Original Articles
Non-adherence to chelation therapy and associated psychosocial factors among transfusion-dependent thalassaemia patients in Kandy, Sri Lanka
Authors:
Anuradha Baminiwatta ,
University of Kelaniya, Ragama, LK
About Anuradha
Department of Psychiatry, Faculty of Medicine
Ruwan Gunathilake,
National Hospital, Kandy, LK
About Ruwan
Paediatric Unit
Shiyama Arambepola,
National Hospital, Kandy, LK
About Shiyama
Psychiatric Unit
Mahinda Arambepola
National Hospital, Kandy, LK
About Mahinda
Paediatric Unit
Abstract
Background: Poor adherence to iron chelation may underlie the detrimental levels of iron overload previously reported among transfusion-dependent thalassaemia (TDT) patients in Sri Lanka. Given the many challenges faced by these patients and families, psychosocial factors may have a significant impact on medication adherence.
Objective: To assess chelation adherence among TDT patients and explore associated psychosocial factors.
Method: TDT patients, aged over 4 years, admitted for blood transfusion to a tertiary care hospital, as well as their mothers, were recruited. Medication adherence was assessed using a questionnaire adapted from Brief Adherence Rating Scale. Serum ferritin (SF) values were recorded as objective measures of non-adherence. Mental health status of patients and their mothers was assessed using Strengths and Difficulties Questionnaire (SDQ) and General Health Questionnaire-30 (GHQ) respectively. Associated psychosocial factors were analysed using multiple linear regression.
Results:Fifty two patients aged 4 to 28 years participated. Thirty four (65%) were female. The average adherence rate was 90%. One fifth of patients had an adherence percentage less than 80%. The mean ferritin level was 3260 ng/ml, whereas 46.2% of patients had SF levels exceeding 2500ng/ml. SF levels correlated positively with non-adherence (r=0.34, 95%CI: 0.071-0.606, p=0.014). Based on multivariate analysis, increasing age and lower SDQ score of patient, lower educational level and greater GHQ-30 score of mother were independent predictors of higher SF levels, but not of adherence rates.
Conclusions: In the paediatric unit of National Hospital, Kandy, 46% of patients had SF levels >2500 ng/ml. There was a significant correlation between SF levels and medication non-adherence (r=0.34, p=0.014). On multivariate analysis, increasing age and lower SDQ score of the patient, lower educational level and greater GHQ-30 score of the mother were independent predictors of higher SF levels, but not of adherence rates.
Sri Lanka Journal of Child Health, 2021; 50(1): 116-123
How to Cite:
Baminiwatta, A., Gunathilake, R., Arambepola, S. and Arambepola, M., 2021. Non-adherence to chelation therapy and associated psychosocial factors among transfusion-dependent thalassaemia patients in Kandy, Sri Lanka. Sri Lanka Journal of Child Health, 50(1), pp.116–123. DOI: http://doi.org/10.4038/sljch.v50i1.9412
Published on
05 Mar 2021.
Peer Reviewed
Downloads