet. 380:1193-1201.
- Hovinga CA, Asato MR, Manjunath R, Wheless JW, Phelps SJ, et al. ( 2008) Association of non-adherence to antiepileptic drugs and seizures, quality of life, and productivity: Survey of patients with epilepsy and physicians. Epilepsy & Behavior 13:316-22.
- Getachew H, Dekema NH, Awol SS, Abdi AA, Mohammed MA (2014) Medication adherence in epilepsy and potential risk factors associated with non adherence in tertiary care teaching hospital in southwest Ethiopia. Gaziantep Med20:59-65.
- Faught RE, Weiner JR, Guérin A, Cunnington MC, Duh MS (2009) Impact of nonadherence to antiepileptic drugs on health care utilization and costs: findings from the RANSOM study. Epilepsia 50:501-509.
- Jones RM, Butler JA, Thomas VA, Peveler RC, Prevett M (2006) Adherence to treatment in patients with epilepsy: Associations with seizure control and illness beliefs. Seizure 15:504-508.
- Martins HH, Alonso NB, Guilhoto LMFF, Guaranha MSB, Yacubian EMT (2009) Clinical, Psychosocial and Scientific Note. J Epilepsy 15:192-196.
- Jin J, Sklar GE, Oh VMS, Li SC ( 2008) Factors affecting therapeutic compliance: A review from the patient’s perspective. Therapeutics and clinical risk management 4: 269–286.
- World Health Organization, Regional Office for the Eastern Mediterranean (2010) Epilepsy in the WHO Eastern Mediterranean region: bridging the gap.
- Davis KL, Candrilli SD, Edin HM (2008) Prevalence and cost of nonadherence with antiepileptic drugs in an adult managed care population. Epilepsia 49:446-454.
- Brown I, Sheeran P, Reuber M (2009) Enhancing antiepileptic drug adherence: a randomized controlled trial. Epilepsy & Behavior 16:634-639.
- Chapman SC, Horne R, Chater A, Hukins D, Smithson WH (2014) Patients’ perspectives on antiepileptic medication: relationships between beliefs about medicines and adherence among patients with epilepsy in UK primary care. Epilepsy Behav 31:312-20.
- Carpentier N, Jonas J, Frismand S, Vignal J-P, Rikir E, et al. (2013) Direct evidence of nonadherence to antiepileptic medication in refractory focal epilepsy. Epilepsia 54:e20-e23.
- Kyngäs H. (2000) Compliance with health regimens of adolescents with epilepsy. Seizure. 9:598-604.
- Ferrari CMM, de Sousa RMC, Castro LHM ( 2013) Factors associated with treatment non-adherence in patients with epilepsy in Brazil. Seizure 22:384-9.
- Liu J, Liu Z, Ding H, Yang X ( 2013) Adherence to treatment and influencing factors in a sample of Chinese epilepsy patients. Epileptic disorders 15:289-294.
- Virág L, Murgaš M, Kuželová M (2012) Pharmacotherapeutic adherence and quality of life in paediatric outpatients with epilepsy. Acta Facultatis Pharmaceuticae Universitatis Comenianae 59:76-83.
- Sweileh WM, Ihbesheh MS, Jarar IS, Taha ASA, Sawalha AF, et al. (2011) Self-reported medication adherence and treatment satisfaction in patients with epilepsy. Epilepsy & Behavior 21:301-305.
- Ogboi Sonny J, Babajide F, Ademola O A, Olabunmi O, Agu P U (2011) Evaluation of Factors Influencing Medication Adherence in Patients with Epilepsy in Rural Communities of Kaduna State, Nigeria. Neuroscience & Medicine 2: 299-305.
- El-Shamaa ET (2013) Factors Contributing To Therapeutic Compliance Of Epileptic Patients And The Suggestive Solutions. Journal of Biology, Agriculture and Healthcare 3:22-35.
- Mbuba CK, Ngugi AK, Fegan G, Ibinda F, Muchohi SN, et al.( 2012) Risk factors associated with the epilepsy treatment gap in Kilifi, Kenya: a cross-sectional study. Lancet Neurol 11:688-696.
- Srivastava K, Arora A, Kataria A, Cappelleri JC, Sadosky A, et al. (2013) Impact of reducing dosing frequency on adherence to oral therapies: a literature review and meta-analysis. Patient Prefer Adherence 7:419-434.
- Bøen H (2012) Characteristics of senior centre users–and the impact of a group programme on social support and late-life depression. Norsk epidemiologi
- Kathomi Mbuba C (2011) Epilepsy treatment gap, associated risk factors and intervention strategies in Kilifi, Kenya: University of Basel.
- Morisky DE, Ang A, Krousel-Wood M, Ward HJ (2008) Predictive Validity of a Medication Adherence Measure in an Outpatient Setting. The Journal of Clinical Hypertension 10:348-354.
- Morisky DE, Green LW, Levine DM (1986) Concurrent and predictive validity of a self-reported measure of medication adherence. Medical care 24:67-74.
- Nakhutina L, Gonzalez JS, Margolis SA, Spada A, Grant A (2011) Adherence to antiepileptic drugs and beliefs about medication among predominantly ethnic minority patients with epilepsy. Epilepsy & Behavior 22:584-586.
(Figure 1): Shows the frequency distribution of reasons for Antiepileptic drug dose skip epileptic patients attending at DURH, 2016 n=265
Figure2: Prevalence of Antiepileptic Drug Non-adherence among Patients with Epilepsy Disorder attending at Dilla University Referral Hospital, 2016
|Socio-demographic characteristic c||Number||Percentage [%]|
Unable to read and write
Able to read and write
Collage and above
(Table 1): Socio demographiccharacteristics of the study subjects inDilla University Referral Hospital, 2016 n=265
|Current AEDs||Phenobarbital||Total prescribed||162||61.1|
|Medication other than AEDs||No||256||96.6|
|Number of AEDs prescribed||One||210||79.2|
Three and more
|Co morbid illness||No||217||81.9|
|Reported experienced side effects||No||161||60.8|
|Ever skip dose||No||137||51.7|
|Duration on treatment||0.03-1 year||71||26.8|
|6years and above||80||30.2|
(Table2): Distribution of patients with epilepsy disorder by clinical and treatment related factors attending at Dilla University Referral Hospital, 2016, n=265.
|How do you get your medication||Freely||78||
|Use substance since starting
|Substance use in 3 month||No||256||96.6|
|Social support||strong support||60||22.6|
(Table 3): Distribution of patients with epilepsy disorder by health care and patient related factors attending at Dilla University Referral Hospital,2016, n=265
|Independent variables||Drug non
|COR [95% CI]
|AOR [95% CI]|
|Collage and above||12[44.4%]||15[55.6%]||1||1|
|Able to read and write||45[40.2%]||67||1.191[0.510,2.781]||0.840[0.360,1.960]|
|Unable to read and write||27[30.7%]||61[69.3%||1.807[0.747,4.375]||0.553[0.229,1.339]|
|Co morbid illness|
|Reported experienced AED side effect|
|Received health information|
|Substance use since starting medication|
|Ever skip dose|
|Duration on treatment|
|6 years and above||32[45.1%]||39[54.9%]||0.406[0.209,0.789]||0.77[0.409,1.478]|
|Strong social support||32[37.1%]||47[62.9%]||1||1|
|Poor social support||44[56%]||58[44%]||3.23[1.85,5.64]||3.06[1.47,6.37]|
Table 4: Factors associated with Antiepileptic Drug Non-adherence among patients with Epilepsy Disorder attending at Dilla University Referral Hospital: 2016(n=265).
Citation: Shegaw M, kassa R, Ali Y, Addissu N (2017) Prevalence And Associated Factors Of Antiepileptic Drug non – adherence Among Epileptic Patients Attending At Out Patient Departement Of Dilla University Referral Hospital, Dilla, Gedeo, SNNPR, Southern Ethiopia. J Psych Cogn Behav 2017: J105