Family caregivers' reported nonadherence to the controller medication of asthma in children in Casablanca (Morocco): Extent and associated factors

ABSTRACT

Objective: Recent statistics show a relatively high prevalence of asthma among Moroccan children and a weak control over their symptoms. To our knowledge, no research has been carried out to document adherence to the controller treatment in this population. This study aims 1) to assess the extent of children's nonadherence to the controller treatment of asthma in an urban region of Morocco as reported by a family caregiver, and 2) to identify the associated factors. Methods: We conducted a cross-sectional study among caregivers of asthmatic children (2–12 years old) in different health and education facilities of Casablanca-Settat. We administered face-to-face questionnaires incorporating validated instruments (Medication Adherence Rating Scale-Asthma (MARS-A), Beliefs about Medicines Questionnaire (BMQ), Asthma Knowledge Questionnaire). Univariate and multivariate log-binomial regressions evaluating the association between several factors and reported nonadherence were performed (prevalence ratios (PR) and 95% confidence intervals (CI)). Results: Through two public hospitals, three private medical clinics, and one private school, 103 caregivers were recruited. Low adherence to the controller treatment of asthma was reported by 48% of the caregivers (MARS-A <45). In the multivariate model, caregivers with the lowest level of knowledge about asthma were almost three times more likely to report low adherence compared to caregivers with the highest level (PR = 2.93; 95% CI: 1.14–7.52). Conclusions: This study highlights the finding that low adherence is widespread in this context and also the importance of targeting caregivers' knowledge of asthma for interventions.

KEYWORDS:

• Asthma
• caregivers
• child
• culture
• drug therapy
• health literacy
• medication adherence
• Morocco
• social stigma
• urban population

Acknowledgements

The authors wish to thank all of the institutions that collaborated with this research and all the participants. We would like to acknowledge the collaboration of Dr. Amar, Dr. Chami, Dr. Labiad, Dr. Naciri, Pr. Slaoui, Dr. Souhail, Dr. Zrikem, and L. Araqi-Houssaini to this study. A special thank you to Dr. Horne for his instruments. S. Lauzier had a research scholar award from the Fonds de recherche du Québec – Santé in partnership with the Institut national d'excellence en santé et en services sociaux during the conduct of the study.

Declaration of interest

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.

Additional information

Funding

This study was partially funded by the Fonds innovation santé of the Faculty of Medicine of Laval University.