Non-adherence with the treatment regimen and its associated factors among patients with schizophrenia in Sub-Saharan Africa: a systematic review and meta-analysis.
| Title: | Non-adherence with the treatment regimen and its associated factors among patients with schizophrenia in Sub-Saharan Africa: a systematic review and meta-analysis. |
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| Authors: | Addisu ZD; Department of Clinical Pharmacy, College of Medicine and Health Sciences, Bahir University, Bahir Dar, Amhara, Ethiopia. zenawdebasu@yahoo.co.uk.; Demsie DG; Department of Pharmacology, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Amhara, Ethiopia.; Tafere C; Department of Pharmaceutics, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Amhara, Ethiopia.; Siraj EA; Department of Pharmaceutics, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Amhara, Ethiopia.; Yazie TS; Pharmacology and Toxicology Unit, Department of Pharmacy, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia.; Yimer EG; School of Medicine, College of Health Sciences, University of Gondar, Gondar, Ethiopia.; Alemu NG; School of Medicine, College of Health Sciences, University of Gondar, Gondar, Ethiopia.; Milikit YZ; School of Medicine, College of Health Sciences, University of Gondar, Gondar, Ethiopia.; Wabela BN; School of Medicine, College of Health Sciences, University of Gondar, Gondar, Ethiopia.; Yismaw MB; Department of Clinical Pharmacy, College of Medicine and Health Sciences, Bahir University, Bahir Dar, Amhara, Ethiopia.; Ayal MA; Bahir Dar Health Science Collage, Bahir Dar, Amhara, Ethiopia.; Beyene DA; Department of Pharmacy, Asrat Woldeyes Health Sciences Campus, Debre Berhan University, Debre Berhan, Amhara, Ethiopia. |
| Source: | Scientific reports [Sci Rep] 2025 Oct 29; Vol. 15 (1), pp. 37843. Date of Electronic Publication: 2025 Oct 29. |
| Publication Type: | Journal Article; Systematic Review; Meta-Analysis |
| Language: | English |
| Journal Info: | Publisher: Nature Publishing Group Country of Publication: England NLM ID: 101563288 Publication Model: Electronic Cited Medium: Internet ISSN: 2045-2322 (Electronic) Linking ISSN: 20452322 NLM ISO Abbreviation: Sci Rep Subsets: MEDLINE |
| Imprint Name(s): | Original Publication: London : Nature Publishing Group, copyright 2011- |
| MeSH Terms: | Schizophrenia*/drug therapy ; Schizophrenia*/epidemiology ; Antipsychotic Agents*/therapeutic use ; Medication Adherence*/psychology; Africa South of the Sahara/epidemiology ; Humans ; Prevalence |
| Abstract: | Schizophrenia is among the serious mental illness affecting about 1% of the global population and ranking among the top ten causes of long-term disability. It is a major contributor to global disability and requires consistent adherence to antipsychotic medication for effective management. However, treatment non-adherence remains a significant challenge, particularly in Sub-Saharan Africa (SSA), where systemic barriers and cultural stigma further exacerbate the issue. This systematic review and meta-analysis aim to estimate the pooled prevalence of antipsychotic non-adherence among patients with schizophrenia in SSA and to identify the factors associated with treatment non-adherence. A systematic search was conducted across multiple databases, including PubMed, Cochrane, Scopus, African Index Medicus, and Google Scholar, for studies published before February 2025. This review has been registered with PROSPERO (registration number: CRD420251038674). Data were extracted using standardized forms, and study quality was assessed using the Joanna Briggs Institute (JBI) tools. A random-effects model was employed to estimate the pooled prevalence, with subgroup analyses and meta-regression conducted to explore sources of heterogeneity. This meta-analysis, which was conducted in SSA, included 16 full-text articles encompassing a total of 5,994 participants. The pooled prevalence of antipsychotic non-adherence was 45.30% (95% CI: 29.57-61.04%), with substantial heterogeneity observed (I2 = 99.51%). The review identified Several factors associated with treatment regimen non-adherence, including EPS (AOR = 3.95, 95% CI: 1.84-8.48), polypharmacy (AOR = 2.15, 95% CI: 1.56-2.96), substance use (AOR = 2.30, 95% CI: 1.43-3.71), alcohol use (AOR = 2.70, 95% CI: 1.21-5.99), perceived stigma (AOR = 2.58, 95% CI: 1.73-3.84), and lack of family support (AOR = 2.01, 95% CI: 1.33-3.04). The study reveals that nearly half of patients with schizophrenia in SSA exhibit non-adherence to antipsychotics, driven by treatment-related side effects, substance use, and socio-cultural barriers. Targeted interventions simplifying regimens, managing EPS, enhancing family involvement, and reducing stigma are urgently needed. Policymakers should prioritize mental health infrastructure and community education to improve adherence and outcomes in this vulnerable population.; (© 2025. The Author(s).) |
| Competing Interests: | Competing interests: The authors declare no competing interests. |
| References: | Psychiatr Serv. 1998 Feb;49(2):196-201. (PMID: 9575004); Ment Illn. 2017 Mar 22;9(1):6889. (PMID: 28479972); Sci Rep. 2024 Apr 27;14(1):9720. (PMID: 38678101); S Afr J Psychiatr. 2018 Mar 05;24:1124. (PMID: 30263211); Eur Heart J. 2013 Oct;34(38):2933-9. (PMID: 23861328); Psychiatry Res. 2015 Jan 30;225(1-2):14-30. (PMID: 25466227); Syst Rev. 2020 Jan 16;9(1):17. (PMID: 31948489); Ann Gen Psychiatry. 2021 Apr 24;20(1):27. (PMID: 33894789); J Nerv Ment Dis. 2006 Jun;194(6):454-7. (PMID: 16772865); Br J Psychiatry. 2004 Jun;184:509-16. (PMID: 15172945); J Clin Psychiatry. 2002 Oct;63(10):892-909. (PMID: 12416599); Indian J Psychiatry. 2023 May;65(5):506-525. (PMID: 37397842); Schizophr Res. 2011 Dec;133(1-3):36-41. (PMID: 21982098); BMC Psychiatry. 2024 Aug 19;24(1):567. (PMID: 39160469); Can J Cardiol. 2012 Sep-Oct;28(5):574-80. (PMID: 22884278); Mol Psychiatry. 2023 Dec;28(12):5319-5327. (PMID: 37500825); Patient Prefer Adherence. 2023 Nov 13;17:2927-2937. (PMID: 38027087); World Psychiatry. 2013 Oct;12(3):216-26. (PMID: 24096780); Psychiatry Res. 2018 Jan;259:289-294. (PMID: 29091831); Syst Rev. 2018 Jan 22;7(1):10. (PMID: 29357926); Arch Psychiatr Nurs. 2015 Oct;29(5):297-301. (PMID: 26397432); Nat Rev Drug Discov. 2023 May;22(5):387-409. (PMID: 36973491); Neuropsychiatr Dis Treat. 2014 Jun 12;10:1069-77. (PMID: 24966677); Int J Ment Health Nurs. 2013 Feb;22(1):35-46. (PMID: 22738372); J Clin Epidemiol. 2018 Aug;100:103-110. (PMID: 29339215); Aust N Z J Psychiatry. 2010 Oct;44(10):921-8. (PMID: 20932206); Int J Evid Based Healthc. 2015 Sep;13(3):147-53. (PMID: 26317388); BMC Geriatr. 2017 Jul 25;17(1):163. (PMID: 28743244); BMC Psychiatry. 2024 Feb 7;24(1):108. (PMID: 38326836); PLoS One. 2015 Mar 27;10(3):e0120560. (PMID: 25816353); Psychiatry J. 2018 Jan 01;2018:9850594. (PMID: 29536020); BMJ Open. 2021 Sep 2;11(9):e044987. (PMID: 34475141); Can J Psychiatry. 2013 Jan;58(1):59-65. (PMID: 23327758); Biometrics. 2018 Sep;74(3):785-794. (PMID: 29141096); BMC Psychiatry. 2014 Aug 30;14:240. (PMID: 25168715); Gen Hosp Psychiatry. 2012 Jan-Feb;34(1):72-9. (PMID: 22036736); AIDS Patient Care STDS. 2001 Sep;15(9):491-4. (PMID: 11587635); Schizophr Res Treatment. 2023 Feb 3;2023:7035893. (PMID: 36778520); BMC Psychiatry. 2012 Mar 20;12:20. (PMID: 22433036); Psychiatry J. 2014;2014:694565. (PMID: 24967300) |
| Contributed Indexing: | Keywords: Antipsychotics; Non-adherence; Schizophrenia; Sub-Saharan Africa |
| Substance Nomenclature: | 0 (Antipsychotic Agents) |
| Entry Date(s): | Date Created: 20251030 Date Completed: 20251030 Latest Revision: 20251209 |
| Update Code: | 20260130 |
| PubMed Central ID: | PMC12572252 |
| DOI: | 10.1038/s41598-025-21647-6 |
| PMID: | 41162442 |
| Database: | MEDLINE |
Journal Article; Systematic Review; Meta-Analysis