---
title: "Adherence to anti-seizure medications in Buikwe and Mukono, Uganda: prevalence, associated factors"
id: "plos-one-9-adherence-to-anti-seizure-medications-among-persons-living-with-epilepsy"
canonical_url: "https://medichelpline.com/clinical-feed/plos-one-9-adherence-to-anti-seizure-medications-among-persons-living-with-epilepsy"
content_type: "clinical_feed_article"
specialty: "Neurology"
source_name: "PLOS ONE (Medicine)"
source_url: "https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0356494"
published_at: "2026-08-21T14:00:00.000Z"
evidence_level: "Journal Feed"
license: "CC-BY-NC-4.0 / Informational Use"
---
# Adherence to anti-seizure medications in Buikwe and Mukono, Uganda: prevalence, associated factors
## Provenance & Clinical Metadata
- **Canonical URL:** https://medichelpline.com/clinical-feed/plos-one-9-adherence-to-anti-seizure-medications-among-persons-living-with-epilepsy
- **Specialty:** [Neurology](https://medichelpline.com/clinical-feed/neurology.md)
- **Primary Source:** PLOS ONE (Medicine)
- **Source URL:** [Original Journal Publication](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0356494)
- **Published At:** 2026-08-21T14:00:00.000Z
- **Evidence Rating:** Journal Feed
## Executive GIST (TL;DR)
- This mixed-methods cross-sectional study enrolled 277 persons living with epilepsy (≥15 years) attending a community clinic in Buikwe District and Mukono General Hospital between April and July 2024. Quantitative data used structured questionnaires and the 8-item **Morisky Medication Adherence Scale**; 20 in-depth interviews explored experiences. - The overall prevalence of adherence to **anti-seizure medications (ASMs)** was 66.5% by the Morisky scale. The most prescribed ASMs at both sites were **phenytoin, carbamazepine, phenobarbitone, sodium valproate, and lamotrigine**. - Factors independently associated with adherence included earning a modest monthly income (adjusted prevalence ratio [aPR] 1.29; 95% CI 1.13–1.53). Factors associated with lower adherence were receiving an inadequate treatment dosage (aPR 0.80; 95% CI 0.64–0.92), waiting three or more hours at the facility (aPR 0.79; 95% CI 0.61–0.91), and being aged 30–34 years (aPR 0.71; 95% CI 0.53–0.95). - Thematic analysis of qualitative interviews identified key experience domains affecting adherence: **fear of stigmatization**, fear of injury and loss of life from seizures, social support, financial burden, individual motivation, misconceptions about ASMs, and limited awareness of ASM effectiveness. - The study pooled participants from both sites because they serve overlapping communities with similar clinical follow-up, medication regimens, and baseline characteristics; site-level comparisons showed no meaningful differences in adherence patterns. - The authors conclude that about two-thirds of participants were adherent and recommend implementing strategies such as incorporating a medication adherence tool into routine care to improve adherence in these settings. - Funding was provided by the National Institute of Neurological Disorders and Stroke (NIH award D43NS118560-01); authors declared no competing interests. All study data are reported within the manuscript and supporting information.
## Clinical Analysis & Structured Key Points
[ Skip to main content ](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0356494#main-content) Advertisement * [plos.org](https://plos.org/) * [Create account](https://community.plos.org/registration/new) * [Sign in](https://journals.plos.org/user/secure/login?page=%2Fplosone%2Farticle%3Fid%3D10.1371%2Fjournal.pone.0356494) * * About * Browse * Publish * [](https://journals.plos.org/plosone/ "PLOS One") * Search [advanced search](https://journals.plos.org/plosone/search) * [Browse Topics](https://journals.plos.org/plosone/subjectAreaBrowse) Browse Subject Areas ? Click through the PLOS taxonomy to find articles in your field. For more information about PLOS Subject Areas, click [here](https://github.com/PLOS/plos-thesaurus/blob/master/README.md "Link opens in new window"). [](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0356494) [](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0356494) * 0 [Save](https://journals.plos.org/plosone/article/metrics?id=10.1371/journal.pone.0356494#savedHeader) [Total Mendeley and Citeulike bookmarks.](https://journals.plos.org/plosone/article/metrics?id=10.1371/journal.pone.0356494#savedHeader) * 0 [Citation](https://journals.plos.org/plosone/article/metrics?id=10.1371/journal.pone.0356494#citedHeader) [Paper's citation count computed by Dimensions.](https://journals.plos.org/plosone/article/metrics?id=10.1371/journal.pone.0356494#citedHeader) * 30 [View](https://journals.plos.org/plosone/article/metrics?id=10.1371/journal.pone.0356494#viewedHeader) [PLOS views and downloads.](https://journals.plos.org/plosone/article/metrics?id=10.1371/journal.pone.0356494#viewedHeader) * 0 [Share](https://journals.plos.org/plosone/article/metrics?id=10.1371/journal.pone.0356494#discussedHeader) [Sum of Facebook, Twitter, Reddit and Wikipedia activity.](https://journals.plos.org/plosone/article/metrics?id=10.1371/journal.pone.0356494#discussedHeader) Open Access Peer-reviewed Research Article # Adherence to anti-seizure medications among persons living with epilepsy attending a community- based epilepsy clinic in Buikwe and Mukono Districts-Uganda: A mixed methods study * Ronald Kibirige , Roles Conceptualization, Data curation, Formal analysis, Investigation, Methodology, Writing – original draft, Writing – review & editing * E-mail: ronaldkibirige@gmail.com Affiliation Department of Epidemiology and Biostatistics, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda [ ![ORCID logo](https://journals.plos.org/resource/img/orcid_16x16.png) https://orcid.org/0009-0006-5563-0773 ](https://orcid.org/0009-0006-5563-0773 "ORCID Registry") ⨯ * Marianna Agaba Nyangire, Roles Conceptualization, Data curation, Formal analysis, Investigation, Methodology, Supervision, Visualization, Writing – review & editing Affiliation Department of Disease Control and Prevention, School of public Health, College of Health Sciences, Makerere University, Kampala, Uganda [ ![ORCID logo](https://journals.plos.org/resource/img/orcid_16x16.png) https://orcid.org/0009-0002-3262-8081 ](https://orcid.org/0009-0002-3262-8081 "ORCID Registry") ⨯ * Mark Kaddumukasa, Roles Conceptualization, Data curation, Formal analysis, Funding acquisition, Methodology, Supervision, Writing – review & editing Affiliation Department of Medicine, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda ⨯ * Christine Muhumuza, Roles Conceptualization, Data curation, Formal analysis, Methodology, Visualization Affiliation Department of Epidemiology and Biostatistics, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda ⨯ * Christopher Burant, Roles Investigation, Project administration, Supervision Affiliation Louis Stokes VA Medical Center, Geriatric Research Education, and Clinical Center, Cleveland, Ohio, United States of America ⨯ * Shirley Moore, Roles Conceptualization, Funding acquisition, Visualization Affiliation Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio, United States of America ⨯ * Elly T. Katabira, Roles Conceptualization, Data curation, Funding acquisition, Methodology, Supervision Affiliation Department of Medicine, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda ⨯ * Martha Sajatovic, Roles Funding acquisition, Visualization Affiliation Neurological and Behavioral Outcomes Center, University Hospitals Cleveland Medical Center & Case Western Reserve University School of Medicine, Cleveland, Ohio, United States of America ⨯ * Jane Tugume, Roles Conceptualization, Formal analysis, Methodology, Visualization Affiliation Department of Epidemiology and Biostatistics, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda ⨯ * John Nsubuga, Roles Conceptualization, Data curation, Formal analysis, Methodology, Visualization Affiliation Department of Epidemiology and Biostatistics, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda ⨯ * Nazarius Mbonna Tumwesigye, Roles Conceptualization, Data curation, Methodology, Validation, Visualization Affiliation Department of Epidemiology and Biostatistics, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda ⨯ * Aggrey David Mukose Roles Conceptualization, Data curation, Formal analysis, Methodology, Supervision, Visualization, Writing – review & editing Affiliation Department of Epidemiology and Biostatistics, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda [ ![ORCID logo](https://journals.plos.org/resource/img/orcid_16x16.png) https://orcid.org/0000-0002-0309-8926 ](https://orcid.org/0000-0002-0309-8926 "ORCID Registry") ⨯ # Adherence to anti-seizure medications among persons living with epilepsy attending a community- based epilepsy clinic in Buikwe and Mukono Districts-Uganda: A mixed methods study * Ronald Kibirige, * Marianna Agaba Nyangire, * Mark Kaddumukasa, * Christine Muhumuza, * Christopher Burant, * Shirley Moore, * Elly T. Katabira, … * Martha Sajatovic, * Jane Tugume, * John Nsubuga ![PLOS](https://journals.plos.org/resource/img/logo-plos-full-color.svg) x * Published: August 21, 2026 * * [Article](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0356494) * [Authors](https://journals.plos.org/plosone/article/authors?id=10.1371/journal.pone.0356494) * [Metrics](https://journals.plos.org/plosone/article/metrics?id=10.1371/journal.pone.0356494) * [Comments](https://journals.plos.org/plosone/article/comments?id=10.1371/journal.pone.0356494) * [Media Coverage](http://plos.altmetric.com/details/doi/10.1371/journal.pone.0356494) * [Peer Review](https://journals.plos.org/plosone/article/peerReview?id=10.1371/journal.pone.0356494) * [Abstract](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0356494#abstract0) * [Introduction](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0356494#sec005) * [Methods](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0356494#sec006) * [Results](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0356494#sec018) * [Discussion](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0356494#sec028) * [Strength and limitations of the study](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0356494#sec030) * [Conclusions](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0356494#sec031) * [Supporting information](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0356494#sec032) * [Acknowledgments](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0356494#ack) * [References](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0356494#references) * [Reader Comments](https://journals.plos.org/plosone/article/comments?id=10.1371/journal.pone.0356494) * [Figures](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0356494) ## Abstract ### Background Epilepsy is a common neurological disease especially in Sub-Saharan Africa. Medication adherence is essential in seizure control; however, majority of patients living with epilepsy have poor adherence to anti- seizure medications. The purpose of this study was to determine the prevalence, the factors associated with, and the experiences with adherence to anti-seizure medications among people living with epilepsy attending a community- based epilepsy clinic in Buikwe District and Mukono General Hospital in Mukono District, central-Uganda. ### Methods and material In this cross-sectional mixed methods study, 277 participants were enrolled and 20 in-depth interviews were conducted from April to July 2024. Socio-demographics and treatment related information were collected using structured questionnaires. Medication adherence was measured using the standardized 8- item Morisky Medication Adherence Scale. Modified Poisson regression was done to determine factors associated with adherence to anti-seizure medications. Thematic analysis was conducted to explore participant’s experiences with adherence to anti-seizure medications. ### Results The overall prevalence of adherence to anti-seizure medications was 66.5%. Factors significantly associated with adherence to Anti-seizure medications were earning a modest monthly income, adjusted prevalence ratios [aPR], (aPR 1.29; CI 1.13-1.53), receiving an inadequate treatment dosage (aPR 0.80; 95% CI 0.64-0.92), waiting for three or more hours at the facility (aPR 0.79: 95% CI 0.61-0.91), and being aged 30 to 34 years (aPR 0.71: CI 0.53-0.95). Key themes describing experiences with adherence to anti-seizure medications included fear of stigmatization, fear of injury and loss of life, social support, financial burden, individual motivation, misconceptions about anti-seizure medications, and limited awareness about their effectiveness. ### Conclusion This study revealed that about two- thirds of people living with epilepsy were adherent to anti-seizure medications. There is a need to implement strategies such as incorporating a medication adherence tool into routine patient care to improve adherence in our settings. ## Figures ![Table 4](https://journals.plos.org/plosone/article/figure/image?size=inline&id=10.1371/journal.pone.0356494.t004) ![Table 1](https://journals.plos.org/plosone/article/figure/image?size=inline&id=10.1371/journal.pone.0356494.t001) ![Table 2](https://journals.plos.org/plosone/article/figure/image?size=inline&id=10.1371/journal.pone.0356494.t002) ![Table 3](https://journals.plos.org/plosone/article/figure/image?size=inline&id=10.1371/journal.pone.0356494.t003) ![Table 4](https://journals.plos.org/plosone/article/figure/image?size=inline&id=10.1371/journal.pone.0356494.t004) ![Table 1](https://journals.plos.org/plosone/article/figure/image?size=inline&id=10.1371/journal.pone.0356494.t001) ![Table 2](https://journals.plos.org/plosone/article/figure/image?size=inline&id=10.1371/journal.pone.0356494.t002) ![Table 3](https://journals.plos.org/plosone/article/figure/image?size=inline&id=10.1371/journal.pone.0356494.t003) **Citation:** Kibirige R, Nyangire MA, Kaddumukasa M, Muhumuza C, Burant C, Moore S, et al. (2026) Adherence to anti-seizure medications among persons living with epilepsy attending a community- based epilepsy clinic in Buikwe and Mukono Districts-Uganda: A mixed methods study. PLoS One 21(8): e0356494. https://doi.org/10.1371/journal.pone.0356494 **Editor:** Hiroki Annaka, Niigata University of Health and Welfare: Niigata Iryo Fukushi Daigaku, JAPAN **Received:** September 19, 2025; **Accepted:** August 3, 2026; **Published:** August 21, 2026 **Copyright:** © 2026 Kibirige et al. This is an open access article distributed under the terms of the [Creative Commons Attribution License](http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. **Data Availability:** All relevant data are within the manuscript and its [Supporting Information](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0356494#sec032) files. **Funding:** Research reported in this publication was supported by the National Institute Of Neurological Disorders And Stroke of the National Institutes of Health under Award Number D43NS118560-01.There was no additional external funding received for this study. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. **Competing interests:** The authors have declared no competing interests. ## Introduction Epilepsy is a chronic neurological disorder affecting approximately 50 million people globally. It is estimated that 80% of people living with epilepsy (PLWE) reside in developing countries like Uganda [[1](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0356494#pone.0356494.ref001),[2](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0356494#pone.0356494.ref002)]. The crude prevalence of epilepsy in Uganda is reported to be 16.9 per 1000 persons [[3](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0356494#pone.0356494.ref003)]. The risk of premature death due to epilepsy is 3 times higher than for the general population, especially among those not receiving regular anti-seizure medications [[4](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0356494#pone.0356494.ref004)]. Anti-seizure medications (ASMs) remain a mainstay of epilepsy treatment with about 70% of PLWE becoming seizure free with ASM treatment [[5](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0356494#pone.0356494.ref005)]. Nearly 90% of PLWE in low and middle- income countries are not receiving appropriate treatment, which could be due to low availability of ASMs, misconceptions about ASMs, perceived epilepsy stigma and cultural attitudes. Thesemay lower the patient’s level of adherence to treatment [[6](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0356494#pone.0356494.ref006)]. Adherence is the most important modifiable factor that can improve treatment outcomes and reduce mortality [[7](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0356494#pone.0356494.ref007)]. Patients who are non-adherent to their medication are frequently hospitalized, often with prolonged lengths of hospital stay [[8](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0356494#pone.0356494.ref008)]. Approximately 25% of prescribed medications are omitted by patients, which might lead to morbidity and mortality including increased hospitalization, unnecessary and costly procedures and treatment failure [[9](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0356494#pone.0356494.ref009)]. The explanatory factors for the low adherence levels are centered around low public awareness, limited diagnostic and treatment resources, beliefs about the treatment and availability of highly trusted non allopathic treatments [[10](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0356494#pone.0356494.ref010),[11](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0356494#pone.0356494.ref011)]. The risk of experiencing successive seizures increases by 21% among patients who do not adhere to their prescribed treatment [[12](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0356494#pone.0356494.ref012)]. Studies in Uganda show that poor adherence to epilepsy treatment is related to social stigma and misconceptions about the condition [[13](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0356494#pone.0356494.ref013)]. Therefore, we set out to determine the level of adherence, the factors associated with adherence, and experiences with adhering to anti-seizure medications among persons living with epilepsy attending a community -based epilepsy clinic in Buikwe District or Mukono General Hospital, Mukono District. Facility records show increasing numbers of people with epilepsy seeking care at both the community-based epilepsy clinic in Buikwe and at Mukono General Hospital. ## Methods ### Study settings This study was carried out in a community-based epilepsy clinic in Buikwe District and at Mukono General Hospital, Mukono District. The community- based epilepsy clinic is in central Uganda, about 60kms from Kampala, the capital city of Uganda. The clinic is carried out monthly by Butabika National Referral Hospital, community epilepsy program in collaboration with the Little Sisters of St Francis. Facility records indicate that the number of people living with epilepsy (PLWE) attending this clinic daily is increasing, with attendance often reaching 200 or more patients per day. Mukono General Hospital is in Mukono town, about 35kms west of the headquarters of Buikwe. More than 100 people living with epilepsy attend a weekly epilepsy clinic at Mukono General Hospital, a government facilitated hospital that provides free anti-seizure medications. The most prescribed anti-seizure medications at both the community-based epilepsy clinic and Mukono General Hospital are; Phenytoin, Carbamazepine, Phenobarbitone, Sodium valproate and Lamotrigine We pooled all these participants from the two clinics, i.e., the community-based epilepsy clinic, and Mukono General Hospital into a single cohort since they serve as epilepsy treatment centers within the same geographical area, with similar clinical follow-up procedures, medication regimens, and patient counseling practices. In addition, these two sites draw patients from overlapping communities within Buikwe, Mukono and surrounding areas, resulting in similar socio-demographic and health system contexts for patients attending either facility. The baseline characteristics of participants from both sites were also assessed and showed no meaningful differences in key variables such as age distribution, sex, socioeconomic indicators, and duration on treatment. Furthermore, a site-level comparison of key outcomes also revealed no significant variation in adherence patterns between the two facilities. ### Study design and population The study was a cross-sectional design conducted both in the community and at the hospital, employing quantitative and qualitative methods [[14](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0356494#pone.0356494.ref014)]. The study adhered to the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines [[15](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0356494#pone.0356494.ref015)]. The study population consisted of persons living with epilepsy15 years and above attending regularly at the community-based epilepsy clinic in Buikwe District, and Mukono General Hospital, Mukono District. The study was conducted from 05th April to 20th July 2024. Participants were approached through mental health care workers, and community health workers, who introduced the research team to the study respondents. ### Sample size calculation For the quantitative component, a sample size of 277 was determined using the modified Kish-Leslie formula for cross-sectional studies, (1965) [[16](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0356494#pone.0356494.ref016)]. ![](https://journals.plos.org/plosone/article/file?type=thumbnail&id=10.1371/jo
## Related Clinical Research

- [CAMSAP3 loss-of-function evidence implicates gene in generalized genetic epilepsy](https://medichelpline.com/clinical-feed/biorxiv-1-camsap3-loss-of-function-models-suggest-causative-role-in-generalized-genetic.md)
- [SCN1A gain-of-function mouse model shows inhibitory neuron dysfunction causes epilepsy and early d](https://medichelpline.com/clinical-feed/biorxiv-12-epilepsy-and-premature-mortality-driven-by-inhibitory-neuron-dysfunction-in-a.md)
- [EEG-derived indices classify sporadic Creutzfeldt-Jakob disease from Alzheimer’s and healthy aging](https://medichelpline.com/clinical-feed/plos-one-17-classification-of-sporadic-creutzfeldt-jakob-disease-based-on-resting-state.md)
- [Bupropion Hydrochloride for Improving Recovery in Acute Ischaemic Stroke: BASE Trial Protocol](https://medichelpline.com/clinical-feed/bmj-open-4-protocol-for-base-a-multicentre-double-blind-randomised-controlled-trial-of.md)
- [Humanoid robots complete laparoscopic gallbladder removal in pigs, offering translational insights](https://medichelpline.com/clinical-feed/nature-1-humanoid-robots-perform-successful-surgery-in-animals.md)

## Navigation
- [← Back to Neurology Feed](https://medichelpline.com/clinical-feed/neurology.md)
- [← All Clinical Specialties](https://medichelpline.com/clinical-feed.md)
## Medical & Regulatory Disclaimer

> [!CAUTION]
> MedicHelpline content is structured for research, educational, and professional discovery purposes. It does not constitute individual medical advice, clinical diagnosis, or treatment recommendations.
> Always verify dosing, contraindications, and regulatory alerts against official product labeling and primary regulatory sources before clinical decision-making.