Adherence to Clinic Appointments and Medication Among Patients Accessing Mental Health Clinics in Lilongwe, Malawi

Abstract Background: Individuals who are nonadherent to treatment have higher rates of symptom recurrence, higher rates of hospital readmission and poorer quality of life. Nkhoma Mission Hospital (NMH) in the central region of Malawi has been integrating mental health within the existing services to ensure that the services are accessible to people. The purpose of the study was to investigate the prevalence and factors of nonadherence to appointments and medication among patients with mental illness. Design and methods: A cross-sectional analytical study was conducted at Nkhoma Mission Hospital. A survey approach and total population sampling were used. The MARS score was used to assess medication adherence. Associations of alcohol use, insight, and stigma with medication adherence were established using the AUDIT, BIRCHWOOD and ISMI scales, respectively. Results: The prevalence of nonadherence to clinic appointments and medication was 64% (n=58) and 46.2%, respectively. Females were 4.7 times more likely to miss clinic appointments than males were (B =-1.555, Exp (B)=0.221, p=0.029), Protestant Christians were 5 times more likely to miss clinic appointments (B = 5.176, p=0.034), clients who were not married were 15 times more likely not to adhere to clinic appointments (B=2.722, Exp(B)=25.12, p=0.002), and clients who visited a mobile clinic were more likely to miss appointments (B =-1.762, Exp (B)=0.172, p=0.020). Patients who had been on medication for less than 2 years had significantly lower adherence to medication (B=-1.631, t=-2.053, p=0.043); patients whose occupation involved farming had lower adherence to medication (B=-1.541, t=-2.057, p=0.043); and psychotic patients had greater adherence to medication than nonpsychotic patients did (B=1.753, t=2.041, p=0.044). Conclusion: It is important to address the factors that influence nonadherence to clinic appointments and medication to avoid relapse.