Magnitude of uncontrolled seizures and associated factors among people with epilepsy. Data from a major teaching hospital in Southwest Ethiopia Yadeta Babu ⇑ , Tadesse Sheleme, Birbirsa Sefera, Firomsa Bekele, Wayessa Olika Department of Pharmacy, College of Health Science, Mettu University, Mettu, Oromia, Ethiopia article info Article history: Received 29 June 2022 Revised 28 December 2022 Accepted 5 January 2023 Keywords: Seizure control Epilepsy Jimma Medical Center Ethiopia abstract Background: Epilepsy is a major public health problem affecting 70 million people worldwide. 90% of glo- bal people with epilepsy were living in developing regions like Ethiopia. Due to the lack of clear guide- lines for treatment selection and the difficulty of individualizing care in resource-poor settings, achieving seizure control can be challenging. Seizure control status among epileptic patients is affected by different factors. Accordingly, this study aimed to assess the magnitude of uncontrolled seizures and associated factors among people with epilepsy attending the outpatient clinic of Jimma Medical Center, Southwest Ethiopia. Methods: A hospital-based retrospective chart review and a respective patient interview conducted among people with epilepsy from October 2020 to June 2021. Sociodemographic, behavioral-related fac- tors, medication adherence, and medication belief were obtained through patient interviews. Seizure control status in the last two years before the study period was retrospectively evaluated and recorded from the charts. Data were entered into Epi Data manager version 4.6 and then exported to SPSS version 23.0 for analysis. A backward logistic regression analysis was done to identify factors associated with uncontrolled seizures. Results: From a total of 314 medical charts reviewed, 149(47.5 %) of patients were with uncontrolled sei- zures. 28.7 %,12.8 %, and 6 % of the patients experienced 1–5,6–10, and >10 seizure episodes during the last two years respectively. Comorbidity [adjusted odds ratio [(AOR): 2.13, 95 % confidence interval (CI):1.26–3.58], nonadherence [AOR: 2.41, 95 %CI: 1.46–3.9], possible adverse drug reaction (ADR) [AOR:1.79, 95 %CI: 1.107–3.01], and drug interaction [AOR: 3.06, 95 %CI: 1.24–7.57] were associated with an uncontrolled seizure. Conclusion and recommendation: Our study showed that a substantial proportion of the patients were with uncontrolled seizures. Epileptic patients with comorbidities, nonadherence, adverse drug reactions, and drug interactions were more prone to have uncontrolled seizures. Hence, to overcome these prob- lems, strategies like community-based education, treatment intensification, and routine assessment of adverse drug reactions and drug interaction may help to improve seizure control status. Ó 2023 Elsevier Inc. All rights reserved. 1. Introduction Epilepsy is a common neurological disorder characterized by abnormal brain activity causing seizures or unusual behavior, sen- sations, and sometimes loss of awareness [1]. It is a major public health problem affecting 70 million people worldwide, of which nearly 90 % were residing in developing regions [2,3]. This is likely due to the increased risk of endemic conditions, such as road traffic injuries, birth-related injuries, malaria or neurocysticercosis (NCC), variations in medical infrastructure, and the availability of preven- tive health programs [3]. Similar to the other developing regions, Ethiopia is highly affected by epilepsy with a reported prevalence of 5.2 per 1000 population and an annual incidence of 64 per 100,000 populations [4]. Antiepileptic drug (AED) is usually recommended for patients who have had one or more epileptic seizures. The choice of therapy for the management of epilepsy varies depending on the fre- quency, types, and severity of the seizures [1,5]. A 2014 review https://doi.org/10.1016/j.yebeh.2023.109089 1525-5050/Ó 2023 Elsevier Inc. All rights reserved. Abbreviations: AED, Antiepileptic drug; AOR, Adjusted odds ratio; ADR, Adverse drug reaction; BMQ, Beliefs about medicine questionnaire; DDI, Drug-drug inter- action; GTC, Generalized tonic-clonic; JMC, Jimma Medical Center; NCC, Neurocys- ticercosis; TASH, Tikur Anbessa Specialized Hospital; UoGRH, University of Gondor referral and teaching hospital. ⇑ Corresponding author. E-mail address: yadetababu@gmail.com (Y. Babu). Epilepsy & Behavior 140 (2023) 109089 Contents lists available at ScienceDirect Epilepsy & Behavior journal homepage: www.elsevier.com/locate/yebeh