Non-adherence with the treatment regimen and its associated factors among patients with schizophrenia in Sub-Saharan Africa: a systematic review and meta-analysis

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.