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Choi D, Im HB, Choi SJ, Han D. Safety classification of herbal medicine use among hypertensive patients: a systematic review and meta-analysis. Front Pharmacol 2024; 15:1321523. [PMID: 38881876 PMCID: PMC11176523 DOI: 10.3389/fphar.2024.1321523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Accepted: 03/27/2024] [Indexed: 06/18/2024] Open
Abstract
Background The use of herbal medicines (HMs) for the treatment of hypertension (HTN) is increasing globally, but research on the potential adverse effects and safety of HMs in HTN patients is limited. Therefore, this systematic review and meta-analysis aim to determine the global prevalence of HM usage among HTN patients and assess the safety of identified herbs based on current scientific evidence. Methods The PubMed/MEDLINE, EMBASE (Ovid), and Cumulated Index to Nursing and Allied Health Literature (CINAHL) databases were searched for cross-sectional studies on the use of HM among HTN patients. Our review includes studies published in English up to the year 2023. After extracting and appraising the data from the studies, a meta-analysis was conducted using the Stata version 16.0 to estimate the pooled prevalence of HM use in patients with HTN (PROSPERO: CRD42023405537). The safety classification of the identified HM was done based on the existing scientific literature. Results This study analyzed 37 cross-sectional studies from 21 countries and found that 37.8% of HTN patients used HM to manage their health. The prevalence of HM use varied significantly based on publication year and geographical region. Among the 71 identified herbs, Allium sativum L., Hibiscus sabdariffa L., and Olea europaea L. were the most commonly used. However, four herbs were identified as contraindicated, 50 herbs required caution, and only 11 herbs were considered safe for use. Conclusion The study highlights the potential risks of toxicities and adverse effects associated with HM use in the treatment of HTN. Ensuring patient safety involves using safe HMs in appropriate doses and avoiding contraindicated HMs. Future research should focus on identifying commonly used herbs, especially in resource-limited countries with poor HTN management, and additional clinical research is required to assess the toxicity and safety of commonly used HMs.
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Affiliation(s)
- Dain Choi
- Department of Global Health and Development, Graduate School, Hanyang University, Seoul, Republic of Korea
- Institute of Health Services Management, Hanyang University, Seoul, Republic of Korea
| | - Hyea Bin Im
- Department of Global Health and Development, Graduate School, Hanyang University, Seoul, Republic of Korea
- Institute of Health Services Management, Hanyang University, Seoul, Republic of Korea
| | - Soo Jeung Choi
- Department of Global Health and Development, Graduate School, Hanyang University, Seoul, Republic of Korea
- Institute of Health Services Management, Hanyang University, Seoul, Republic of Korea
- Department of Preventive Medicine, College of Medicine, Hanyang University, Seoul, Republic of Korea
| | - Dongwoon Han
- Department of Global Health and Development, Graduate School, Hanyang University, Seoul, Republic of Korea
- Institute of Health Services Management, Hanyang University, Seoul, Republic of Korea
- Department of Preventive Medicine, College of Medicine, Hanyang University, Seoul, Republic of Korea
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Atibila F, Asamani JA, Donkoh ET, Ruiter R, Kok G, Hoor GT. Estimating the Lifetime Cost of Managing Hypertension in Ghana: A Modelling Study. Health Serv Insights 2024; 17:11786329241241909. [PMID: 38559500 PMCID: PMC10981221 DOI: 10.1177/11786329241241909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Accepted: 03/09/2024] [Indexed: 04/04/2024] Open
Abstract
Introduction Over the last decade, hypertension (HPT) is among the leading causes of death and morbidity in Ghana. In recent past, most health policy research in Ghana and Africa focussed on communicable diseases. In recent times, Ghana and other developing nations have shifted their attention to non-communicable diseases because most of these countries are going through an epidemiologic transition where there is a surge in the prevalence of HPT. This paper was therefore set out to estimate the cost of treating HPT in Ghana from the patients' and health system's perspectives. Method We used a cost of illness framework to simulate the cost of HPT management in Ghana taking into account 4 of the common target organ complications with the most mortality implication. A decision analytic model (DAM) was developed in Microsoft® Excel to simulate the progression of HPT patients and the Markov model was employed in simulating the lifetime cost of illness. Results The results show that by 10 years from diagnosis, the probability of death from any of the 4 complications (ie, stroke, myocardial infarction, heart failure, and chronic kidney disease) is roughly 41.03%. By 20 years (or 243 months) from diagnosis, the probability of death is estimated to be 69.61%. However, by the 30th anniversary, the probability of death among the cohort is 82.3%. Also, the lifetime discounted cost of treating HPT is about GHS 869 106 which could range between GHS 570 239 and GHS 1.202 million if wide uncertainty is taken into account. This is equivalent to USD 119 056 (range: USD 78 115-164 723). Conclusion By highlighting the lifetime cost of treating HPT in Ghana, policies can be formulated regarding the cost of treating HPT by the non-communicable disease unit and National Health Insurance Authority (NHIA) of the Ministry of Health.
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Affiliation(s)
- Fidelis Atibila
- Valley View University, Techiman-Bono East Region, Ghana
- Department of Works and Social Psychology Maastricht University, Maastricht, The Netherlands
| | - James Avoka Asamani
- World Health Organization, Regional Office for Africa, Universal Health Coverage – Life Course Cluster, Brazzaville, Congo
| | - Emmanuel Timmy Donkoh
- Department of Basic and Applied Biology, University of Energy and Natural Resources, UENR Sunyani, Ghana
| | - Rob Ruiter
- Department of Works and Social Psychology Maastricht University, Maastricht, The Netherlands
| | - Gerjo Kok
- Department of Works and Social Psychology Maastricht University, Maastricht, The Netherlands
| | - Gill Ten Hoor
- Department of Works and Social Psychology Maastricht University, Maastricht, The Netherlands
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Ye J, Sanuade OA, Hirschhorn LR, Walunas TL, Smith JD, Birkett MA, Baldridge AS, Ojji DB, Huffman MD. Interventions and contextual factors to improve retention in care for patients with hypertension in primary care: Hermeneutic systematic review. Prev Med 2024; 180:107880. [PMID: 38301908 PMCID: PMC10919242 DOI: 10.1016/j.ypmed.2024.107880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 01/23/2024] [Accepted: 01/24/2024] [Indexed: 02/03/2024]
Abstract
BACKGROUND Regular engagement over time in hypertension care, or retention, is a crucial but understudied step in optimizing patient outcomes. This systematic review leverages a hermeneutic methodology to identify, evaluate, and quantify the effects of interventions and contextual factors for improving retention for patients with hypertension. METHODS We searched for articles that were published between 2000 and 2022 from multiple electronic databases, including MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, clinicaltrials.gov, and WHO International Trials Registry. We followed the latest version of the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guideline to report the findings for this review. We also synthesized the findings using a hermeneutic methodology for systematic reviews, which used an iterative process to review, integrate, analyze, and interpret evidence. RESULTS From 4686 screened titles and abstracts, 18 unique studies from 9 countries were identified, including 10 (56%) randomized controlled trials (RCTs), 3 (17%) cluster RCTs, and 5 (28%) non-RCT studies. The number of participants ranged from 76 to 1562. The overall mean age range was 41-67 years, and the proportion of female participants ranged from 0% to 100%. Most (n = 17, 94%) studies used non-physician personnel to implement the proposed interventions. Fourteen studies (78%) implemented multilevel combinations of interventions. Education and training, team-based care, consultation, and Short Message Service reminders were the most common interventions tested. CONCLUSIONS This review presents the most comprehensive findings on retention in hypertension care to date and fills the gaps in the literature, including the effectiveness of interventions, their components, and contextual factors. Adaptation of and implementing HIV care models, such differentiated service delivery, may be more effective and merit further study. REGISTRATION CRD42021291368. PROTOCOL REGISTRATION PROSPERO 2021 CRD42021291368. Available at: https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=291368.
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Affiliation(s)
- Jiancheng Ye
- Weill Cornell Medicine, NY, New York, USA; Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
| | - Olutobi A Sanuade
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA; Department of Population Health Sciences, Spencer Fox Eccles School of Medicine at the University of Utah, Salt Lake City, UT, USA
| | - Lisa R Hirschhorn
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA; Northwestern University Robert J Havey Institute for Global Health, Chicago, IL, USA
| | - Theresa L Walunas
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Justin D Smith
- Department of Population Health Sciences, Spencer Fox Eccles School of Medicine at the University of Utah, Salt Lake City, UT, USA
| | | | - Abigail S Baldridge
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA; Northwestern University Robert J Havey Institute for Global Health, Chicago, IL, USA
| | - Dike B Ojji
- Cardiovascular Research Unit, University of Abuja Teaching Hospital, Gwagwalada, Abuja, Nigeria; University of Abuja, Abuja, Nigeria
| | - Mark D Huffman
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA; Washington University in St. Louis, St. Louis, MO, USA; The George Institute for Global Health, Sydney, Australia
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Povia JP, Masenga SK, Hamooya BM, Gebremeskel Y. Productivity-adjusted life-years and correlates of uncontrolled hypertension at two health facilities in Zambia. PLoS One 2023; 18:e0295401. [PMID: 38060497 PMCID: PMC10703239 DOI: 10.1371/journal.pone.0295401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 11/21/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Hypertension has in the recent past surfaced as one of the conditions that has a significant impact on workforce productivity in emerging economies. Zambia is no different and has in the recent past recorded increasing cases. Despite the impact of hypertension being of great importance in regards to productivity, we have scarcity of data and studies on hypertension-related Productivity-Adjusted Life-Years (PALYs) in Zambia and Africa at large. This study assessed the impact of hypertension on PALYs lost and socioeconomic factors associated with nonadherence to antihypertensive medication (NATAM). METHODS This was a cross-sectional study of 198 participants from Livingstone University Teaching Hospital and Maramba Clinic situated in Livingstone, Zambia. Structured questionnaires were used to collect data. Productivity index multiplied by years lived was used to calculate PALYs and descriptive statistics were used to summarize sociodemographic, clinical and economic variables. Multivariable logistic regression was used to determine factors associated with NATAM. RESULTS The participants had a median age (interquartile range (IQR)) of 49 years (41, 59) and 60.1% (n = 119) were females while 39.9% (n = 79) were male. Our estimated PALYs lost per person due to hypertension were 0.2 (IQR 0.0, 2.7). Cumulative PALYs value lost due to the burden of hypertension was estimated to be at $871,239.58 in gross domestic product (GDP). The prevalence of NATAM was 48% (n = 95). The factors that were significantly associated with NATAM were age (odds ratio (OR) 0.94; 95% confidence interval (CI) 0.90, 0.98), female sex (OR 2.52; 95%CI 1.18, 5.40), self-employment (OR 2.57; 95%CI 1.02, 6.45) and absenteeism from work (OR 3.60; 95%CI 1.16, 11.22). CONCLUSIONS Findings in our study highlight a high economic loss of PALYs due to hypertension with a potential to impact GDP negatively. We also found that NATAM reduced productivity and income among individuals of working age further impacting PALYs lost due to hypertension. The factors associated with NATAM were age, sex, employment status and absenteeism from work. This study underscores the need for interventions targeting young people, females, self-employed individuals, and absentees at work to improve adherence to antihypertensive drugs in order to reduce PALYs lost due to hypertension.
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Affiliation(s)
- Joreen P. Povia
- Department of Economics, School of Social Sciences, Mulungushi University, Kabwe, Zambia
- HAND Research Group, School of Medicine and Health Sciences, Mulungushi University, Livingstone Campus, Livingstone, Zambia
| | - Sepiso K. Masenga
- HAND Research Group, School of Medicine and Health Sciences, Mulungushi University, Livingstone Campus, Livingstone, Zambia
| | - Benson M. Hamooya
- HAND Research Group, School of Medicine and Health Sciences, Mulungushi University, Livingstone Campus, Livingstone, Zambia
| | - Yordanos Gebremeskel
- Department of Economics, School of Social Sciences, Mulungushi University, Kabwe, Zambia
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Aovare P, Abdulai K, Laar A, van der Linden EL, Moens N, Richard E, Moll van Charante EP, Agyemang C. Assessing the Effectiveness of mHealth Interventions for Diabetes and Hypertension Management in Africa: Systematic Review and Meta-Analysis. JMIR Mhealth Uhealth 2023; 11:e43742. [PMID: 37646291 PMCID: PMC10477453 DOI: 10.2196/43742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Revised: 03/28/2023] [Accepted: 06/09/2023] [Indexed: 09/01/2023] Open
Abstract
Background Mobile health (mHealth) interventions are effective in improving chronic disease management, mainly in high-income countries. However, less is known about the efficacy of mHealth interventions for the reduction of cardiovascular risk factors, including for hypertension and diabetes, which are rapidly increasing in low- and middle-income countries. Objective This study aimed to assess the efficacy of mHealth interventions for diabetes and hypertension management in Africa. Methods We searched PubMed, Cochrane Library, Google Scholar, African Journals Online, and Web of Science for relevant studies published from inception to July 2022. The main outcomes of interest were changes in hemoglobin A1c (HbA1c), systolic blood pressure, and diastolic blood pressure. The random or fixed effect model was used for the meta-analysis, and the I2 statistic was used to gauge study heterogeneity. Z tests and P values were used to evaluate the effect of mHealth interventions on HbA1c and blood pressure levels. Results This review included 7 studies (randomized controlled trials) with a total of 2249 participants. Two studies assessed the effect of mHealth on glycemic control, and 5 studies assessed the effect of mHealth on blood pressure control. The use of mHealth interventions was not associated with significant reductions in HbA1c levels (weighted mean difference [WMD] 0.20, 95% CI -0.40 to 0.80; P=.51) among patients with diabetes and systolic blood pressure (WMD -1.39, 95% CI -4.46 to 1.68; P=.37) and diastolic blood pressure (WMD 0.36, 95% CI -1.37 to 2.05; P=.69) among patients with hypertension. After conducting sensitivity analyses using the leave-one-out method, the Kingue et al study had an impact on the intervention, resulting in a 2 mm Hg reduction in systolic blood pressure (WMD -2.22, 95% CI -3.94 to -0.60; P=.01) but was nonsignificant for diastolic blood pressure and HbA1c levels after omitting the study. Conclusions Our review provided no conclusive evidence for the effectiveness of mHealth interventions in reducing blood pressure and glycemic control in Africa among persons with diabetes and hypertension. To confirm these findings, larger randomized controlled trials are required.
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Affiliation(s)
- Pearl Aovare
- Department of Public & Occupational Health, University of Amsterdam, Amsterdam, Netherlands
| | - Kasim Abdulai
- Department of Clinical Nutrition and Dietetics, University of Cape Coast, Cape Coast, Ghana
| | - Amos Laar
- Department of Population, Family and Reproductive Health, University of Ghana, Accra, Ghana
| | - Eva L van der Linden
- Department of Vascular Medicine, University of Amsterdam, Amsterdam, Netherlands
| | - Nicolaas Moens
- Department of Economics, eHealth, and Digital Transformation, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Edo Richard
- Department of Neurology, University of Amsterdam, Amsterdam, Netherlands
- Department of Neurology, Donders Institute for Brain, Behaviour and Cognition, Radboud University Medical Centre, Nijmegen, Netherlands
| | - Eric P Moll van Charante
- Department of Public & Occupational Health, University of Amsterdam, Amsterdam, Netherlands
- Department of General Practice, University of Amsterdam, Amsterdam, Netherlands
| | - Charles Agyemang
- Department of Public & Occupational Health, University of Amsterdam, Amsterdam, Netherlands
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Jarrah M, Khader Y, Alkouri O, Al-Bashaireh A, Alhalaiqa F, Al Marzouqi A, Qaladi OA, Alharbi A, Alshahrani YM, Alqarni AS, Oweis A. Medication Adherence and Its Influencing Factors among Patients with Heart Failure: A Cross Sectional Study. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59050960. [PMID: 37241192 DOI: 10.3390/medicina59050960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 04/26/2023] [Accepted: 05/12/2023] [Indexed: 05/28/2023]
Abstract
Background and objectives: The chronic nature of heart failure requires long-lasting consumption of various medications. Despite the therapeutic benefits of heart failure medications, about 50% of patients with heart failure don't adequately adhere to their medications as prescribed globally. This study aimed to determine medication adherence levels among Jordanians with heart failure and its influencing factors. Materials and Methods: A cross-sectional study was conducted among 164 patients with heart failure attending cardiac clinics in the north of Jordan. The Medication Adherence Scale was used to measure medication adherence. Results: Overall, 33.5% of patients had high adherence, and 47% had partial to poor adherence. The proportion of patients with good to high adherence was significantly higher among patients younger than 60 years, having >high school level of education, being married, living with somebody, and having insurance. Conclusions: Patient-centered approach, targeting age, level of education, marital status, and health insurance coverage, should be developed using evidence-based guidelines to enhance adherence to medication and health outcomes in Jordanian patients with heart failure. The development and implementation of new and feasible strategies, particularly suited to Jordan's healthcare system capabilities, is important to improve medication adherence.
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Affiliation(s)
- Mohamad Jarrah
- Department of Internal Medicine, Jordan University of Science and Technology, P.O. Box 3030, Irbid 22110, Jordan
| | - Yousef Khader
- Department of Public Health, Community Medicine, Jordan University of Science and Technology, P.O. Box 3030, Irbid 22110, Jordan
| | - Osama Alkouri
- Faculty of Nursing, Yarmouk Univerity, P.O. Box 566, Irbid 21163, Jordan
| | - Ahmad Al-Bashaireh
- Higher Colleges of Technology, Abu Dhabi P.O. Box 25026, United Arab Emirates
| | | | - Ameena Al Marzouqi
- College of Health Sciences, University of Sharjah, Sharjah P.O. Box 27272, United Arab Emirates
| | - Omar Awadh Qaladi
- College of Nursing, King Saud University, P.O. Box 11451, Riyadh 11451, Saudi Arabia
| | - Abdulhafith Alharbi
- College of Nursing, University of Hail, P.O. Box 2440, Hail 81451, Saudi Arabia
| | | | | | - Arwa Oweis
- Faculty of Nursing, Jordan University of Science and Technology, P.O. Box 3030, Irbid 22110, Jordan
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Contemporary aetiology of acute heart failure in a teaching hospital in Ghana. BMC Cardiovasc Disord 2023; 23:82. [PMID: 36765294 PMCID: PMC9921595 DOI: 10.1186/s12872-023-03103-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 01/31/2023] [Indexed: 02/12/2023] Open
Abstract
BACKGROUND Heart failure (HF) is recognized as a global public health disease associated with high morbidity and mortality. It is suggested that the main underlying causes of HF in developing countries differ from those identified in well-resourced countries. This study therefore presents the cardiovascular risk factors and the underlying aetiology of HF among admitted patients in a teaching Hospital in Ghana. METHOD The study prospectively recruited 140 consecutive patients admitted for heart failure at the Medical department of the Korle-Bu Teaching Hospital from March to October, 2014. The study evaluated the cardiovascular risk factors and the aetiologies of heart failure, and compared the risk factors and aetiologies with patient's age and gender. RESULTS The mean age of the study participants was 51.3 ± 16.8 years. The commonest cardiovascular risk factors observed were hypertension (46.5%), history of previous HF (40.7%), excessive alcohol use (38.6%), and family history of heart disease (29.3%); predominantly hypertension (68.3%). The major underlying aetiology of HF were dilated cardiomyopathy (38.6%), hypertensive heart disease (21.4%), ischaemic heart disease (13.6%) and valvular heart disease (12.9%). These underlying aetiology of HF were more common in patients aged 40 years and above (p = 0.004) and those presenting with multiple risk factors (p = 0.001). CONCLUSION The major underlying aetiology of heart failure in adults were dilated cardiomyopathy, hypertensive heart disease, ischaemic heart disease and valvular heart disease, which were significantly high among patients aged 40 years and above and those presenting multiple risk factors. Hypertension, excessive alcohol use, family history of heart disease and personal history of previous heart failure diagnosis are noted as the main cardiovascular risk factors among heart failure patients.
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Oseni TIA, Blankson PK, Dele-Ojo BF, Duodu F, Echieh CP, Alabi SB, Tayo BO, Sarpong DF, Amoakoh-Coleman M, Boima V, Ogedegbe G. Medication adherence and blood pressure control: A preliminary assessment of the role of health insurance in Nigeria and Ghana. SAGE Open Med 2023; 11:20503121231152324. [PMID: 36741928 PMCID: PMC9893381 DOI: 10.1177/20503121231152324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 01/05/2023] [Indexed: 02/04/2023] Open
Abstract
Objectives This study sought to assess the current impact of health insurance coverage on medication adherence and blood pressure control of patients being managed for hypertension in Ghana and Nigeria. Methods The study was a prospective study among 109 patients with hypertension in two health facilities with similar population dynamics in Ghana and Nigeria. Patients were systematically selected, categorized as having health insurance coverage or not, and followed up monthly for 6 months. The outcome variables (medication adherence and blood pressure control) were then measured and compared at 6 months. Analysis was done using Stata with level of significance set at p ⩽ 0.05. Results There was a 90% insurance coverage among participants from Ghana compared to 15% from Nigeria. National Health Insurance Authority enrolees in both countries had better blood pressure control and medication adherence compared to non-enrolees (adjusted odds ratio = 2.6 and 4.5, respectively). Conclusion National Health Insurance Authority enrolment was found to be poor among respondents in Nigeria compared to Ghana. Enrolment into the National health financing schemes in both countries led to better blood pressure control and medication adherence among patients with hypertension at primary health facilities. There is therefore the need for system strengthening to improve their sustainability.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Vincent Boima
- University of Ghana College of Health Sciences, Accra, Greater Accra, Ghana
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Sahile AT, Nurhussien HA. Level of self-care practices and associated factors among hypertensive patients in Addis Ababa, Ethiopia. BMC Cardiovasc Disord 2023; 23:48. [PMID: 36698084 PMCID: PMC9875385 DOI: 10.1186/s12872-023-03062-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 01/12/2023] [Indexed: 01/26/2023] Open
Abstract
OBJECTIVES The study assessed the level of self-care practice and its predictors among hypertensive patients in the health centers of Bole Sub-city, Addis Ababa, Ethiopia. METHODS A multi-Center-based cross-sectional study that employed 370 hypertensive participants at the conveniently selected Health Centers in Bole Sub-City; from August 01-30, 2020. The researchers selected the participants based on a simple random sampling method after applying for a pre-tested interviewer-administered questionnaire and secured for informed consent. All the statistical analyses were SPSS 22.0 software based. The authors used binary logistics regression to identify the presence and strength of association; with its respective 95%CI and p-value less than five percent as a significant level. RESULTS The overall level of good self-care practice among hypertensive patients was 53.0% (95% CI: 47.2-58.8%) whereas 61.4%, 63.8%, 92.7%, 82.7%, and 18% of the study participants were adherent to medication, good weight management, non-smokers, alcohol abstainers and physical activity consecutively. Being illiterate had 2.347 and 2.084 times higher odds of having had good self-care practice compared to secondary school and a diploma or above consecutively. Being a merchant, civil, and retired were associated with good self-care practice than being unemployed. CONCLUSION AND RECOMMENDATION The study reported a lower level of self-care practice in the study settings. Educational level and occupation were factors identified for self-care practice. The authors recommended policymakers, healthcare workers, and researchers work on the identified factors of self-care practice of hypertensive participants in the study settings.
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Affiliation(s)
- Addisu Tadesse Sahile
- grid.442847.90000 0004 4914 9615Department of Public Health, Unity University, Addis Ababa, Ethiopia
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Thew HZ, Ching SM, Lim HM, Mos MH, Tze LCK, Low KF, Shaari N, Lin JYS, Lee KW, Ramachandran V. Prevalence and determinants of medications non-adherence among patients with uncontrolled hypertension in primary care setting in Sarawak, Malaysia: A cross-sectional study. MALAYSIAN FAMILY PHYSICIAN : THE OFFICIAL JOURNAL OF THE ACADEMY OF FAMILY PHYSICIANS OF MALAYSIA 2022; 17:128-136. [PMID: 36606165 PMCID: PMC9809434 DOI: 10.51866/oa.182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
INTRODUCTION Non-adherence to antihypertensive medications is a leading cause of uncontrolled hypertension and its complications. However, data on the factors associated with non-adherence to antihypertensive medications in the communities of Sarawak, Malaysia, are limited. This study aimed to examine the prevalence and determinants of medication non-adherence among patients with uncontrolled hypertension. METHOD A cross-sectional study was conducted using the systematic sampling method in four government primary healthcare clinics in Sarawak. A self-administered questionnaire was used to obtain socio-demographic data and evaluate non-adherence. Blood pressure was measured, and relevant clinical variables were collected from medical records. Multivariate logistic regression was used to determine the determinants of medication non-adherence. RESULTS A total of 488 patients with uncontrolled hypertension were enrolled in this study. The prevalence of medication non-adherence was 39.3%. There were four predictors of medication non-adherence among the patients with uncontrolled hypertension: tertiary educational level (odds ratio [OR]=4.21, 95% confidence interval [CI] = 1.67-10.61, P=0.010), complementary alternative medication (0R=2.03, 95% CI=1.12-3.69, P=0.020), non-usage of calcium channel blockers (0R=1.57, 95% CI=1.02-2.41, P=0.039) and 1 mmHg increase in the systolic blood pressure (0R=1.03, 95% CI=1.00-1.05, P=0.006). CONCLUSION Because of the high prevalence of medication non-adherence among patients with uncontrolled hypertension, primary care physicians should be more vigilant in identifying those at risk of being non-adherent. Early intervention should be conducted to address non-adherence for blood pressure control.
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Affiliation(s)
- Hui Zhu Thew
- MD (NNSMA), MMed (UPM), Department of Family Medicine, Faculty Medicine and Health Sciences, Serdang, Malaysia
| | - Siew Mooi Ching
- MD (UNIMAS), MMed (UM), Department of Family Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia
- Malaysian Research Institute on Ageing (MyAgeing), Universiti Putra, Malaysia, Serdang, Malaysia
- Department of Medical Sciences, School of Healthcare and Medical Sciences, Sunway University, 5 Jalan University, Bandar Sunway, Selangor Darul Ehsan, Malaysia
| | - Hooi Min Lim
- MBBS (UM), MMed (UM), Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Mike Hitler Mos
- MBBS (UM), Klinik Kesihatan Batu Kawa, Jalan Ensing Timur, Off Jalan, Stapok Utama,Kuching, Sarawak, Malaysia
| | - Lorna Chin Kin Tze
- MD (UPM), MAFP, FRACGP, Klinik Kesihatan Miri, Jalan Merbau, Miri, Sarawak, Malaysia
| | - Kui Feng Low
- MD, Klinik Kesihatan Jalan Masjid, Jalan Masjid, Kuching, Sarawak, Malaysia
| | - Nurdarlina Shaari
- MBBS(UM), MAFP, FRACGP, Klinik Kesihatan Telaga Air, Jalan Matang, Kuching, Sarawak, Malaysia
| | - Jody Yii Sze Lin
- MD (UNIMAS), MAFP, FRACGP, Klinik Kesihatan Tudan, Jalan Permyjaya, Miri, Sarawak, Malaysia
| | - Kai Wei Lee
- Ph.D. (UPM), Department of Medical Microbiology, Faculty of Medicine and Health Sciences, Universiti Putra, Malaysia, Serdang, Malaysia
| | - Vasudevan Ramachandran
- Ph.D. (UPM), Faculty of Health Sciences, University College MAIWP, International College, Taman Batu, Muda, Batu Caves, Kuala Lumpur, Malaysia
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Cao W, Kadir AA, Wang J, Hu L, Wen L, Yu M, Peng L, Chen L, Luo N, Hassan II. Medication non-adherence and associated factors among older adult stroke survivors in China. Front Pharmacol 2022; 13:1054603. [PMID: 36506570 PMCID: PMC9731135 DOI: 10.3389/fphar.2022.1054603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 11/02/2022] [Indexed: 11/25/2022] Open
Abstract
Aim: Medication non-adherence has remained a common and costly global health issue of growing importance among older adults. This study aims to determine the prevalence and associated factors related to medication non-adherence among older adult stroke survivors in China. Methods and results: In this cross-sectional study, a total of 402 older adult stroke survivors were recruited from three tertiary hospitals in China. The results of the survey showed that 61.4% exhibited medication non-adherence. The chances of medication non-adherence among older adult stroke survivors who had primary school or less educational levels were higher than those who had senior secondary and junior college educational levels [OR (95% CI) = 0.440(0.249, 0.778)] as well as those who had a bachelor's degree or above educational levels [OR (95%CI) = 0.367(0.202, 0.667)]. Moreover, the probability of medication non-adherence with 4-5 and ≥6 types of total prescription medications per day increased by 1.993 times [OR (95% CI) = 1.993(1.190, 3.339))] and 2.233 times [OR (95%CI) = 2.233(1.159, 4.300)], respectively, as compared to when there were ≤3 types. Furthermore, medication non-adherence decreased with the increase in health literacy scores (β = -0.641 (95% CI; (0.913, 0.965)) and BMQ specific-necessity scores (β = -0.131 (95% CI; 0.806, 0.995)). On the other hand, when the BMQ specific-concerns score increased by one unit, medication non-adherence increased by 11.1% [OR (95% CI) = 1.111(1.044, 1.182)]. Conclusion: The present study found that patient medication adherence among older adult stroke survivors in China is problematic and associated with educational levels, total prescribed drugs per day, beliefs about medication, and health literacy scores. This indicates that measures should be taken to enhance medication adherence among such higher-risk populations.
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Affiliation(s)
- Wenjing Cao
- School of Health Sciences, Health Campus, Universiti Sains Malaysia, Kelantan, Malaysia,Xiang Nan University, Chenzhou, Hunan, China
| | - Azidah Abdul Kadir
- School of Medical Sciences, Health Campus, Universiti Sains Malaysia, Kelantan, Malaysia
| | - Juan Wang
- Guangdong Pharmaceutical University, Guangzhou, Guangdong, China
| | - Lin Hu
- Xiang Nan University, Chenzhou, Hunan, China
| | - Linlan Wen
- Chenzhou No.1 People’s Hospital, Chenzhou, Hunan, China
| | - Mei Yu
- Chenzhou Third People’s Hospital, Chenzhou, Hunan, China
| | - Liqun Peng
- Affiliated hospital of Xiangnan University, Chenzhou, Hunan, China
| | - Lanying Chen
- Affiliated hospital of Xiangnan University, Chenzhou, Hunan, China
| | - Na Luo
- Xiang Nan University, Chenzhou, Hunan, China
| | - Intan Idiana Hassan
- School of Health Sciences, Health Campus, Universiti Sains Malaysia, Kelantan, Malaysia,*Correspondence: Intan Idiana Hassan, ,
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Ye J, Orji IA, Baldridge AS, Ojo TM, Shedul G, Ugwuneji EN, Egenti NB, Aluka-Omitiran K, Okoli RCB, Eze H, Nwankwo A, Hirschhorn LR, Chopra A, Ale BM, Shedul GL, Tripathi P, Kandula NR, Huffman MD, Ojji DB. Characteristics and Patterns of Retention in Hypertension Care in Primary Care Settings From the Hypertension Treatment in Nigeria Program. JAMA Netw Open 2022; 5:e2230025. [PMID: 36066896 PMCID: PMC9449788 DOI: 10.1001/jamanetworkopen.2022.30025] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND More than 1.2 billion adults worldwide have hypertension. High retention in clinical care is essential for long-term management of hypertension, but 1-year retention rates are less than 50% in many resource-limited settings. OBJECTIVE To evaluate short-term retention rates and associated factors among patients with hypertension in primary health care centers in the Federal Capital Territory of Nigeria. DESIGN, SETTING, AND PARTICIPANTS In this cohort study, data were collected by trained study staff from adults aged 18 years or older at 60 public, primary health care centers in Nigeria between January 2020 and July 2021 as part of the Hypertension Treatment in Nigeria (HTN) Program. Patients with hypertension were registered. EXPOSURES Follow-up visit for hypertension care within 37 days of the registration visit. MAIN OUTCOMES AND MEASURES The main outcome was the 3-month rolling average 37-day retention rate in hypertension care, calculated by dividing the number of patients who had a follow-up visit within 37 days of their first (ie, registration) visit in the program by the total number of registered patients with hypertension during multiple consecutive 3-month periods. Interrupted time series analyses evaluated trends in retention rates before and after the intervention phase of the HTN Program. Mixed-effects, multivariable regression models evaluated associations between patient-, site-, and area council-level factors, hypertension treatment and control status, and 37-day retention rate. RESULTS In total, 10 686 patients (68.3% female; mean [SD] age, 48.8 [12.7] years) were included in the analysis. During the study period, the 3-month rolling average 37-day retention rate was 41% (95% CI, 37%-46%), with wide variability among sites. The retention rate was higher among patients who were older (adjusted odds ratio [aOR], 1.01 per year; 95% CI, 1.01-1.02 per year), were female (aOR, 1.11; 95% CI, 1.01-1.23), had a higher body mass index (aOR, 1.01; 95% CI, 1.00-1.02), were in the Kuje vs the Abaji area council (aOR, 2.25; 95% CI, 1.25-4.04), received hypertension treatment at the registration visit (aOR, 1.27; 95% CI, 1.07-1.50), and were registered during the postintervention period (aOR, 1.16; 95% CI, 1.06-1.26). CONCLUSIONS AND RELEVANCE The findings suggest that retention in hypertension care is suboptimal in primary health care centers in Nigeria, although large variability among sites was found. Potentially modifiable and nonmodifiable factors associated with retention were identified and may inform multilevel, contextualized implementation strategies to improve retention.
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Affiliation(s)
- Jiancheng Ye
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Ikechukwu A. Orji
- Cardiovascular Research Unit, University of Abuja Teaching Hospital, Gwagwalada, Abuja, Nigeria
| | | | - Tunde M. Ojo
- Cardiovascular Research Unit, University of Abuja Teaching Hospital, Gwagwalada, Abuja, Nigeria
| | - Grace Shedul
- Cardiovascular Research Unit, University of Abuja Teaching Hospital, Gwagwalada, Abuja, Nigeria
| | - Eugenia N. Ugwuneji
- Cardiovascular Research Unit, University of Abuja Teaching Hospital, Gwagwalada, Abuja, Nigeria
| | - Nonye B. Egenti
- Cardiovascular Research Unit, University of Abuja Teaching Hospital, Gwagwalada, Abuja, Nigeria
| | | | | | - Helen Eze
- Cardiovascular Research Unit, University of Abuja Teaching Hospital, Gwagwalada, Abuja, Nigeria
| | - Ada Nwankwo
- Cardiovascular Research Unit, University of Abuja Teaching Hospital, Gwagwalada, Abuja, Nigeria
| | | | - Aashima Chopra
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Boni M. Ale
- Cardiovascular Research Unit, University of Abuja Teaching Hospital, Gwagwalada, Abuja, Nigeria
- Holo Healthcare, Nairobi, Kenya
| | - Gabriel L. Shedul
- Cardiovascular Research Unit, University of Abuja Teaching Hospital, Gwagwalada, Abuja, Nigeria
| | - Priya Tripathi
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | | | - Mark D. Huffman
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
- The George Institute for Global Health, Sydney, New South Wales, Australia
- Washington University in St Louis, St Louis, Missouri
| | - Dike B. Ojji
- Cardiovascular Research Unit, University of Abuja Teaching Hospital, Gwagwalada, Abuja, Nigeria
- University of Abuja, Abuja, Nigeria
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Predictors of Nonadherence to Medications among Hypertensive Patients in Ghana: An Application of the Health Belief Model. Int J Hypertens 2022; 2022:1418149. [PMID: 36059589 PMCID: PMC9433278 DOI: 10.1155/2022/1418149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Revised: 06/04/2022] [Accepted: 06/28/2022] [Indexed: 11/17/2022] Open
Abstract
Introduction. Hypertension (HPT) is recognized as a significant public health problem worldwide from a health and economic perspective. This study determined predictors of nonadherence to HPT medications in Ghana using the health belief model. Methods. A cross-sectional descriptive survey employing a quantitative approach was conducted among HPT patients who routinely attend clinics at selected hospitals in the Brong Ahafo region of Ghana. Respondents (n = 399) were recruited using a multistage sampling technique. Results. The prevalence of nonadherence was 63.7% (n = 254). Nonadherence to hypertension medication was associated with lower education status (
). In logistic regression analysis, patients with high “perceived susceptibility” and “perceived severity” were more likely to forfeit their HPT medication schedules, while patients with high “perceived barriers” and “cues to action” were less likely to skip their medication. Conclusion. The present study suggests a plausible path to improving medication adherence in this population. Given the high prevalence of nonadherence, policymakers need to urgently design tailor-made health promotion interventions to ensure optimal health outcomes.
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Kisigo GA, Mcharo OC, Robert JL, Peck RN, Sundararajan R, Okello ES. Understanding barriers and facilitators to clinic attendance and medication adherence among adults with hypertensive urgency in Tanzania. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000919. [PMID: 36962785 PMCID: PMC10021323 DOI: 10.1371/journal.pgph.0000919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 07/25/2022] [Indexed: 11/18/2022]
Abstract
Hypertensive urgency is a major risk factor for cardiovascular events and premature deaths. Lack of medication adherence is associated with poor health outcomes among patients with hypertensive urgency in resource-limited settings. To inform the development of tailored interventions to improve health outcomes in this population, this study aimed at understanding facilitators and barriers to clinic attendance and medication adherence among Tanzanian adults with hypertensive urgency. We conducted in-depth interviews with 38 purposively selected participants from three groups: 1) patients with hypertension attending hypertension clinic, 2) patients with hypertension not attending hypertension clinic, and 3) clinic health workers. Interviews were conducted using a semi-structured guide which included open-ended questions with prompts to encourage detailed responses. In their narrative, patients and healthcare workers discussed 21 types of barriers/facilitators to clinic attendance and medication adherence: 12 common to both behaviors (traditional medicine, knowledge and awareness, stigma, social support, insurance, reminder cues, symptoms, self-efficacy, peer support, specialized care, social services, religious beliefs); 6 distinct to clinic attendance (transport, clinic location, appointment, patient-provider interaction, service fragmentation, quality of care); and 3 distinct to medication adherence (drug stock, side effects, medicine beliefs). The majority of identified barriers/facilitators overlap between clinic attendance and medication adherence. The identified barriers may be surmountable using tailored supportive intervention approaches, such as peer counselors, to help patients overcome social challenges of clinic attendance and medication adherence.
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Affiliation(s)
- Godfrey A. Kisigo
- Mwanza Intervention Trials Unit, National Institute for Medical Research, Mwanza, Tanzania
- Center for Global Health, Weill Cornell Medicine, New York, New York, United States of America
| | - Onike C. Mcharo
- Mwanza Intervention Trials Unit, National Institute for Medical Research, Mwanza, Tanzania
| | - John L. Robert
- Mwanza Intervention Trials Unit, National Institute for Medical Research, Mwanza, Tanzania
| | - Robert N. Peck
- Mwanza Intervention Trials Unit, National Institute for Medical Research, Mwanza, Tanzania
- Center for Global Health, Weill Cornell Medicine, New York, New York, United States of America
| | - Radhika Sundararajan
- Center for Global Health, Weill Cornell Medicine, New York, New York, United States of America
- Department of Emergency Medicine, Weill Cornell Medicine, New York, New York, United States of America
| | - Elialilia S. Okello
- Mwanza Intervention Trials Unit, National Institute for Medical Research, Mwanza, Tanzania
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Hollingworth SA, Ankrah D, Uzochukwu BSC, Okeke CC, Ruiz F, Thacher E. Antihypertensive medicine use differs between Ghana and Nigeria. BMC Cardiovasc Disord 2022; 22:368. [PMID: 35948937 PMCID: PMC9364553 DOI: 10.1186/s12872-022-02799-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 05/19/2022] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Non-communicable diseases are a growing burden in many African countries; cardiovascular disease is the main disease. Antihypertensive medicines (AHM) are a common treatment option but we know little about community use in most low- and medium-income countries (LMIC). We aimed to describe the use of antihypertensive medicines (AHM) in Ghana and Nigeria using a novel data source. METHODS We used data from mPharma-a health and pharmaceutical company which distributes pharmaceuticals to hospital and retail pharmacies. We extracted data using the anatomical therapeutic chemical (ATC) classification codes and calculated use in defined daily doses and explored patterns by class, medicines, dose, and originator or generic product. RESULTS AHM use differed between Ghana and Nigeria. The most used classes in Ghana were angiotensin receptor blockers (ARB) followed by calcium channel blockers (CCB) and angiotensin-converting-enzyme inhibitors (ACEi). The five most used products were 16 mg candesartan, 30 mg nifedipine, 10 mg lisinopril, 5 mg amlodipine and 50 mg losartan. In Nigeria ARB, CCB and diuretics were widely used; the top five products were 50 mg losartan, 10 mg lisinopril, 30 mg nifedipine, 40 mg furosemide, and 5 mg amlodipine. More originator products were used in Ghana than Nigeria. CONCLUSION The differences between Ghana and Nigeria may result from a combination of medical, contextual and policy evidence and reflect factors related to clinical guidance (e.g. standard treatment guidelines), accessibility to prescribers and the role of community pharmacies, and structure of the health system and universal health coverage including funding for medicines. We show the feasibility of using novel data sources to gain insights on medicines use in the community.
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Affiliation(s)
- Samantha A. Hollingworth
- School of Pharmacy, The University of Queensland, 20 Cornwall St, Woolloongabba, QLD 4102 Australia
- Faculty of Pharmacy and Pharmaceutical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Daniel Ankrah
- Department of Pharmacy, Korle Bu Teaching Hospital, Accra, Ghana
| | | | - Chinyere C. Okeke
- Department of Community Medicine, College of Medicine, University of Nigeria, Enugu, Nigeria
| | - Francis Ruiz
- International Decision Support Initiative, London School of Hygiene and Tropical Medicine, London, UK
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Blood Pressure Profile and Factors Affecting Medication Adherence in Older Persons with Hypertension in Two Care Centers. AGEING INTERNATIONAL 2022. [DOI: 10.1007/s12126-022-09498-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Woode E, Boakye‐Gyasi E, Obirikorang Y, Adu EA, Obirikorang C, Acheampong E, Odame‐Anto E. Predictors of medication nonadherence among hypertensive clients in a Ghanaian population: Application of the Hill‐Bone and Perceived Barriers to Treatment Compliance Scale. Health Sci Rep 2022; 5:e584. [PMID: 35509411 PMCID: PMC9059218 DOI: 10.1002/hsr2.584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 02/07/2022] [Accepted: 02/28/2022] [Indexed: 11/28/2022] Open
Abstract
Background and Aim Nonadherence to antihypertensive medication impairs optimal blood pressure and is influenced by multiple interrelating factors. Knowing the complexity of medication nonadherence and its associated factors is essential for intervention strategies. This study evaluated the predictors of medication nonadherence among hypertensive clients in a Ghanaian population. Methods This was a hospital‐based cross‐sectional study conducted at the Hypertensive Clinic of the Kwame Nkrumah University of Science and Technology (KNUST) Hospital, Kumasi, Ghana. A self‐designed questionnaire, the Hill‐Bone Compliance to High Blood Pressure Therapy and Perceived Barriers to Treatment Compliance Scales, were used for data collection from 246 hypertensives. Data were analyzed using Statistical Package for Social Sciences, version 25. Results Medication nonadherence was observed among 8.5% of the study participants. In a multivariate regression model perceived noneffectiveness of medication (odds ratio [OR] = 1.76, 95% confidence interval [CI]: 1.34–2.31, p < 0.001) and barriers to alcohol and smoking cessation (OR = 2.83, 95% CI: 1.31–6.13, p = 0.008) were associated increased odds of antihypertensive medication nonadherence. Also, patients who do not know their total prescription (OR = 8.81, 95% CI: 2.28–34.0, p = 0.002) were more likely to be nonadherent to their antihypertensive medications. Moreover, clients who associate signs/symptoms of palpitations (OR = 5.82, 95% CI: 1.31–25.80, p = 0.021), poor sleep (OR = 3.92, 95% CI: 1.09–14.12, p = 0.036) and decreased sexual drive (OR = 4.74, 95% CI: 0.96–23.28, p = 0.055), were more likely to be nonadherent to antihypertensive medication. Conclusion In conclusion, we observed a lower nonadherence rate among hypertensive clients in a Ghanaian population with correlates being medication‐related factors. Most importantly, perceived noneffectiveness of medication, barriers to smoking and alcohol cessation, palpitations, poor sleep, and decreased sexual drive significantly predicted lower adherence and could serve as indicators for high risk of nonadherence to antihypertensive medications.
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Affiliation(s)
- Eric Woode
- Department of Pharmacology and Toxicology, School Of Pharmacy University of Health and Allied Sciences Ho Ghana
| | - Eric Boakye‐Gyasi
- Department of Pharmacology, Faculty of Pharmacy and Pharmaceutical Sciences, College of Health Sciences Kwame Nkrumah University of Science and Technology Kumasi Ghana
| | - Yaa Obirikorang
- Department of Pharmacology, Faculty of Pharmacy and Pharmaceutical Sciences, College of Health Sciences Kwame Nkrumah University of Science and Technology Kumasi Ghana
- Department of Nursing, Faculty of Health Sciences Garden City University College Kumasi Ghana
| | - Evans A. Adu
- Department of Molecular Medicine, School of Medicine and Dentistry Kwame Nkrumah University of Science and Technology Kumasi Ghana
| | - Christian Obirikorang
- Department of Molecular Medicine, School of Medicine and Dentistry Kwame Nkrumah University of Science and Technology Kumasi Ghana
| | - Emmanuel Acheampong
- Department of Molecular Medicine, School of Medicine and Dentistry Kwame Nkrumah University of Science and Technology Kumasi Ghana
- Department of Medical Diagnostics, Faculty of Allied Health Science, College of Health Sciences Kwame Nkrumah University of Science and Technology Kumasi West Africa Ghana
| | - Enoch Odame‐Anto
- Department of Medical Diagnostics, Faculty of Allied Health Science, College of Health Sciences Kwame Nkrumah University of Science and Technology Kumasi West Africa Ghana
- School of Medical and Health Science, Centre for Precision Health Edith Cowan University Perth Australia
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Onwukwe SC, Ngene NC. Blood pressure control in hypertensive patients attending a rural community health centre in Gauteng Province, South Africa: A cross-sectional study. S Afr Fam Pract (2004) 2022; 64:e1-e9. [PMID: 35384677 PMCID: PMC8991089 DOI: 10.4102/safp.v64i1.5403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Revised: 11/21/2021] [Accepted: 11/23/2021] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Hypertension is a major cause of morbidity and mortality and its control has important clinical and socio-economic benefits to the family and community. Unfortunately, the extent of blood pressure (BP) control and its potential predictors in hypertensive patients in many rural communities in low-resource settings are largely unknown. This study assessed the extent of uncontrolled BP and its predictors amongst hypertensive patients accessing primary health care in a rural community in South Africa. METHODS This cross-sectional study included 422 randomly selected hypertensive patients. Demographic and clinical data were collected using structured face-to-face questionnaire supplemented by respondents' clinical records. RESULTS Obesity plus overweight (n = 286, 67.8%) and diabetes (n = 228, 54.0%) were the most common comorbidities. Treatment adherence was achieved in only 36.3% and BP was controlled to target in 50.2% of the respondents. Significant predictors of uncontrolled BP were poor treatment adherence (odds ratio [OR] = 15.88, 95% confidence interval [CI] = 8.96, 28.14, p 0.001), obesity compared with normal weight and overweight (OR = 3.75, 95% CI = 2.17, 6.46, p 0.001) and being a diabetic (OR = 2.83, 95% CI = 1.74, 4.61, p 0.001). CONCLUSION Poor adherence to treatment was the major predictor of uncontrolled BP. The increase in uncontrolled BP in the presence of diabetes and/or obesity as risk predictors, indicates the need for appropriate behaviour change/interventions and management of these conditions in line with the health belief model (HBM). We also propose the use of Community-Based Physical and Electronic Reminding and Tracking System (CB-PERTS) to address poor treatment adherence.
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Affiliation(s)
- Sergius C Onwukwe
- Department of Public Health, Faculty of Health Science, University of Liverpool, Liverpool, United Kingdom; and, Department of Family Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg.
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Which domains of the theoretical domains framework should be targeted in interventions to increase adherence to antihypertensives? A systematic review. J Hypertens 2022; 40:853-859. [DOI: 10.1097/hjh.0000000000003113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Setiadi AP, Widiyastuti S, Mariati IGAD, Sunderland B, Wibowo YI. Socioeconomic impacts on medication adherence among patients with hypertension: A multicentre cross-sectional study in Lombok, Indonesia. PHARMACIA 2022. [DOI: 10.3897/pharmacia.69.e78441] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Socioeconomic impacts on adherence are understudied, particularly in disadvantaged areas. This study aimed to evaluate socioeconomic factors on medication adherence among patients with hypertension in Lombok, Indonesia. A cross-sectional survey was conducted in all six public hospital outpatient clinics in Lombok in 2017. Data was obtained using a validated questionnaire to which the Morisky Green Levine Adherence Scale (MGLS) questionnaire was used to assess medication adherence. Binary logistic regression was performed to determine independent socioeconomic associations. A total of 693 patients with hypertension were included (response rate 84%). The majority had low adherence (76.2%). Significant independent associations were reported between setting and education with adherence (rural versus urban setting: odds ratio 3.54, p<0.001; primary versus university level education: odds ratio 5.39, p<0.001). Socioeconomic associations provide some basis for the development of patient and population-based interventions to improve adherence among patients with hypertension in Indonesia, particularly in disadvantaged areas.
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Unmet needs of hypertension care in Nigeria: results of the community action against non-communicable diseases (COMAAND) project preintervention survey. Blood Press Monit 2022; 27:27-32. [PMID: 34992204 DOI: 10.1097/mbp.0000000000000561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Assessing the state of hypertension care remains the first step towards planning a robust health system needed to tackle the rising burden of hypertension. Prior to the commencement of the Community Action Against Non-Communicable Disease project, we assessed hypertension care using the hypertension care cascade (HCC). This will serve as a baseline to evaluate project performance upon completion. METHODS Hypertensive subjects were grouped into a mutually exclusive care cascade of 5 categories including unscreened and undiagnosed; screened but undiagnosed; diagnosed but untreated; treated but uncontrolled and treated with controlled hypertension. RESULTS Of the 372 participants, mean age 48.9 years, 161 (43.3%) were hypertensive, of whom only 12.0% had controlled blood pressure (BP). Among the 88.0% with uncontrolled BP,19.0% were unscreened and undiagnosed, 48.5% were screened but undiagnosed, 13.0% were diagnosed but untreated and 7.5% were treated but BP uncontrolled. The HCC demonstrates that 19% of the hypertensive patients were lost at the screening stage, 60% of those who were screened never diagnosed, 40% of those who were diagnosed did not receive treatment and 60% of those who were on treatment did not reach target BP. CONCLUSION Unmet need of hypertension care is substantially high, thus underpinning the need for intervention with a multifaceted approach.
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22
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Kifle ZD, Adugna M, Chanie GS, Mohammed A. Prevalence and associated factors of hypertension complications among hypertensive patients at University of Gondar Comprehensive Specialized Referral Hospital. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2022. [DOI: 10.1016/j.cegh.2021.100951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Abaynew Y, Hussien M. A Qualitative Study on Barriers to Treatment and Control of Hypertension Among Patients at Dessie Referral Hospital, Northeast Ethiopia, Ethiopia: Healthcare Workers' Perspective. Integr Blood Press Control 2021; 14:173-178. [PMID: 34887681 PMCID: PMC8650830 DOI: 10.2147/ibpc.s339773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 11/30/2021] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Hypertension is the leading cause of morbidity and mortality and accounts for 13% of all deaths and 7% of the disease burden in the world. Although the importance of controlling hypertension has been recognized for many years, the majority of patients with hypertension remain uncontrolled. Studies indicate a very low adherence to lifestyle modifications among patients in the study area. Hypertensive patients face set of problems associated with adherence to antihypertensive drugs and healthy lifestyle modifications. OBJECTIVE The objective of the study was to explore barriers to hypertension treatment and control from healthcare workers' perspective and experiences at Dessie Referral Hospital, Ethiopia. METHODS Seven healthcare workers actively involved in managing hypertensive individuals at Dessie Referral Hospital were recruited for the study. Participants were purposively selected from outpatient, inpatient, and pharmacy departments. The required data were collected by the principal investigator on exit interviews. An interview guide was developed by reviewing previous literature. Interviews were semi-structured, 8-20 minutes in duration, and designed to elicit healthcare workers'experiences and perceptions and conducted until data saturation was reached. All interviews were recorded, transcribed verbatim, and thematically analyzed. Each theme was supported by using the participants' quotes. RESULTS Three themes emerged. The major barriers impacted patients' medication adherence and healthy lifestyle modifications were common use of diets during social settings, low level of awareness, lack of resources, misconceptions about hypertension, use of traditional medicines, inadequate physical activities, and high cost of drugs. CONCLUSION Patients' misconceptions about hypertension, common use of diets during festivals, and inadequate physical activities were factors associated with inadequate blood pressure control. Healthcare workers should better understand the problems that hypertensive patients' face, thus achieving better control.
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Affiliation(s)
- Yeshewas Abaynew
- School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Mohammed Hussien
- Department of Health Systems Management and Health Economics, School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
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Simegn BK, Chelkeba L, Alamirew BD. Clinicians' prescribing pattern, rate of patients' medication adherence and its determinants among adult hypertensive patients at Jimma University Medical Center: Prospective cohort study. PLoS One 2021; 16:e0259421. [PMID: 34780479 PMCID: PMC8592482 DOI: 10.1371/journal.pone.0259421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 10/19/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Many studies conducted in the past focused on patients' sociodemographic factors and medical profiles to identify the determinants of suboptimal blood pressure control. However, prescribing patterns and clinicians' adherence to guidelines are also important factors affecting the rate of blood pressure control. Therefore, this study aimed to determine clinicians' prescribing patterns, patients' medication adherence, and its determinants among hypertensive patients at Jimma University Medical Center. METHODS A general prospective cohort study was conducted among hypertensive patients who had regular follow-up at Jimma university ambulatory cardiac clinic from March 20, 2018, to June 20, 2018. Patients' specific data was collected with a face-to-face interview and from their medical charts. Clinicians' related data were collected through a self-administered questionnaire. Data were analyzed using SPSS version 21.0. Bivariate and multivariable logistic regression analyses were done to identify key independent variables influencing patients' adherence. P-Values of less than 0.05 were considered statically significant. RESULTS From the total of 416 patients, 237(57.0%) of them were males with a mean age of 56.50 ± 11.96 years. Angiotensin-converting enzyme inhibitors were the most frequently prescribed class of antihypertensives, accounting for 261(63.7%) prescriptions. Combination therapy was used by the majority of patients, with 275 (66.1%) patients receiving two or more antihypertensive drugs. Patients' medication adherence was 46.6%, while clinicians' guideline adherence was 44.2%. Patients with merchant occupation (P = 0.020), physical inactivity (P = 0.033), and diabetes mellitus co-morbidity (P = 0.008) were significantly associated with a higher rate of medication non-adherence. CONCLUSION The rate of medication adherence was poor among hypertensive patients. Physicians were not-adherent to standard treatment guideline. The most commonly prescribed class of drugs were angiotensin-converting enzyme inhibitors. Effective education should be given to patients to improve medication adherence. Prescribers should be trained on treatment guidelines regularly to keep them up-to-date with current trends of hypertension treatment and for better treatment outcomes.
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Affiliation(s)
- Bekalu Kebede Simegn
- Department of Pharmacy, College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia
| | - Legese Chelkeba
- Department of Clinical Pharmacy, School of Pharmacy, College Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Bekalu Dessie Alamirew
- Department of Pharmacy, College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia
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Wake AD, Tuji TS, Sime AT, Mekonnin MT, Taji TM, Hussein AA. Nonadherence to Self-Care Practices, Antihypertensive Medications, and Associated Factors among Hypertensive Patients in a Follow-up Clinic at Asella Referral and Teaching Hospital, Ethiopia: A Cross-Sectional Study. Int J Hypertens 2021; 2021:7359318. [PMID: 34754517 PMCID: PMC8572638 DOI: 10.1155/2021/7359318] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 10/18/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Hypertension is one of the most common noncommunicable diseases affecting several individuals globally. However, the level of nonadherence to self-care practices, antihypertensive medications, and associated factors among hypertensive patients in a follow-up clinic at Asella Referral and Teaching Hospital is unknown. OBJECTIVE To assess the level of nonadherence to self-care practices, antihypertensive medications, and associated factors among hypertensive patients in a follow-up clinic at Asella Referral and Teaching Hospital, Arsi Zone, Oromia Regional State, Ethiopia, in 2020. METHODS An institution-based cross-sectional survey was conducted on 115 hypertensive patients who visited the follow-up clinic at Asella Referral and Teaching Hospital from December 24, 2020, to January 15, 2021. Data were entered into EpiData version 4.2.0.0 and exported to SPSS version 21.0 for statistical analysis. Binary and multivariable logistic regression analysis was used to assess the presence of statistical association between dependent and independent variables. RESULTS A total of 115 hypertensive patients were enrolled into the study, giving a response rate of 98.29%. The mean age of the study participants was 55.17 years (SD = 17.986). More than half of them (59 (51.3%)) were females. More than half of them (58 (50.4%)) were married. Nearly two-thirds of them (79 (68.7%)) had formal education. The level of nonadherence to self-care practices was 67.0% (n = 77, 95% CI: 60.0, 75.7). Meanwhile, the patient's level of nonadherence to antihypertensive medications was 16.5% (n = 19, 95% CI: 10.4, 24.3). The multivariable logistic regression analysis showed that age >45 years (AOR = 2.89, 95% CI: 1.16, 7.18), having no formal education (AOR = 1.67, 95% CI: 1.32, 3.74), and having ≤5 years' duration since diagnoses of hypertension (AOR = 1.56, 95% CI: 1.07, 3.25) were factors significantly associated with nonadherence to self-care practices. Being male (AOR = 2.09, 95% CI: 1.93, 9.59), being married (AOR = 4.22, 95% CI: 1.29, 13.76), and having an average monthly income of ≤2500 ETB (AOR = 1.58, 95% CI: 1.09, 7.08) were factors significantly associated with nonadherence to medications. CONCLUSION In the present study, the level of both nonadherence to self-care practices and antihypertensive medications was relatively high. There is a need to initiate programs that could create awareness about adherence to self-care practices and antihypertensive medications among hypertensive patients to improve their level of adherence.
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Affiliation(s)
- Addisu Dabi Wake
- Nursing Department, College of Health Sciences, Arsi University, Asella, Ethiopia
| | - Techane Sisay Tuji
- Nursing Department, College of Health Sciences, Arsi University, Asella, Ethiopia
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Harrison MA, Marfo AFA, Opare-Addo MNA, Ankrah DNA, Acheampong F, Nelson F, Buabeng KO. Anti-hypertensive medication access and affordability and their association with blood pressure control at a teaching hospital in Ghana. Pan Afr Med J 2021; 39:184. [PMID: 34584609 PMCID: PMC8449564 DOI: 10.11604/pamj.2021.39.184.27977] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 06/25/2021] [Indexed: 11/27/2022] Open
Abstract
Introduction many hypertensive patients require two or more anti-hypertensive drugs, but in low- and middle-income countries there may be challenges with medication access or affordability. The objective of this study was to determine accessibility and affordability of anti-hypertensive medicines and their association with blood pressure (BP) control among hypertensive patients attending the Korle-Bu teaching hospital (KBTH) polyclinic. Methods a cross-sectional study was conducted among 310 systematically sampled hypertensive patients attending the KBTH Polyclinic in Ghana. A structured questionnaire was used to obtain data on patient demographics and clinical characteristics, prices, availability and mode of payment of generic anti-hypertensive medicines. Results fifty-nine patients (19.4%) made out-of-pocket payments. At the private pharmacy and hospital, 123 (40.5%) and 77 patients (25.3%) respectively could not afford four anti-hypertensive medicines. Medicines availability at KBTH was 60%. Continuous access to BP drugs at KBTH was 14.8%. Overall access was 74.9% (SD ± 41.3). Out-of-pocket affordability of the medicines was positively correlated with BP control (R=0.12, p=0.037). Obtaining medicines via health insurance only was more likely to result in BP control than making any out-of-pocket payments (OR= 2.185; 95% CI, 1.215 - 3.927). Access at KBTH was more likely to result in BP control (OR=1.642; 95% C.I, 0.843 - 3.201). Conclusion there were access challenges although most patients obtained BP medication free. Out-of-pocket affordability is a challenge for some hypertensive patients. Access to affordable BP medication can improve BP control. These findings provide an impetus for urgently evaluating access to affordable anti-hypertensive medicines in other hospitals in Ghana.
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Affiliation(s)
- Mark Amankwa Harrison
- Pharmacy Department, Korle Bu Teaching Hospital, Accra, Ghana.,Department of Pharmacy Practice, Faculty of Pharmacy and Pharmaceutical Sciences, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Afia Frimpomaa Asare Marfo
- Department of Pharmacy Practice, Faculty of Pharmacy and Pharmaceutical Sciences, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Mercy Naa Aduele Opare-Addo
- Department of Pharmacy Practice, Faculty of Pharmacy and Pharmaceutical Sciences, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | | | | | - Frempomaa Nelson
- Pharmacy Department, Korle Bu Teaching Hospital, Accra, Ghana.,Department of Pharmacy Practice, Faculty of Pharmacy and Pharmaceutical Sciences, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Kwame Ohene Buabeng
- Department of Pharmacy Practice, Faculty of Pharmacy and Pharmaceutical Sciences, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
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Haung Z, Hong SA, Tejativaddhana P, Puckpinyo A, Myint MNHA. Multiple self-care behaviors and associated factors in community-dwelling patients with hypertension in Myanmar. NAGOYA JOURNAL OF MEDICAL SCIENCE 2021; 82:363-376. [PMID: 32581415 PMCID: PMC7276404 DOI: 10.18999/nagjms.82.2.363] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
This study aimed to identify the prevalence of self-care behaviors and the associated factors among hypertensive patients in primary care in Myanmar. This cross-sectional study was conducted from April to May 2019 among 410 hypertensive patients in Myitkyina Township, Kachin State, Myanmar. Hypertensive patients aged 30–70 years old and being registered at the community health centers in Myitkyina Township were selected using multi-stage cluster random sampling. Self-care behaviors were measured by Hypertensive Self-Care Activity Level Effect (H-SCALE). Chi-square test and multiple logistic regression analysis were used to explore the associated factors. Prevalence of adherence to multiple self-care behaviors were low: avoidance of tobacco use at 50.2%, followed by physical activity at 24.9%, medication at 24.1%, weight management at 9.5%, and healthy diet at 2.7%, while abstinence from harmful alcohol drinking was high at 97.8%. Multiple logistic regression analysis indicated that younger patients, low family income, inadequate knowledge, and no comorbidity were associated with non-adherence to medication. Living in rural area and having poor self-efficacy were associated with non-adherence to weight management, while being younger, female and having poor self-efficacy were also associated with non-adherence to physical activity. Compared with Kachin, other ethnics were more likely to be non-adherent to avoidance of tobacco use. Although a majority of respondents were not harmful drinkers, adherence to medication, healthy diet, physical activity, weight management and avoidance of tobacco use were very low. Health practitioners should provide education programs for hypertensive patients to direct them towards practical techniques in managing their blood pressure.
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Affiliation(s)
- Ze Haung
- ASEAN Institute for Health Development, Mahidol University, Nakhon Pathom, Thailand.,Township Department of Public Health, Myitkyina, Myanmar
| | - Seo Ah Hong
- ASEAN Institute for Health Development, Mahidol University, Nakhon Pathom, Thailand
| | | | - Apa Puckpinyo
- ASEAN Institute for Health Development, Mahidol University, Nakhon Pathom, Thailand
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Mabhida SE, Mashatola L, Kaur M, Sharma JR, Apalata T, Muhamed B, Benjeddou M, Johnson R. Hypertension in African Populations: Review and Computational Insights. Genes (Basel) 2021; 12:genes12040532. [PMID: 33917487 PMCID: PMC8067483 DOI: 10.3390/genes12040532] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 03/17/2021] [Accepted: 03/18/2021] [Indexed: 01/11/2023] Open
Abstract
Hypertension (HTN) is a persistent public health problem affecting approximately 1.3 billion individuals globally. Treatment-resistant hypertension (TRH) is defined as high blood pressure (BP) in a hypertensive patient that remains above goal despite use of ≥3 antihypertensive agents of different classes including a diuretic. Despite a plethora of treatment options available, only 31.0% of individuals have their HTN controlled. Interindividual genetic variability to drug response might explain this disappointing outcome because of genetic polymorphisms. Additionally, the poor knowledge of pathophysiological mechanisms underlying hypertensive disease and the long-term interaction of antihypertensive drugs with blood pressure control mechanisms further aggravates the problem. Furthermore, in Africa, there is a paucity of pharmacogenomic data on the treatment of resistant hypertension. Therefore, identification of genetic signals having the potential to predict the response of a drug for a given individual in an African population has been the subject of intensive investigation. In this review, we aim to systematically extract and discuss African evidence on the genetic variation, and pharmacogenomics towards the treatment of HTN. Furthermore, in silico methods are utilized to elucidate biological processes that will aid in identifying novel drug targets for the treatment of resistant hypertension in an African population. To provide an expanded view of genetic variants associated with the development of HTN, this study was performed using publicly available databases such as PubMed, Scopus, Web of Science, African Journal Online, PharmGKB searching for relevant papers between 1984 and 2020. A total of 2784 articles were reviewed, and only 42 studies were included following the inclusion criteria. Twenty studies reported associations with HTN and genes such as AGT (rs699), ACE (rs1799752), NOS3 (rs1799983), MTHFR (rs1801133), AGTR1 (rs5186), while twenty-two studies did not show any association within the African population. Thereafter, an in silico predictive approach was utilized to identify several genes including CLCNKB, CYPB11B2, SH2B2, STK9, and TBX5 which may act as potential drug targets because they are involved in pathways known to influence blood pressure. Next, co-expressed genes were identified as they are controlled by the same transcriptional regulatory program and may potentially be more effective as multiple drug targets in the treatment regimens for HTN. Genes belonging to the co-expressed gene cluster, ACE, AGT, AGTR1, AGTR2, and NOS3 as well as CSK and ADRG1 showed enrichment of G-protein-coupled receptor activity, the classical targets of drug discovery, which mediate cellular signaling processes. The latter is of importance, as the targeting of co-regulatory gene clusters will allow for the development of more effective HTN drug targets that could decrease the prevalence of both controlled and TRH.
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Affiliation(s)
- Sihle E. Mabhida
- Biomedical Research and Innovation Platform, South African Medical Research Council, Tygerberg 7505, South Africa; (S.E.M.); (J.R.S.)
- Department of Biotechnology, Faculty of Natural Science, University of the Western Cape, Private Bag X17, Bellville, Cape Town 7535, South Africa;
| | - Lebohang Mashatola
- School of Molecular and Cell Biology, University of the Witwatersrand, Private Bag 3, Johannesburg 2050, South Africa; (L.M.); (M.K.)
| | - Mandeep Kaur
- School of Molecular and Cell Biology, University of the Witwatersrand, Private Bag 3, Johannesburg 2050, South Africa; (L.M.); (M.K.)
| | - Jyoti R. Sharma
- Biomedical Research and Innovation Platform, South African Medical Research Council, Tygerberg 7505, South Africa; (S.E.M.); (J.R.S.)
| | - Teke Apalata
- Division of Medical Microbiology, Department of Laboratory-Medicine and Pathology, Faculty of Health Sciences, Walter Sisulu University and National Health Laboratory Services, Mthatha 5100, South Africa;
| | - Babu Muhamed
- Hatter Institute for Cardiovascular Diseases Research in Africa, Department of Medicine, University of Cape Town, Cape Town 7535, South Africa;
- Children’s National Health System, Division of Cardiology, Washington, DC 20010, USA
| | - Mongi Benjeddou
- Department of Biotechnology, Faculty of Natural Science, University of the Western Cape, Private Bag X17, Bellville, Cape Town 7535, South Africa;
| | - Rabia Johnson
- Biomedical Research and Innovation Platform, South African Medical Research Council, Tygerberg 7505, South Africa; (S.E.M.); (J.R.S.)
- Division of Medical Physiology, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg 7505, South Africa
- Correspondence: ; Tel.: +27-21-938-0866
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The Effect of Cognitive-Behavioral Intervention on Self-Care Behaviors and Blood Pressure Control in Patients with Primary Hypertension. JOURNAL OF EDUCATION AND COMMUNITY HEALTH 2021. [DOI: 10.52547/jech.8.1.41] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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30
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Tola Gemeda A, Regassa LD, Weldesenbet AB, Merga BT, Legesse N, Tusa BS. Adherence to antihypertensive medications and associated factors among hypertensive patients in Ethiopia: Systematic review and meta-analysis. SAGE Open Med 2021; 8:2050312120982459. [PMID: 33489230 PMCID: PMC7768850 DOI: 10.1177/2050312120982459] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 12/01/2020] [Indexed: 11/16/2022] Open
Abstract
The foundation of controlling hypertension is adherence to antihypertensive medication adherence. This systematic review and meta-analysis aimed to assess the magnitude and associated factors of adherence to antihypertensive medication among adult hypertensive patients in Ethiopia. A comprehensible bibliographic searching was conducted from PubMed, EMBASE, Scopus, and Web of Science core collection. All published and unpublished studies that had been accessible before 31 May 2020, and written in English were eligible. Joanna Briggs Institute assessment tool was used to evaluate the quality of the findings of the included studies. Stata software 16.0 was used to analyze the data. Study-specific estimates were pooled to determine the overall prevalence estimate across studies using a random-effects meta-analysis model. Publication bias and heterogeneity were checked. Fourteen studies with a total of 4938 hypertensive patients were included in the final systematic review and meta-analysis. The pooled prevalence of medication adherence among hypertensive patients in Ethiopia was 65.41% (95% confidence interval: 58.91-71.91). Sub-group analysis shown that the pooled prevalence of medication adherence was the highest (69.07%, 95% confidence interval: 57.83-80.31, I 2 = 93.51) among studies using questionnaire technique whereas the lowest in Morisky Medication Adherence Scale eight-items (60.66%, 95% confidence interval: 48.92-72.40, I 2 = 97.16). Moreover, medication adherence was associated with the presence of comorbidities (pooled odds ratio = 0.23, 95% confidence interval: 0.07-0.38, p = 0.030, I 2 = 54.9%) and knowledge about the disease and its management (pooled odds ratio = 2.98, 95% confidence interval: 1.72-4.24, p = 0.04, I 2 = 55.55%) but not with place of residence (pooled odds ratio = 1.22, 95% confidence interval: 0.51-1.93, p = 0.00, I 2 = 76.9%). Despite a lack of uniformity among included studies, adherence to antihypertensive medication among the hypertensive population in Ethiopia was moderate. The presence of comorbidities and/or complications reduced the odds of adherence whereas having good knowledge about the disease increased chance of medication adherence among hypertensive patients.
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Affiliation(s)
- Assefa Tola Gemeda
- Department of Epidemiology and Biostatistics, School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Lemma Demissie Regassa
- Department of Epidemiology and Biostatistics, School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Adisu Birhanu Weldesenbet
- Department of Epidemiology and Biostatistics, School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Bedasa Taye Merga
- Department of Public Health and Health Policy, School of Public Health, College of Health and Medical Sciences, Haramaya University, Haramaya, Ethiopia
| | - Nanti Legesse
- School of Pharmacy, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Biruk Shalmeno Tusa
- Department of Epidemiology and Biostatistics, School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
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Rampamba EM, Meyer JC, Helberg E, Godman B. Medicines Availability among Hypertensive Patients in Primary Health Care Facilities in a Rural Province in South Africa: Findings and Implications. J Res Pharm Pract 2021; 9:181-185. [PMID: 33912500 PMCID: PMC8067899 DOI: 10.4103/jrpp.jrpp_20_49] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 07/24/2020] [Indexed: 11/26/2022] Open
Abstract
Objective: Controlling blood pressure (BP) in hypertensive patients is a challenge, with the lack of antihypertensive medicines negatively impacting on BP control. Consequently, we assessed the availability of prescribed antihypertensives among patients with chronic hypertension attending primary health care (PHC) facilities in a rural province of South Africa and explored any association between medicines availability, the number of prescribed antihypertensive medicines and BP control. Methods: Secondary data that included patients' demographics, BP, and data on medicines availability of the intervention group from a 3 months' operational study conducted in rural PHC facilities in South Africa were analyzed. The association between medicines availability, the number of antihypertensive medicines, and BP control was explored. Findings: Fifty-five African patients (89.1% females) with a mean age of 61.3 years were included. Two-thirds (67.2%) received all their medicines during their monthly visits, 25.5% received some, and for 7.3%, there was no record of whether medicines were dispensed or not. Patients with controlled BP (60.0%) were more likely to have been prescribed only one antihypertensive medicine compared to patients with uncontrolled BP (20.7%) (P = 0.017; odds ratio: 5.75; 95% confidence interval: 1.46, 22.61). Conclusion: It is concerning that one-third of patients went home without all of their antihypertensive medicines from PHC facilities in this Province of South Africa where there is evidence of use of herbal medicines and uncontrolled BP contributing to high morbidity and mortality from cardiovascular diseases. Additional studies are needed to fully explore the association between medicines availability, their use, and BP control among patients.
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Affiliation(s)
- Enos M Rampamba
- Division of Public Health Pharmacy and Management, Sefako Makgatho Health Sciences University, Ga-Rankuwa, Pretoria, South Africa.,Department of Pharmacy, Tshilidzini Regional Hospital, Limpopo Province, South Africa
| | - Johanna C Meyer
- Division of Public Health Pharmacy and Management, Sefako Makgatho Health Sciences University, Ga-Rankuwa, Pretoria, South Africa
| | - Elvera Helberg
- Division of Public Health Pharmacy and Management, Sefako Makgatho Health Sciences University, Ga-Rankuwa, Pretoria, South Africa
| | - Brian Godman
- Division of Public Health Pharmacy and Management, Sefako Makgatho Health Sciences University, Ga-Rankuwa, Pretoria, South Africa.,Department of Pharmacoepidemiology, Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, United Kingdom.,Department of Laboratory Medicine, Division of Clinical Pharmacology, Karolinska Institutet, Karolinska University Hospital Huddinge, Stockholm, Sweden.,School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia
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32
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Mebrahtu G, M Moleki M, Okoth Achila O, Seyoum Y, Adnoy ET, Ovberedjo M. Antihypertensive Medication Adherence and Associated Factors: A Cross-Sectional Analysis of Patients Attending a National Referral Hospital in Asmara, Eritrea. Patient Prefer Adherence 2021; 15:2619-2632. [PMID: 34848951 PMCID: PMC8627305 DOI: 10.2147/ppa.s319987] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 10/28/2021] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Recent research suggests that poor adherence to antihypertensive medication (AHM) is a major problem in the management of hypertension. This study was therefore designed to evaluate the frequency of AHM and associated risk factors in patients attending a national referral hospital in Asmara, Eritrea. METHODS A total of 335 respondents (females: 222 (66.3%) participated in this cross-sectional study. Adherence to Medication was evaluated using a modified version of the Medication Adherence Report Scale (MARS). Additional data were abstracted from patients' medical records and a WHO STEPwise questionnaire. RESULTS The mean (±SD) age of the study participants was 59.65 (±12.20) years (females: 56.82 (±9.95) vs males: 57.17 (±9.60) years, p-value=0.001). Similarly, the median (IQR) for diastolic blood pressure (DBP) and systolic blood pressure (SBP) were 85.00 mmHg (IQR: 80.00-90.00 mmHg) and 145.00 mmHg (IQR: 130.00-160.00 mmHg), respectively. Overall, 246 (73.4%) and 244 (72.8%) participants had poor knowledge and poor adherence to AHM, respectively. In the multivariate analysis, factors associated with increased odds of poor adherence to AHM included sex (females: adjusted odds ratio (aOR): 4.95; 95% CI: 1.52-16.11, p value=0.008); employment status (Ref: employed/NGO) (self-employed: aOR: 1.95; 95% CI: 0.45-8.48, p-value=0.373) (housewife: aOR: 0.13; 95% CI: 0.04-0.413, p-value=0.001) (unemployed: aOR: 1.38; 95% CI:0.32-5.98; p-value=0.670); lack of attendance of health talk at the clinic (aOR: 2.33; 95% CI: 1.17-4.63; p-value=0.016); high cost of transportation (yes: aOR: 6.87; 95% CI: 3.25-14.52; p-value<0.001); knowledge (poor: aOR: 6.23; 95% CI: 2.36-18.05, p-value<0.001) and hypertension stage (Stage 3: aOR: 5.55; 95% CI, 1.44-21.37, p-value=0.013). Low level of knowledge regarding hypertension-related complications or associated risk factors was also noted. CONCLUSION The high level of poor adherence to anti-hypertension medications and low level of knowledge on hypertension should raise concern. Overall, decentralization of health care services and educational support are vital intervention pathways in this population.
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Affiliation(s)
- Goitom Mebrahtu
- Division of Clinical Services, Ministry of Health, Asmara, Eritrea
| | - Mary M Moleki
- Department of Health Studies, University of South Africa (UNISA), Pretoria, South Africa
| | - Oliver Okoth Achila
- Department of Clinical Laboratory Services, Orotta School of Medicine and Health Sciences, Asmara, Eritrea
- Correspondence: Oliver Okoth Achila Email
| | - Yemane Seyoum
- Department of Internal Medicine, Orotta School of Medicine and Health Sciences, Asmara, Eritrea
| | - Elias T Adnoy
- Public Health Unit, Orotta School of Medicine and Health Science, Asmara, Eritrea
| | - Martin Ovberedjo
- Eritrea Country Office, World Health Organisation (WHO), Asmara, Eritrea
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Shen Z, Shi S, Ding S, Zhong Z. Mediating Effect of Self-Efficacy on the Relationship Between Medication Literacy and Medication Adherence Among Patients With Hypertension. Front Pharmacol 2020; 11:569092. [PMID: 33364943 PMCID: PMC7750474 DOI: 10.3389/fphar.2020.569092] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 10/27/2020] [Indexed: 12/31/2022] Open
Abstract
Background: Studies have reported that medication literacy had a positive effect on medication adherence in patients with hypertension. However, little is known about the mechanism underlying this relationship in patients with hypertension. Objective: The purpose of this study was to investigate the mediating effect of self-efficacy between medication literacy and medication adherence. Methods: A total of 790 patients with hypertension were investigated using the Chinese Medication Literacy Scale for Hypertensive Patients (C-MLSHP), the Morisky Medication Adherence Scale-8 (MMAS-8) and the Medication Adherence Self-efficacy Scale-Revision (MASES-R). Hierarchical regression and the bootstrap approach were used to analyze the mediating effect of self-efficacy on the relationship between medication literacy and medication adherence. Results: A total of 60.9% of hypertensive patients were low adherent to their antihypertensive drug regimens. Self-efficacy had a significant positive correlation with medication literacy (r= 0.408, p < 0.001) and medication adherence (r = 0.591, p < 0.001). Self-efficacy accounts for 28.7% of the total mediating effect on the relationship between medication literacy and adherence to antihypertensive regimens for hypertensive patients. Conclusion: More than half of the hypertensive patients in the study were low adherent to antihypertensive regimens. Self-efficacy had a partial significant mediating effect on the relationship between medication literacy and medication adherence. Therefore, it was suggested that hypertensive patients' medication adherence might be improved and driven by increasing self-efficacy. Targeted interventions to improve patients' self-efficacy should be developed and implemented. In addition, health care providers should also be aware of the importance of medication literacy assessment and promotion in patients with hypertension.
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Affiliation(s)
- Zhiying Shen
- Department of Hematology, Third Xiangya Hospital, Central South University, Changsha, China
- Department of Nursing, Third Xiangya Hospital, Central South University, Changsha, China
- Clinical Nursing Safety Management Reasearch Center of Central South University, Third Xiangya Hospital, Central South University, Changsha, China
| | - Shuangjiao Shi
- Department of Nursing, Third Xiangya Hospital, Central South University, Changsha, China
- Clinical Nursing Safety Management Reasearch Center of Central South University, Third Xiangya Hospital, Central South University, Changsha, China
| | - Siqing Ding
- Department of Nursing, Third Xiangya Hospital, Central South University, Changsha, China
- Clinical Nursing Safety Management Reasearch Center of Central South University, Third Xiangya Hospital, Central South University, Changsha, China
| | - Zhuqing Zhong
- Department of Nursing, Third Xiangya Hospital, Central South University, Changsha, China
- Clinical Nursing Safety Management Reasearch Center of Central South University, Third Xiangya Hospital, Central South University, Changsha, China
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"It's because I think too much": Perspectives and experiences of adults with hypertension engaged in HIV care in northern Tanzania. PLoS One 2020; 15:e0243059. [PMID: 33270765 PMCID: PMC7714125 DOI: 10.1371/journal.pone.0243059] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Accepted: 11/13/2020] [Indexed: 12/13/2022] Open
Abstract
Background Hypertension, a leading risk for cardiovascular mortality, is an important co-morbidity among people living with HIV (PLHIV). In Tanzania, hypertension prevalence among PLHIV approaches 20 to 30%. However, most patients are unaware of their diagnosis and are not receiving treatment. Understanding the barriers to hypertension care is a critical first step in developing interventions to improve cardiovascular outcomes among PLHIV in Tanzania and similar settings. Methods Between September 1st and November 26th, 2018 thirteen semi structured in-depth interviews were conducted with hypertensive patients engaged in HIV care in two HIV clinics located in government health facilities in northern Tanzania. Interviews were audio-recorded, translated into English, transcribed and thematically coded using NVivo. Data analysis was conducted using applied thematic analysis. Results Participants had a median age of 54 (IQR 41–65) years. Of the 13 participants, eight stated they had used antihypertensive medication previously, but only one participant described current use of antihypertensive therapy. All participants were currently using antiretroviral therapy. The data revealed a range of themes including limited hypertension knowledge. Universally, all participants believed that “thinking too much”, i.e. stress, was the major contributor to hypertension and that by “reducing thoughts”, one may control hypertension. Additional emerging themes included a perceived overlap between hypertension and HIV, delays in hypertension diagnosis and linkage to care, challenges with provider communication and counseling, reluctance towards antihypertensive medication, lack of integration of hypertension and HIV care, and additional structural barriers to hypertension care. Conclusions Participants described multiple, intersecting challenges related to hypertension management. Barriers specific to PLHIV included siloed care, HIV-related stigma, and burden from multiple medical conditions. Multifaceted strategies that seek to address structural barriers, hypertension education, psychosocial stressors and stigma, and that are integrated within HIV care are urgently needed to improve cardiovascular outcomes among PLHIV in sub-Saharan Africa.
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Ekanem US, Dan EI, Etukudo GG, Ndon II, Etebom EE, Nkobo KB. An Assessment of Antihypertensive Medication Adherence among Hypertensive Patients Attending the Outpatient Clinics in the University of Uyo Teaching Hospital, Uyo. Niger Med J 2020; 61:120-125. [PMID: 33100461 PMCID: PMC7547759 DOI: 10.4103/nmj.nmj_95_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 09/22/2019] [Accepted: 03/29/2020] [Indexed: 11/05/2022] Open
Abstract
Context: Hypertension is a global cause of significant morbidity, ranking top as a cause of increased disability-adjusted life years. Patients who do not take their prescribed medication show almost a fourfold increase in the risk of dying from stroke by the second year after being prescribed treatment and a nearly threefold increased risk in the 10th year when compared to patients who take their prescribed medication. Medication adherence is a key factor in the control of high blood pressure. Objective: The objective of the study was to assess the antihypertensive medication adherence rate of patients attending the outpatient clinics at the University of Uyo Teaching Hospital (UUTH) and to explore factors that affect their adherence to the medications. Materials and Methods: This was a descriptive cross-sectional study of adult hypertensive patients attending the outpatient clinics at UUTH, from May to July 2018, who had been placed on antihypertensive medication(s) for at least 6 months. A standardized Morisky Medication Adherence 8 Questionnaire for assessing medication adherence was modified and used for the data collection. The questionnaires were administered by trained interviewers. Data were analyzed using SPSS 20.0. Results: A total of 379 hypertensive patients took part in the study; 85.2% were adherent to antihypertensive medication(s), but only 14.2% showed good adherence. Four of the five dimensions considered in the Morisky Assessment greatly affected antihypertensive medication adherence. The mean age of the study participants was 60.8 ± 1.8 years, and 75% were male. Conclusion: Good adherence to antihypertensive medication was quite low in this study population, and it was affected by all dimensions of the Morisky Assessment; health-care providers should pay more attention to their patient's drug adherence, educate them on medication adherence, and get them involved in their care.
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Affiliation(s)
| | - Emem Ime Dan
- Department of Obstetrics and Gyneacology, Emmanuel General Hospital, Eket, Akwa Ibom State, Nigeria
| | - George George Etukudo
- Department of Internal Medicine, Emmanuel General Hospital, Eket, Akwa Ibom State, Nigeria
| | | | - Ekemini Essien Etebom
- Department of Obstetrics and Gyneacology, University of Uyo Teaching Hospital, Uyo, Akwa Ibom State, Nigeria
| | - Kingsley Bassey Nkobo
- Department of Surgery, University of Uyo Teaching Hospital, Uyo, Akwa Ibom State, Nigeria
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The Role of Lifestyle Factors in Controlling Blood Pressure among Hypertensive Patients in Two Health Facilities in Urban Ghana: A Cross-Sectional Study. Int J Hypertens 2020; 2020:9379128. [PMID: 33005451 PMCID: PMC7508215 DOI: 10.1155/2020/9379128] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 05/18/2020] [Accepted: 08/29/2020] [Indexed: 12/20/2022] Open
Abstract
Introduction Despite efforts to combat hypertension by pharmacotherapy, hypertension control rates remain low. Lifestyle modifications of individuals diagnosed with hypertension have prospects for the prevention and control of hypertension. This study assessed the effect of modifiable lifestyle factors on blood pressure control among adults in urban Accra. Methods In this cross-sectional study, 360 diagnosed hypertensive patients who were ≥18 years old, selected from two secondary-level referral hospitals in the Greater Accra Region, were interviewed. Demographic information, diet components, and exercise assessments as well as blood pressure measurements were taken. Chi-squared tests and binomial logistic regression were used to determine the association between demographic and lifestyle factors with blood pressure control. Area under the receiver-operator curves (AUROC) was used to identify lifestyle factors predicting optimal blood pressure control among patients diagnosed with hypertension. Results Approximately 54.2% of participants had no knowledge of either causes or complications of hypertension. Similarly, 52.5% of patients that had not achieved blood pressure control lacked knowledge of causes or complications of hypertension. Longer time since diagnosis of 2–5 years (AOR = 0.08 (95% CI: 0.01–0.47)) and 6–10 years (AOR = 0.08 (95% CI: 0.01–0.50)) and diets, mainly composed of meat (AOR = 0.13 (95% CI: 0.02–0.70)) and starch (AOR = 0.14 (95% CI: 0.03–0.79)), predicted poor blood pressure control compared to patients diagnosed within a year and diets without meat and starch as main components, respectively. Additionally, engaging in some physical activity of 30 minutes to one hour (AOR = 5.64 (95% CI: 2.08–15.32)) and more than an hour (AOR = 11.38, 95% CI: 2.01–64.47)) predicted blood pressure control. Conclusion The study concludes that increased physical activity, abstaining from alcohol and smoking, increased intake of fruits and vegetables, and reduced intake of carbohydrates, meat, and fat have a positive influence on blood pressure control. Lifestyle modifying factors have a key role in complementing pharmacotherapy in hypertension control.
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Sarkodie E, Afriyie DK, Hutton-Nyameaye A, Amponsah SK. Adherence to drug therapy among hypertensive patients attending two district hospitals in Ghana. Afr Health Sci 2020; 20:1355-1367. [PMID: 33402985 PMCID: PMC7751545 DOI: 10.4314/ahs.v20i3.42] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND A major drawback to the management of hypertension among patients is poor adherence to pharmacotherapy. Factors that influence non-adherence to antihypertensive drugs could vary, depending on the prevailing condition of patient and setting. Knowledge of adherence patterns and behavior of hypertensive patients to pharmacotherapy could improve health-directed policies towards hypertension management. OBJECTIVE The objective of this study was to determine factors that influence adherence to oral antihypertensive drugs among patients attending two district hospitals in the Volta Region of Ghana. METHODS The study was cross-sectional. Respondents were hypertensive patients attending Krachi West District (n=187) and Hohoe Municipal (n=183) hospitals between March 2016 to May 2016. Data was collected using a structured questionnaire and Morisky 8 Item Measurement of adherence scale. RESULTS Adherence to oral antihypertensive drugs was 89.2%. However, more than half of these respondents appeared to have uncontrolled blood pressure; and this may be due to self-response bias, blood pressure being measured only on the day of the interview or use of fake drugs (which was not assessed in this study). The strongest predictors of adherence were; knowledge on hypertension, perception of severity of condition and the amount of alcohol consumed in a day by respondents. CONCLUSION Good adherence to oral antihypertensive drugs was observed in this population despite uncontrolled hypertension in a number of the respondents. The three independent predictors of adherence to antihypertensive medications in this study were respondent's knowledge about hypertension, perception of severity of their condition and the amount of alcohol consumed in a day. Regular patient education and counseling by medical practitioners should be encouraged in these settings to improve patient adherence.
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Affiliation(s)
- Emmanuel Sarkodie
- Department of Pharmacy Practice, School of Pharmacy, University of Health and Allied Sciences, Ho, Ghana
| | | | - Araba Hutton-Nyameaye
- Department of Pharmacy Practice, School of Pharmacy, University of Health and Allied Sciences, Ho, Ghana
| | - Seth Kwabena Amponsah
- Department of Pharmacology and Toxicology, School of Pharmacy, University of Ghana, Legon, Ghana
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Omoronyia O, Ayuk A, Nwafor K, Legogie A. Hypertensive patients' knowledge of cardiovascular disease in Calabar, Nigeria. J Egypt Public Health Assoc 2020; 95:16. [PMID: 32813101 PMCID: PMC7364754 DOI: 10.1186/s42506-020-00045-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2019] [Accepted: 06/10/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND This study aimed at assessing knowledge of cardiovascular disease risk factors and prevention, among hypertensive patients in a developing country setting with high cardiometabolic disease morbidity and mortality. METHODS Using descriptive cross-sectional study design and random sampling method, a 30-item questionnaire was used to obtain quantitative data on knowledge of key aspects of cardiovascular disease and practice of preventive measures among hypertensive patients in Calabar. RESULT Two hundred and twelve (212) respondents were surveyed with mean age of 45.5 ± 10.8 years. Approximately two-thirds of respondents (67.9%) had unsatisfactory level of knowledge of CVD. Most respondents had unsatisfactory level of knowledge of appropriate diet (77.4%), basic epidemiology (80.2%), risk factors (63.2%), and symptoms of CVD (74.5%). The mean score for knowledge of risk factors was significantly higher among females compared with males (p < 0.05). Consumers compared with non-consumers of alcohol had significantly lower mean scores for knowledge of appropriate diet and symptoms of CVD (p < 0.05). Except for medical knowledge where mean score of knowledge was significantly higher among respondents occasionally exercised or consumed fresh fruits compared with other groups, there was no significant difference in mean score of knowledge for other components comparing the various categories of active exercise and consumption of fresh fruits (p > 0.05). CONCLUSION Unsatisfactory level of knowledge of cardiovascular disease among hypertensive patients in the study setting was high. There is urgent need to improve efforts and strategies for health education and counseling of patients toward sustainable adoption of preventive behaviors.
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Affiliation(s)
- Ogban Omoronyia
- Department of Community Medicine, University of Calabar, Calabar, Nigeria.
| | - Agam Ayuk
- Department of Family Medicine, University of Calabar, Calabar, Nigeria
| | - Kenneth Nwafor
- Department of Family Medicine, University of Calabar, Calabar, Nigeria
| | - Annette Legogie
- Department of Family Medicine, University of Calabar, Calabar, Nigeria
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Knowledge on Hypertension and Self-Care Practice among Adult Hypertensive Patients at University of Gondar Comprehensive Specialized Hospital, Ethiopia, 2019. Int J Hypertens 2020; 2020:5649165. [PMID: 32373351 PMCID: PMC7191404 DOI: 10.1155/2020/5649165] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 03/27/2020] [Accepted: 04/03/2020] [Indexed: 02/07/2023] Open
Abstract
Background Patients with hypertension need to be aware of various aspects of hypertension and exercise self-care. But, there is limited information regarding this issue. Objective of the Study. This study was designed to assess knowledge on hypertension and self-care practice among adult hypertensive patients in the University of Gondar Comprehensive Specialized Hospital, Ethiopia. Materials and Methods Descriptive cross-sectional study was conducted among 384 hypertensive patients from April to May 2019. The study participants were selected using a systematic random sampling technique. Data were collected using a pretested interviewer-administered questionnaire. Descriptive statistics such as percentage and frequency of patients' knowledge on hypertension and their self-care practice were computed. Cross-tabulation was used to see the frequency and percentage of selected sociodemographic variables and knowledge level with self-care practice subscales. Finally, the results were summarized and presented in texts, figures, and tables. Results Among the study participants, 215 (56%) and 228 (59.4%) had good knowledge and self-care practice towards hypertension, respectively. The participants who had good knowledge had good self-care practice frequency. Conclusions In this study, knowledge on hypertension was low, while self-care practice was moderate on the self-care interventions. Hence, increasing patients' awareness and intervention on medication adherence, low salt diet consumption, physical activity, weight management, cigarette smoking cessation, and alcohol consumption reduction is important.
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Li S, Odedina S, Agwai I, Ojengbede O, Huo D, Olopade OI. Traditional medicine usage among adult women in Ibadan, Nigeria: a cross-sectional study. BMC Complement Med Ther 2020; 20:93. [PMID: 32192455 PMCID: PMC7083039 DOI: 10.1186/s12906-020-02881-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Accepted: 03/05/2020] [Indexed: 12/24/2022] Open
Abstract
Background Previous research has revealed high rates of traditional medicine usage in Nigeria. Reports of widespread contamination of herbal medicine products and higher rates of noncompliance with Western medications among traditional medicine users have raised concerns about the safety of traditional medicine use. Few studies have explored how demographic factors predict rates of traditional medicine use in the general population. Methods We conducted interviews of 748 adult women recruited from the communities in the city of Ibadan, Nigeria from 2013 to 2015. A structured questionnaire was created to collect data on rates of traditional medicine use and demographic factors such as age, education, ethnicity, and occupation. Multivariate logistic regressions were run to examine factors related to traditional medicine use, and the effects were measured with odds ratios (OR) along with 95% confidence interval (95%CI). Results The overall proportion of traditional medicine use was 81.6%. Women from the Ibo and Hausa ethnic groups were significantly less likely to use traditional medicine than the majority Yoruba group (OR 0.25, 95%CI 0.10–0.63;, OR 0.43, 95%CI 0.24–0.76) respectively). In addition, educated women were less likely than their non-educated counterparts to have used traditional medicine, with the biggest effect seen in women with a secondary education (OR 0.42, 95%CI 0.21–0.85). Conclusions We found a high rate of traditional medicine usage, consistent with that found in prior research. A novel finding was the significance of ethnicity as a predictor for usage rates.
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Affiliation(s)
- Suellen Li
- Department of Internal Medicine, Massachusetts General Hospital, Boston, MA, USA.
| | - Stella Odedina
- Center for Population and Reproductive Health, College of Medicine, University of Ibadan, UCH, Ibadan, Nigeria
| | - Imaria Agwai
- Center for Population and Reproductive Health, College of Medicine, University of Ibadan, UCH, Ibadan, Nigeria
| | - Oladosu Ojengbede
- Center for Population and Reproductive Health, College of Medicine, University of Ibadan, UCH, Ibadan, Nigeria
| | - Dezheng Huo
- Department of Public Health Sciences, University of Chicago, Chicago, IL, USA
| | - Olufunmilayo I Olopade
- Center for Clinical Cancer Genetics and Global Health, Department of Medicine, University of Chicago, Chicago, IL, USA
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Hassanein M. Adherence to antihypertensive fixed-dose combination among Egyptian patients presenting with essential hypertension. Egypt Heart J 2020; 72:10. [PMID: 32140895 PMCID: PMC7058724 DOI: 10.1186/s43044-020-00044-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Accepted: 02/19/2020] [Indexed: 01/13/2023] Open
Abstract
Background Many patients with hypertension require more than one drug to achieve blood pressure control. They are prescribed with fixed-dose combination (FDC) antihypertensive therapy rather than monotherapies. Although it is commonly admitted that the use of FDC may improve compliance to treatment, adherence rates in patients receiving FDCs have not been documented. Therefore, the aim of this study was to assess the adherence to treatment in patients receiving FDCs of antihypertensive medications in a real-world setting in Egypt. Results We conducted a multi-center cross-sectional study over a period of 1 year from Jan 2017 to Jan 2018. We included patients above 21 years old with essential hypertension who were already prescribed with an FDC of antihypertensive treatment for at least 3-month duration. We assessed the adherence to treatment by patient self-assessment using the Morisky 8-Item Medication Adherence Scale (MMAS 8). This study enrolled 2000 hypertensive Egyptian patients. The mean age of enrolled patients was 55.8 ± 10.9 years. Male to female ratio was 1.08. The mean MMAS score was 6.5 ± 1.9. Our analysis showed that 825 (41.3%) patients reached high adherence score, 523 (26.2%) medium adherence, and 652 (32.6%) low adherence. Furthermore, Male patients showed higher adherence rate than females (56.4% versus 43.6%, p < 0.001). Out of 746 patients with controlled blood pressure (< 140/90), 387 (51.9%) patients were highly adherent to treatment. Higher level of education was significantly associated with high adherence rate; 559 (67.8%) patients were university graduates, 232 (28.1%) had primary/secondary school education, and 34 (4.1%) were illiterate (p < 0.001). Moreover, once daily (99.2%) fixed-dose combination was associated with higher adherence rate than twice regimen daily (0.8%), p = 0.03. Multivariate logistic regression analysis showed that patients with high level of education, employed patients, and patients with controlled blood pressure have high adherence rate to medication. Conclusions Higher adherence to medication is associated with high level of education and employment, and it can lead to better blood pressure control. Thus, patient education programs may increase patients’ adherence to their medication.
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Kretchy IA, Boima V, Agyabeng K, Koduah A, Appiah B. Psycho-behavioural factors associated with medication adherence among male out-patients with hypertension in a Ghanaian hospital. PLoS One 2020; 15:e0227874. [PMID: 31995606 PMCID: PMC6988959 DOI: 10.1371/journal.pone.0227874] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Accepted: 01/01/2020] [Indexed: 11/18/2022] Open
Abstract
Medication adherence is a key health outcome that reflects the health and general well-being of patients with hypertension. Challenges with adherence are common and associated with clinical, behavioural and psychosocial factors. This study sought to provide data on the extent of medication adherence among male patients with hypertension and their biopsychosocial predictors. Patient and clinical characteristics, psychological distress, insomnia and sexual dysfunction were hypothesized to predict outcomes of medication adherence. Utilizing quantitative data from a hospital-based cross-sectional study from 358 male out-patients with hypertension attending a tertiary hospital in Ghana, medication adherence was associated with age, marital status, educational level, income, duration of diagnosis, number of medications taken and sexual dysfunction. These findings support the need for biopsychosocial interventions aiming at promoting adherence while taking these factors into consideration for the benefit of improving the health and general well-being of male patients with hypertension.
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Affiliation(s)
- Irene A. Kretchy
- Department of Pharmacy Practice and Clinical Pharmacy, School of Pharmacy, College of Health Sciences, University of Ghana, Legon, Ghana
| | - Vincent Boima
- Department of Medicine and Therapeutics, University of Ghana Medical School, College of Health Sciences, University of Ghana, Korle-Bu, Ghana
- * E-mail: ,
| | - Kofi Agyabeng
- Department of Biostatistics, School of Public Health, College of Health Sciences, University of Ghana, Legon, Ghana
| | - Augustina Koduah
- Department of Pharmacy Practice and Clinical Pharmacy, School of Pharmacy, College of Health Sciences, University of Ghana, Legon, Ghana
| | - Bernard Appiah
- Department of Environmental and Occupational Health, School of Public Health, Texas A&M Health Science Center, TAMU, College Station, Texas, United States of America
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Chen YJ, Chang J, Yang SY. Psychometric Evaluation of Chinese Version of Adherence to Refills and Medications Scale (ARMS) and Blood-Pressure Control Among Elderly with Hypertension. Patient Prefer Adherence 2020; 14:213-220. [PMID: 32103905 PMCID: PMC7020932 DOI: 10.2147/ppa.s236268] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Accepted: 12/25/2019] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE This study aimed to develop the ARMS-C and test its psychometric properties in hypertensive patients, to assess the level of medication adherence and to identify associated predictors for medication adherence and blood-pressure control among Chinese hypertensive patients. METHODS Hypertensive elderly who met inclusion criteria were recruited from an aged-care facility in Henan Province between January 2019 and July 2019. The patients completed the adapted ARMS-C. The scale's factor structure, internal consistency, and construct validity were tested. RESULTS Good internal consistency (Cronbach's α=0.89) and test-retest reliability (r=0.86, p<0.01) were obtained. Item-total correlation coefficients for the ten-item ARMS-C were 0.505-0.801. Factor analysis of construct validity identified two factors, explaining a total variance of 63.3%. Binary regression showed that patients with scores at level 2 (≤20 ARMS-10 scores <30) were six times as likely to have blood pressure uncontrolled as those at level 1 (ARMS-10 scores <20, OR 6.6, 95% CI 1.7-25.1; p=0.006), and patients with scores at level 3 (ARMS-10 scores >30) were 115 times as likely to have blood pressure uncontrolled as those at level 1 (ARMS-10 scores <20,OR 115, 95% CI 9-1,470; p=0). CONCLUSION The ten-item ARMS-C is a reliable and valid self-reporting screening tool for adherence to medication and refills in elderly hypertensive Chinese patients.
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Affiliation(s)
- Yi-Jing Chen
- Department of Health Care Clinic, First Affiliated Hospital of Zhengzhou University, Henan, People’s Republic of China
- Academy of Medical Science, Zhengzhou University, Henan, People’s Republic of China
| | - Jing Chang
- Department of Health Care Clinic, First Affiliated Hospital of Zhengzhou University, Henan, People’s Republic of China
- Correspondence: Jing Chang Email
| | - Si-Yu Yang
- Xiangya Medical School, Central South University, Changsha, People’s Republic of China
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Shi S, Shen Z, Duan Y, Ding S, Zhong Z. Association Between Medication Literacy and Medication Adherence Among Patients With Hypertension. Front Pharmacol 2019; 10:822. [PMID: 31396088 PMCID: PMC6664237 DOI: 10.3389/fphar.2019.00822] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 06/25/2019] [Indexed: 01/08/2023] Open
Abstract
Background: Few studies have investigated the association between medication literacy and medication adherence as well as the influence of medication literacy on medication adherence in hypertensive patients. Thus, the goal of the present study was to determine the association between medication literacy and medication adherence in hypertensive patients. Methods: A cross-sectional survey was conducted between August 2016 and December 2016. Self-administered questionnaires were completed, including a self-developed and structured socio-demographic questionnaire; a self-developed, validated, and self-reported Medication Literacy Scale for Hypertensive Patients (C-MLSHP) used for medication literacy measurement; and the Chinese Version of the Morisky Medication Adherence Scale-8 (C-MMAS-8), an eight-item validated, self-report scale for adherence measurement with a total score range of 0-8. A cut-off of 6 was applied to differentiate adherence levels, including patients with an MMAS score <6 (low adherence), MMAS score = 8 (high adherence), and MMAS score ≥6 and <8 (moderate adherence). In this study, hypertensive patients' medication literacy levels and adherence to antihypertensive agents were identified. Pearson correlation analysis was carried out to identify the correlation between medication literacy and adherence. Binary logistic regression analysis was performed with medication adherence as the outcome variable in order to confirm factors associated with medication adherence. Results: A total of 420 hypertensive patients, including 198 women and 222 men with a mean age of 60.6 years (SD = 12.4), were recruited. The mean score of hypertensive patients on the medication literacy scale was 24.03 (SD = 5.13). The mean scores of the four dimensions of knowledge, attitude, skill, and behavior on the medication literacy scale of this study were 6.22 ± 2.22, 5.04 ± 1.16, 4.50 ± 2.21, and 8.27 ± 1.90, respectively. Regarding medication adherence, the mean score of the C-MMAS-8 in this study was 4.82 (SD = 2.11). A total of 63.6% of patients presented with low adherence, 29.5% presented with moderate adherence, and 7.6% presented with high adherence. The Pearson correlation results showed that medication literacy (r = 0.342, P < 0.01) as a whole variable and the three dimensions of knowledge (r = 0.284, P < 0.01), attitude (r = 0.405, P < 0.01), and behavior (r = 0.237, P < 0.01) were significantly associated with medication adherence. Binary logistic regression analysis indicated that annual income [OR 1.199 (95% CI: 1.011-1.421); P = 0.037] and two dimensions of attitude [OR 2.174 (95% CI: 1.748-2.706); P = 0.000] and behavior [OR 1.139 (95% CI: 1.002-1.294); P = 0.046] in medication literacy were found to be independent predictors of medication adherence. Individuals with better attitudes and behavior literacy in medication literacy were more likely to adhere to the use of antihypertensive agents. Those who had higher annual incomes were more likely to adhere to the use of antihypertensive agents. Conclusion: The levels of medication literacy and medication adherence of hypertensive patients are suboptimal and need to be improved in China. The level of medication literacy in patients with hypertension could affect their adherence to antihypertensive drugs. It was suggested that hypertensive patients' medication adherence could be improved and driven by increasing the medication literacy level, especially in the attitude and behavior domains. Pertinent strategies that are specific to several dimensions of medication literacy should be developed and implemented in order to promote full medication literacy among hypertensive patients, thus facilitating optimal adherence and blood pressure control.
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Affiliation(s)
- Shuangjiao Shi
- Nursing Department, Third Xiangya Hospital, Central South University, Changsha, China
- Xiangya School of Nursing, Central South University, Changsha, China
| | - Zhiying Shen
- Nursing Department, Third Xiangya Hospital, Central South University, Changsha, China
| | - Yinglong Duan
- Nursing Department, Third Xiangya Hospital, Central South University, Changsha, China
| | - Siqing Ding
- Nursing Department, Third Xiangya Hospital, Central South University, Changsha, China
- Xiangya School of Nursing, Central South University, Changsha, China
| | - Zhuqing Zhong
- Nursing Department, Third Xiangya Hospital, Central South University, Changsha, China
- Xiangya School of Nursing, Central South University, Changsha, China
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Niriayo YL, Ibrahim S, Kassa TD, Asgedom SW, Atey TM, Gidey K, Demoz GT, Kahsay D. Practice and predictors of self-care behaviors among ambulatory patients with hypertension in Ethiopia. PLoS One 2019; 14:e0218947. [PMID: 31242265 PMCID: PMC6594646 DOI: 10.1371/journal.pone.0218947] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Accepted: 06/12/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Despite the benefits of evidence-based self-care behaviors in the management of hypertension, hypertensive patients have low rate of adherence to the recommended self-care behaviors. Studies related to self-care behaviors among hypertensive patients are limited in Ethiopia. OBJECTIVE To assess the rate of adherence to self-care behaviors and associated factors among hypertensive patients. METHOD A cross-sectional study was conducted at the cardiac clinic of Ayder comprehensive specialized hospital among ambulatory hypertensive patients. Self-care behaviors were assessed using an adopted Hypertension Self-Care Activity Level Effects (H-SCALE). Data were collected through patient interview and review of medical records. Binary logistic regression analysis was performed to identify predictors of self-care behaviors. RESULT A total of 276 patients were included in the study. The majority of the participants were nonsmokers (89.9%) and alcohol abstainers (68.8%). Less than half of the participants were adherent to the prescribed antihypertensive medications (48.2%) and recommended physical activity level (44.9%). Moreover, only 21.45% and 29% were adherent to weight management and low salt diet recommendations, respectively. Our finding indicated that rural resident (adjusted odds ratio [AOR]: 0.45, 95% confidence interval [CI]: 0.21-0.97), comorbidity (AOR: 0.16, 95% CI: 0.08-0.31), and negative medication belief (AOR: 0.25, 95% CI: 0.14-0.46) were significantly associated with medication adherence. Female sex (AOR: 0.46, 95% CI: 0.23-0.92), old age (AOR: 0.19, 95% CI: 0.06-0.60) and lack of knowledge on self-care behaviors (AOR: 0.13, 95% CI: 0.03-0.57) were significantly associated with adherence to weight management. Female sex (AOR: 1.97, 95% CI: 1.03-3.75) and lack of knowledge on self-care (AOR: 0.07, 95% CI: 0.03-0.16) were significantly associated with adherence to alcohol abstinence. Female sex (AOR: 6.33, 95% CI: 1.80-22.31) and khat chewing (AOR: 0.08, 95% CI: 0.03-0.24) were significantly associated with non-smoking behavior. There was also a significant association between female sex and physical activity (AOR: 0.22, 95% CI: 0.12-0.40). CONCLUSION The rate of adherence to self-care behaviors particularly weight management, low salt intake, physical exercise, and medication intake was low in our study. Elders, females, khat chewers, rural residents, and patients with negative medication belief, comorbidity, and inadequate knowledge of SCBs were less adherent to self-care behaviors compared to their counterparts. Therefore, health care providers should pay more emphasis to patients at risk of having low self-care behaviors.
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Affiliation(s)
- Yirga Legesse Niriayo
- Department of Clinical Pharmacy, School of Pharmacy, College of Health Sciences, Mekelle University, Mekelle, Tigray, Ethiopia
- * E-mail: ,
| | - Seid Ibrahim
- Department of Clinical Pharmacy, School of Pharmacy, College of Health Sciences, Mekelle University, Mekelle, Tigray, Ethiopia
| | - Tesfaye Dessale Kassa
- Department of Clinical Pharmacy, School of Pharmacy, College of Health Sciences, Mekelle University, Mekelle, Tigray, Ethiopia
| | - Solomon Weldegebreal Asgedom
- Department of Clinical Pharmacy, School of Pharmacy, College of Health Sciences, Mekelle University, Mekelle, Tigray, Ethiopia
| | - Tesfay Mahari Atey
- Department of Clinical Pharmacy, School of Pharmacy, College of Health Sciences, Mekelle University, Mekelle, Tigray, Ethiopia
| | - Kidu Gidey
- Department of Clinical Pharmacy, School of Pharmacy, College of Health Sciences, Mekelle University, Mekelle, Tigray, Ethiopia
| | - Gebre Teklemariam Demoz
- Clinical Pharmacy and Pharmacy Practice Unit, Department of Pharmacy, College of Health Sciences, Aksum University, Aksum, Tigray, Ethiopia
| | - Desalegn Kahsay
- Department of Clinical Pharmacy, School of Pharmacy, College of Health Sciences, Mekelle University, Mekelle, Tigray, Ethiopia
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Mabunda K, Ngamasana EL, Babalola JO, Zunza M, Nyasulu P. Determinants of poor adherence to antiretroviral treatment using a combined effect of age and education among human immunodeficiency virus infected young adults attending care at Letaba Hospital HIV Clinic, Limpopo Province, South Africa. Pan Afr Med J 2019; 32:37. [PMID: 31143342 PMCID: PMC6522179 DOI: 10.11604/pamj.2019.32.37.17722] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Accepted: 12/27/2018] [Indexed: 01/01/2023] Open
Abstract
INTRODUCTION sustained viral suppression using antiretroviral treatment (ART) occurs with adherence to treatment of at least 95%. Non-adherence promotes the development of drug-resistance and treatment failure in individuals infected with Human Immunodeficiency Virus. In Limpopo Province, the adherence rate is approximately 61%, but the prevalence and the factors associated with adherence at Letaba hospital HIV clinic are not well established. Therefore, the aim of this study was to identify the factors associated with adherence among HIV-infected young adults, aged 18-35 years, attending the clinic. METHODS a cross-sectional survey was conducted in Letaba HIV clinic among young adults of 18-35 years old. Logistic regression analysis was performed to determine factors associated with ART adherence. We reported odds ratios with the corresponding 95% confidence intervals and p-values. A p-value < 0.1 was considered as statistically significant. ART adherence was defined as taking more than 95% of the prescribed treatment, 3 days prior to completion of the questionnaire. RESULTS a total of 281 participants were enrolled with 163 (58.0%) females and more than three quarter, 222 (79.0%) between the ages of 18 and 29 years. The overall ART adherence stood at (87.2%) (95% CI: 63.0%-89.0%) representing 245 participants. Non-adherers to treatment, 36 (12.8%): patients reported no reason (3.9%), forgetting (3.2%), feeling good (3.2%), fear and running out of treatment (2.5%) as some of the reasons for not taking treatment within the three days prior to data collection. The following factors: tertiary education (p = 0.07), age (30-35; p-value: 0.07), drug availability (p-value: 0.07), were only marginally significantly associated with ART adherence. CONCLUSION the study found unsatisfactory ART adherence among our participants. Our study suggests that factors other than sociodemographic and clinical factors might better explain differences in adherence. This highlights the need for a more complex study that would look at the entire system in which these patients are navigating as well as their mental models.
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Affiliation(s)
- Kuhlula Mabunda
- Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | | | - Joseph Omoniyi Babalola
- Division of Community Paediatrics, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Moleen Zunza
- Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Peter Nyasulu
- Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- Division of Community Paediatrics, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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47
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Dokun-Mowete CA, Sharma M, Beatty F. Using Multitheory Model to Predict Low-Salt Intake Among Nigerian Adults Living With Hypertension. INTERNATIONAL QUARTERLY OF COMMUNITY HEALTH EDUCATION 2019; 39:245-255. [PMID: 30602335 DOI: 10.1177/0272684x18821308] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
One of the public health recommendations for the management of hypertension is the reduction of sodium/salt intake. The purpose of this study was to use the novel multitheory model of health behavior change to predict the initiation and maintenance of low-salt intake among adult Nigerian hypertensives. A quantitative cross-sectional design utilizing a convenience sample of 149 consenting Nigerian adults living with hypertension were self-administered a valid and reliable 39-item instrument. Multivariate regression analysis revealed 40.6% of the variance in initiating the consumption of low-salt diets explained by advantages outweighing disadvantages, behavioral confidence, and changes in physical environment. About 41.8% of the variance to sustain the intake of low-salt diet was explained by emotional transformation, practice for change, and changes in social environment. The results justified the predictive role of multitheory model and adequacy of its utility to build evidence-based health education interventions for hypertension in Nigeria.
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Affiliation(s)
| | - Manoj Sharma
- 2 Behavioral and Environmental Health, School of Public Health, Jackson State University, MS, USA.,3 College of Health Sciences, Walden University, Minneapolis, MN, USA
| | - Frazier Beatty
- 3 College of Health Sciences, Walden University, Minneapolis, MN, USA
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48
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Beune E, Nieuwkerk P, Stronks K, Meeks K, Schulze MB, Mockenhaupt FP, Danquah I, Klipstein-Grobusch K, Agyei-Baffour P, Spranger J, Addo J, Smeeth L, Agyemang C. Medication non-adherence and blood pressure control among hypertensive migrant and non-migrant populations of sub-Saharan African origin: the RODAM study. J Hum Hypertens 2018; 33:131-148. [PMID: 30323204 DOI: 10.1038/s41371-018-0120-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Revised: 09/19/2018] [Accepted: 09/24/2018] [Indexed: 01/23/2023]
Abstract
Large differences in blood pressure (BP) control rates have been observed between sub-Saharan African migrant populations in Europe compared to their counterparts living in Africa. Our main objective was to investigate whether inter-geographical differences in BP control rates can be explained by differences in medication non-adherence. Additionally, we studied the prevalence of medication non-adherence and associations between medication non-adherence, socio-demographic-related, clinical/treatment-related, lifestyle factors, and experienced stress on the one hand and BP control on the other hand. We used data from the multi-center RODAM (Research on Obesity and Diabetes Among African Migrants) study, from Ghanaians receiving antihypertensive therapy and residing in three European countries versus non-migrants residing in rural and urban Ghana (n = 1303). Bivariate and multivariate logistic regression analyses stratified by sex were applied. We found inter-geographical differences in BP control rates among Ghanaian males but not among females. Ghanaian males residing in Amsterdam and Berlin had not only the lowest BP control rates but also the lowest rates of medication non-adherence. Inter-geographical differences in BP control rates among males became therefore more pronounced after adjustment for medication adherence. Medication non-adherence was significantly and independently associated with suboptimal BP control in males and females. Other factors associated with suboptimal BP control in females were a higher number of prescribed antihypertensives, higher fasting glucose levels, and pregnancy-induced diabetes. When adjusted for medication non-adherence and socio-demographic-, clinical/treatment-, lifestyle-, and stress-related factors, inter-geographical differences in BP control in males disappeared, except for Berlin. In conclusion, the observed inter-geographical differences in BP control rates in Ghanaian males cannot be explained by differences in medication non-adherence.
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Affiliation(s)
- Erik Beune
- Department of Public Health, Amsterdam Public Health Research Institute, Academic Medical Center, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
| | - Pythia Nieuwkerk
- Department of Medical Psychology, Academic Medical Center, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Karien Stronks
- Department of Public Health, Amsterdam Public Health Research Institute, Academic Medical Center, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Karlijn Meeks
- Department of Public Health, Amsterdam Public Health Research Institute, Academic Medical Center, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Matthias B Schulze
- Department of Molecular Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke, Arthur-Scheunert-Allee 114-116, 14558, Nuthetal, Germany
| | - Frank P Mockenhaupt
- Institute of Tropical Medicine and International Health, Charité-University Medicine Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Ina Danquah
- Department of Molecular Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke, Arthur-Scheunert-Allee 114-116, 14558, Nuthetal, Germany.,Institute for Social Medicine, Epidemiology and Health Economics, Charité-Universitaetsmedizin Berlin, Berlin, Germany
| | - Kerstin Klipstein-Grobusch
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.,Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Peter Agyei-Baffour
- School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Joachim Spranger
- Department of Endocrinology and Metabolism, DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany.,Center for Cardiovascular Research (CCR), Charite Universitaetsmedizin Berlin, Berlin, Germany
| | - Juliet Addo
- Department of Non-communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Liam Smeeth
- Department of Non-communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Charles Agyemang
- Department of Public Health, Amsterdam Public Health Research Institute, Academic Medical Center, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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Adidja NM, Agbor VN, Aminde JA, Ngwasiri CA, Ngu KB, Aminde LN. Non-adherence to antihypertensive pharmacotherapy in Buea, Cameroon: a cross-sectional community-based study. BMC Cardiovasc Disord 2018; 18:150. [PMID: 30041606 PMCID: PMC6056997 DOI: 10.1186/s12872-018-0888-z] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Accepted: 07/16/2018] [Indexed: 12/14/2022] Open
Abstract
Background Hypertension is a challenging public health problem with a huge burden in the developing countries. Non-adherence to antihypertensive treatment is a big obstacle in blood pressure (BP) control and favours disease progression to complications. Our objectives were to determine the rate of non-adherence to antihypertensive pharmacotherapy, investigate factors associated with non-adherence, and to assess the association between non-adherence and BP control in the Buea Health District (BHD), Cameroon. Methods A community-based cross-sectional study using stratified cluster sampling was conducted in the BHD from November 2013 – March 2014. Eligible consenting adult participants had their BP measured and classified using the Joint National Committee VII criteria. The Morisky medication adherence scale was used to assess adherence to BP lowering medication. Multivariable logistic regression models were used to predict non-adherence. Results One hundred and eighty-three participants were recruited with mean age of 55.9 years. Overall, 67.7% (95% CI: 59.8–73.6%) of participants were non-adherent to their medications. After adjusting for age, sex and other covariates, forgetfulness (aOR = 7.9, 95%CI: 3.0–20.8), multiple daily doses (aOR = 2.5, 95%CI: 1.2–5.6), financial constraints (aOR = 2.8, 95%CI: 1.1–6.9) and adverse drug effects (aOR = 7.6, 95%CI: 1.7–33.0) independently predicted non-adherence to anti-hypertensive medication. BP was controlled in only 21.3% of participants and was better in those who were adherent to medication (47.5% versus 8.2%, p < 0.01). Conclusion At least two of every three hypertensive patients in the Buea Health District are non-adherent to treatment. Forgetfulness, multiple daily doses of medication, financial constraints and medication adverse effects are the major predictors of non-adherence in hypertensive patients. These factors should be targeted to improve adherence and BP control, which will contribute to stem hypertension-related morbidity and mortality.
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Affiliation(s)
- Nkengla Menka Adidja
- Faculty of Health Sciences, University of Buea, Buea, Cameroon.,Djeleng Sub-divisional Hospital, Bafoussam, Cameroon
| | - Valirie Ndip Agbor
- Ibal Sub-divisional Hospital, Oku, Cameroon.,Faculty of Medicine & Biomedical Sciences, University of Yaoundé 1, Yaoundé, Cameroon
| | - Jeannine A Aminde
- Faculty of Health Sciences, University of Buea, Buea, Cameroon.,Etoug-Ebe Baptist Hospital, Yaoundé, Cameroon
| | - Calypse A Ngwasiri
- Bamendjou District Hospital, Bamendjou, Cameroon.,Clinical Research Education, Networking & Consultancy (CRENC), Douala, Cameroon
| | - Kathleen Blackett Ngu
- Faculty of Medicine & Biomedical Sciences, University of Yaoundé 1, Yaoundé, Cameroon
| | - Leopold Ndemnge Aminde
- Faculty of Medicine, School of Public Health, The University of Queensland, Brisbane, Australia.
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50
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Boratas S, Kilic HF. Evaluation of medication adherence in hypertensive patients and influential factors. Pak J Med Sci 2018; 34:959-963. [PMID: 30190761 PMCID: PMC6115554 DOI: 10.12669/pjms.344.14994] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective: This study aims to evaluate medication adherence in hypertensive patients and to identify the influential factors. Methods: This descriptive, cross-sectional study included a total of 147 hypertensive patients who were admitted to Akdogan Health Center between December 2016 and February 2017. The Descriptive Data Form and Medication Adherence Self-Efficacy Scale were used as the data collection tools. Results: The mean Medication Adherence Self-Efficacy Scale score was found to be 70.29 ± 8.52. Age, duration of HT, the frequency of follow-up visit for HT, the status of taking medication regularly, the frequency of blood pressure measurement and the status of alternative method use were found to be effective in medication adherence. Conclusions: Our study results suggest that medication adherence is good in patients with hypertension (HT). Factors which are effective in medication adherence should be taken into consideration, when evaluating the medication adherence in patients with HT.
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Affiliation(s)
- Selma Boratas
- Selma Boratas, M.Sc. Staff Nurse, Akdogan Health Center, Famagusta, North Cyprus, via Mersin 10 Turkey
| | - Hulya Firat Kilic
- Hulya Firat Kilic, PhD, RN. Assistant Professor, Department of Nursing, Faculty of Health Sciences, Eastern Mediterranean University, Famagusta, North Cyprus, via Mersin 10 Turkey
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