Magnitude and factors associated with nonadherence to antiepileptic drug treatment in Africa: A cross-sectional multisite study

Objectives: The epilepsy treatment gap is large in low- and middle-income countries, but the reasons behind nonadherence to treatment with antiepileptic drugs (AEDs) across African countries remain unclear. We investigated the extent to which AEDs are not taken and associated factors in people with active convulsive epilepsy (ACE) identified in cross-sectional studies conducted in five African countries. Methods: We approached 2,192 people with a confirmed diagnosis of ACE for consent to give blood voluntarily. Participants were asked if they were taking AEDs, and plasma drug concentrations were measured using a fluorescence polarization immunoassay analyzer. Information about possible risk factors was collected using questionnaire-based clinical interviews. We determined factors associated with nonadherence to AED treatment in children and adults, as measured by detectable and optimal levels, using multilevel logistic regression. Results: In 1,303 samples assayed (43.7% were children), AEDs were detected in 482, but only 287 had optimal levels. Of the 1,303 samples, 532 (40.8%) were from people who had reported they were on AEDs. The overall prevalence of nonadherence to treatment was 63.1% (95% confidence interval [CI] 60.5–65.6%) as measured by detectable AED levels and 79.1% (95% CI 73.3–84.3%) as measured by optimal AED levels; self-reported nonadherence was 65.1% (95% CI 45.0–79.5%). Nonadherence was significantly (p < 0.001) more common among the children than among adults for optimal and detectable levels of AEDs, as was the self-reported nonadherence. In children, lack of previous hospitalization and learning difficulties were independently associated with nonadherence to treatment. In adults, history of delivery at home, absence of burn marks, and not seeking traditional medicine were independently associated with the nonadherence to AED treatment. Significance: Only about 20% of people with epilepsy benefit fully from antiepileptic drugs in sub-Saharan Africa, according to optimum AEDs levels. Children taking AEDs should be supervised to promote compliance

Supplementary comparison of the measurement of the alpha and beta particle surface emission rates from large area sources (CCRI(II)-S10 LASCE)

International audienceIn 2009, the Consultative Committee for Ionizing Radiation (CCRI) approved its first supplementary comparison, to be organized by the ENEA (as the pilot laboratory), for the measurement of the alpha and beta particle surface (i.e. 2 solid angle) emission rate from large area sources of the type used for calibrating surface contamination monitors. Five sources were disseminated to the twenty-three participating laboratories consisting of one each of 241Am, 14C, 147Pm and 90Sr for emission rate measurements, with one additional 90Sr source for the evaluation of source uniformity. Measurements of the radionuclide activity and radionuclidic purity were also made although not strictly required. This report describes the organization of this comparison and the material and measurement methods used. The proposed supplementary comparison reference values (SCRV) for each of the comparison measurands are given, together with the Degrees of Equivalence and their associated uncertainties for each participating laboratory. The results of this supplementary comparison may be used as evidence by participating National Metrology Institutes (NMIs) and Designated Institutes (DIs) when submitting calibration and measurement capabilities (CMCs) for the given radionuclides for similar types of large area sources; this is an important aspect of this comparison, given that only one other international supplementary comparison for surface emission rates had been organized before