Prevalence and non adherence to prescribed anti-hypertensive medication and associated factors among our patients at Uganda Heart Institute

Abstract

Background: Hypertension is a major public health problem both in the developed and developing countries, but with a much bigger burden in developing countries including the Sub Saharan Africa. Non-adherence to pharmacological therapy is a growing concern worldwide and constitutes a major barrier to safe, cost-effective and effective use of drugs hence posing a negative effect on health outcomes. It presents a big obstacle to blood pressure control and favours disease progression to complications. The major objectives in this study were to estimate the prevalence of non-adherence to prescribed antihypertensive medication as well as identify factors associated with non-adherence at Uganda Heart Institute, Mulago in Kampala, Uganda.

Methods: A hospital based cross sectional study was conducted at Uganda Heart Institute from October 2020 to November 2020. Eligibly consenting adult participants were recruited in the study. The Morisky medication adherence scale was used to assess adherence to medication. Data was collected regarding socio-demographic, drug related and healthcare service delivery factors using an interviewer administered questionnaire. Univariate and bivariate logistic regression analysis was conducted using STATA software version 14.2. Results: A total of 260 participants were enrolled in the study, with a mean age of 60.5 years (SD±11) and majority were in the age group of 60-74 years. The prevalence of non-adherence was 42/60 (16.15%;95% CI 71.4%-81.7%). Factors that were significantly associated with non-adherence were; education level where patients who had attained secondary education (P value 0.002, OR 0.2), tertiary education (P value 0.002, OR 0.2) and University education (P value <0.001, 0R 0.15) were more likely to adhere to medication compared to those with primary level of education. Also, being on other medications (P value 0.001; OR 4.4, 95% CI 1.7%-10.8%); so many medications to take, (P value 0.001; OR 5.6, 95% CI 2.1%-14.9%); being away from home (P value 0.015; OR 2.4, 95% CI 1.2%-4.8%); lack of money (P value 0.041; OR 8.2, 95% CI 1.1%-61.9%); long distance to the hospital (P value 0.002; OR 3.6, 95% CI 1.6-8.2) and lack of drugs at the health facility (P value 0.002; OR 3.1, 95% ci 1.5-6.5) were the other factors significantly associated with non-adherence.

Conclusion: The prevalence of non-adherence among out patients at Uganda Heart institute was found to be low. This information provides baseline data to help address the issue of non-adherence among hypertensive patients in our health institutions.

Key words: Hypertension, Non adherence, Morisky scale, Uganda Heart Institute