Factors associated with poor adherence to medication among hypertensive patients in twelve low and middle income Sub-Saharan countries
Over the past few decades, the prevalence of hypertension has dramatically increased in Sub-Saharan Africa. Poor adherence has been identified as a major cause of failure to control hypertension. Scarce data are available in Africa. We assessed adherence to medication and identified socioeconomics,...
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| Veröffentlicht in: | PloS one 2019-07, Vol.14 (7), p.e0219266-e0219266 |
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| creator | Macquart de Terline, Diane Kane, Adama Kramoh, Kouadio Euloge Ali Toure, Ibrahim Mipinda, Jean Bruno Diop, Ibrahima Bara Nhavoto, Carol Balde, Dadhi M Ferreira, Beatriz Dèdonougbo Houenassi, Martin Ikama, Méo Stéphane Kingue, Samuel Kouam Kouam, Charles Takombe, Jean Laurent Limbole, Emmanuel Mfeukeu Kuate, Liliane N'guetta, Roland Damorou, Jean Marc Sesso, Zouwera Sidy Ali, Abdallahi Perier, Marie-Cécile Azizi, Michel Empana, Jean Philippe Jouven, Xavier Antignac, Marie |
| description | Over the past few decades, the prevalence of hypertension has dramatically increased in Sub-Saharan Africa. Poor adherence has been identified as a major cause of failure to control hypertension. Scarce data are available in Africa.
We assessed adherence to medication and identified socioeconomics, clinical and treatment factors associated with low adherence among hypertensive patients in 12 sub-Saharan African countries.
We conducted a cross-sectional survey in urban clinics of both low and middle income countries. Data were collected by physicians on demographics, treatment and clinical data among hypertensive patients attending the clinics. Adherence was assessed by questionnaires completed by the patients. Factors associated with low adherence were investigated using logistic regression with a random effect on countries.
There were 2198 individuals from 12 countries enrolled in the study. Overall, 678 (30.8%), 738 (33.6%), 782 (35.6%) participants had respectively low, medium and high adherence to antihypertensive medication. Multivariate analysis showed that the use of traditional medicine (OR: 2.28, 95%CI [1.79-2.90]) and individual wealth index (low vs. high wealth: OR: 1.86, 95%CI [1.35-2.56] and middle vs. high wealth: OR: 1.42, 95%CI [1.11-1.81]) were significantly and independently associated with poor adherence to medication. In stratified analysis, these differences in adherence to medication according to individual wealth index were observed in low-income countries (p |
| doi_str_mv | 10.1371/journal.pone.0219266 |
| format | Article |
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We assessed adherence to medication and identified socioeconomics, clinical and treatment factors associated with low adherence among hypertensive patients in 12 sub-Saharan African countries.
We conducted a cross-sectional survey in urban clinics of both low and middle income countries. Data were collected by physicians on demographics, treatment and clinical data among hypertensive patients attending the clinics. Adherence was assessed by questionnaires completed by the patients. Factors associated with low adherence were investigated using logistic regression with a random effect on countries.
There were 2198 individuals from 12 countries enrolled in the study. Overall, 678 (30.8%), 738 (33.6%), 782 (35.6%) participants had respectively low, medium and high adherence to antihypertensive medication. Multivariate analysis showed that the use of traditional medicine (OR: 2.28, 95%CI [1.79-2.90]) and individual wealth index (low vs. high wealth: OR: 1.86, 95%CI [1.35-2.56] and middle vs. high wealth: OR: 1.42, 95%CI [1.11-1.81]) were significantly and independently associated with poor adherence to medication. In stratified analysis, these differences in adherence to medication according to individual wealth index were observed in low-income countries (p<0.001) but not in middle-income countries (p = 0.17). In addition, 26.5% of the patients admitted having stopped their treatment due to financial reasons and this proportion was 4 fold higher in the lowest than highest wealth group (47.8% vs 11.4%) (p<0.001).
This study revealed the high frequency of poor adherence in African patients and the associated factors. These findings should be useful for tailoring future programs to tackle hypertension in low income countries that are better adapted to patients, with a potential associated enhancement of their effectiveness.</description><identifier>ISSN: 1932-6203</identifier><identifier>EISSN: 1932-6203</identifier><identifier>DOI: 10.1371/journal.pone.0219266</identifier><identifier>PMID: 31291293</identifier><language>eng</language><publisher>United States: Public Library of Science</publisher><subject>Adhesion ; Adult ; Africa South of the Sahara - epidemiology ; Aged ; Aged, 80 and over ; Alternative medicine ; Analysis ; Antihypertensive agents ; Antihypertensive Agents - adverse effects ; Antihypertensive Agents - therapeutic use ; Antihypertensives ; Biology and Life Sciences ; Blood pressure ; Calcium Channels - genetics ; Cardiology ; Cardiology and cardiovascular system ; Complications and side effects ; Cross-Sectional Studies ; Demographic aspects ; Demographics ; Demography ; Developing countries ; Developing Countries - economics ; Dosage and administration ; Drug therapy ; Drugs ; Economic factors ; Female ; Hospitals ; Human health and pathology ; Humans ; Hypertension ; Hypertension - drug therapy ; Hypertension - economics ; Hypertension - epidemiology ; Income ; Internal medicine ; LDCs ; Life Sciences ; Low income groups ; Male ; Medical personnel ; Medical research ; Medication Adherence ; Medicine and Health Sciences ; Middle Aged ; Multivariate analysis ; Patient compliance ; Patients ; Pharmaceutical sciences ; Pharmacology ; Pharmacy ; Physical Sciences ; Physicians ; Poverty - economics ; Prevalence ; Public health ; Regression analysis ; Research and Analysis Methods ; Santé publique et épidémiologie ; Social factors ; Socioeconomic Factors ; Socioeconomics ; Surveys ; Surveys and Questionnaires ; Systematic review ; Traditional medicine</subject><ispartof>PloS one, 2019-07, Vol.14 (7), p.e0219266-e0219266</ispartof><rights>COPYRIGHT 2019 Public Library of Science</rights><rights>2019 Macquart de Terline et al. This is an open access article distributed under the terms of the Creative Commons Attribution License: http://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>Distributed under a Creative Commons Attribution 4.0 International License</rights><rights>2019 Macquart de Terline et al 2019 Macquart de Terline et al</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c726t-ee2e75f872a8a2b6e9409998cbdf0543e53b424d7ee7916fa867c19759e8b0463</citedby><cites>FETCH-LOGICAL-c726t-ee2e75f872a8a2b6e9409998cbdf0543e53b424d7ee7916fa867c19759e8b0463</cites><orcidid>0000-0003-4272-1597</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC6619761/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC6619761/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,315,729,782,786,866,887,2106,2932,23875,27933,27934,53800,53802</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/31291293$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink><backlink>$$Uhttps://hal.sorbonne-universite.fr/hal-02303488$$DView record in HAL$$Hfree_for_read</backlink></links><search><contributor>Li, Yan</contributor><creatorcontrib>Macquart de Terline, Diane</creatorcontrib><creatorcontrib>Kane, Adama</creatorcontrib><creatorcontrib>Kramoh, Kouadio Euloge</creatorcontrib><creatorcontrib>Ali Toure, Ibrahim</creatorcontrib><creatorcontrib>Mipinda, Jean Bruno</creatorcontrib><creatorcontrib>Diop, Ibrahima Bara</creatorcontrib><creatorcontrib>Nhavoto, Carol</creatorcontrib><creatorcontrib>Balde, Dadhi M</creatorcontrib><creatorcontrib>Ferreira, Beatriz</creatorcontrib><creatorcontrib>Dèdonougbo Houenassi, Martin</creatorcontrib><creatorcontrib>Ikama, Méo Stéphane</creatorcontrib><creatorcontrib>Kingue, Samuel</creatorcontrib><creatorcontrib>Kouam Kouam, Charles</creatorcontrib><creatorcontrib>Takombe, Jean Laurent</creatorcontrib><creatorcontrib>Limbole, Emmanuel</creatorcontrib><creatorcontrib>Mfeukeu Kuate, Liliane</creatorcontrib><creatorcontrib>N'guetta, Roland</creatorcontrib><creatorcontrib>Damorou, Jean Marc</creatorcontrib><creatorcontrib>Sesso, Zouwera</creatorcontrib><creatorcontrib>Sidy Ali, Abdallahi</creatorcontrib><creatorcontrib>Perier, Marie-Cécile</creatorcontrib><creatorcontrib>Azizi, Michel</creatorcontrib><creatorcontrib>Empana, Jean Philippe</creatorcontrib><creatorcontrib>Jouven, Xavier</creatorcontrib><creatorcontrib>Antignac, Marie</creatorcontrib><title>Factors associated with poor adherence to medication among hypertensive patients in twelve low and middle income Sub-Saharan countries</title><title>PloS one</title><addtitle>PLoS One</addtitle><description>Over the past few decades, the prevalence of hypertension has dramatically increased in Sub-Saharan Africa. Poor adherence has been identified as a major cause of failure to control hypertension. Scarce data are available in Africa.
We assessed adherence to medication and identified socioeconomics, clinical and treatment factors associated with low adherence among hypertensive patients in 12 sub-Saharan African countries.
We conducted a cross-sectional survey in urban clinics of both low and middle income countries. Data were collected by physicians on demographics, treatment and clinical data among hypertensive patients attending the clinics. Adherence was assessed by questionnaires completed by the patients. Factors associated with low adherence were investigated using logistic regression with a random effect on countries.
There were 2198 individuals from 12 countries enrolled in the study. Overall, 678 (30.8%), 738 (33.6%), 782 (35.6%) participants had respectively low, medium and high adherence to antihypertensive medication. Multivariate analysis showed that the use of traditional medicine (OR: 2.28, 95%CI [1.79-2.90]) and individual wealth index (low vs. high wealth: OR: 1.86, 95%CI [1.35-2.56] and middle vs. high wealth: OR: 1.42, 95%CI [1.11-1.81]) were significantly and independently associated with poor adherence to medication. In stratified analysis, these differences in adherence to medication according to individual wealth index were observed in low-income countries (p<0.001) but not in middle-income countries (p = 0.17). In addition, 26.5% of the patients admitted having stopped their treatment due to financial reasons and this proportion was 4 fold higher in the lowest than highest wealth group (47.8% vs 11.4%) (p<0.001).
This study revealed the high frequency of poor adherence in African patients and the associated factors. These findings should be useful for tailoring future programs to tackle hypertension in low income countries that are better adapted to patients, with a potential associated enhancement of their effectiveness.</description><subject>Adhesion</subject><subject>Adult</subject><subject>Africa South of the Sahara - epidemiology</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Alternative medicine</subject><subject>Analysis</subject><subject>Antihypertensive agents</subject><subject>Antihypertensive Agents - adverse effects</subject><subject>Antihypertensive Agents - therapeutic use</subject><subject>Antihypertensives</subject><subject>Biology and Life Sciences</subject><subject>Blood pressure</subject><subject>Calcium Channels - genetics</subject><subject>Cardiology</subject><subject>Cardiology and cardiovascular system</subject><subject>Complications and side effects</subject><subject>Cross-Sectional Studies</subject><subject>Demographic aspects</subject><subject>Demographics</subject><subject>Demography</subject><subject>Developing countries</subject><subject>Developing Countries - economics</subject><subject>Dosage and administration</subject><subject>Drug therapy</subject><subject>Drugs</subject><subject>Economic factors</subject><subject>Female</subject><subject>Hospitals</subject><subject>Human health and pathology</subject><subject>Humans</subject><subject>Hypertension</subject><subject>Hypertension - drug therapy</subject><subject>Hypertension - economics</subject><subject>Hypertension - epidemiology</subject><subject>Income</subject><subject>Internal medicine</subject><subject>LDCs</subject><subject>Life Sciences</subject><subject>Low income groups</subject><subject>Male</subject><subject>Medical personnel</subject><subject>Medical research</subject><subject>Medication Adherence</subject><subject>Medicine and Health Sciences</subject><subject>Middle Aged</subject><subject>Multivariate analysis</subject><subject>Patient compliance</subject><subject>Patients</subject><subject>Pharmaceutical sciences</subject><subject>Pharmacology</subject><subject>Pharmacy</subject><subject>Physical Sciences</subject><subject>Physicians</subject><subject>Poverty - economics</subject><subject>Prevalence</subject><subject>Public health</subject><subject>Regression analysis</subject><subject>Research and Analysis Methods</subject><subject>Santé publique et épidémiologie</subject><subject>Social factors</subject><subject>Socioeconomic Factors</subject><subject>Socioeconomics</subject><subject>Surveys</subject><subject>Surveys and Questionnaires</subject><subject>Systematic review</subject><subject>Traditional medicine</subject><issn>1932-6203</issn><issn>1932-6203</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><sourceid>DOA</sourceid><recordid>eNqNk99qFDEUxgdRbK2-gWhAEHux6-TPJJMboRRrC4WCVW9DJnNmJ2UmWZNMa1_A5zbjbku3eCETmHDO73xJvuQUxWtcLjEV-OOVn4LTw3LtHSxLgiXh_EmxjyUlC05K-vTBfK94EeNVWVa05vx5sUcxkXnQ_eL3iTbJh4h0jN5YnaBFNzb1aO19QLrtIYAzgJJHI7TW6GS9Q3r0boX62zWEBC7aa0DrnAGXIrIOpRsYcmjwN0i7Fo22bQfICeNHQJdTs7jUvQ7aIeMnl4KF-LJ41ukhwqvt_6D4fvL52_Hp4vziy9nx0fnCCMLTAoCAqLpaEF1r0nCQrJRS1qZpu7JiFCraMMJaASAk5p2uuTBYikpC3ZSM04Pi7UZ3PfiothZGRUjFCWYVY5k42xCt11dqHeyow63y2qq_AR9WSodkzQCK4o62dSUZCMFKwSSvK8IEF8JUbdPgrPVpu9rUZPdM9ifoYUd0N-Nsr1b-WnGeN81ngcONQP-o7PToXM2xktCSsrq-ntkP28WC_zlBTGq00cAwaAd-2pwRl5XkJKPvHqH_dmJLrXQ-rHWdz3s0s6g6qiSpecXwTC3_QeWvhdGa_DY7m-M7BYc7BZlJ8Cut9BSjOrv8-v_sxY9d9v0Dtgc9pD76YZofbNwF2QY0wccYoLt3Fpdqbq07N9TcWmrbWrnszcPLvC-66yX6B3X6HmU</recordid><startdate>20190710</startdate><enddate>20190710</enddate><creator>Macquart 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associated with poor adherence to medication among hypertensive patients in twelve low and middle income Sub-Saharan countries</title><author>Macquart de Terline, Diane ; Kane, Adama ; Kramoh, Kouadio Euloge ; Ali Toure, Ibrahim ; Mipinda, Jean Bruno ; Diop, Ibrahima Bara ; Nhavoto, Carol ; Balde, Dadhi M ; Ferreira, Beatriz ; Dèdonougbo Houenassi, Martin ; Ikama, Méo Stéphane ; Kingue, Samuel ; Kouam Kouam, Charles ; Takombe, Jean Laurent ; Limbole, Emmanuel ; Mfeukeu Kuate, Liliane ; N'guetta, Roland ; Damorou, Jean Marc ; Sesso, Zouwera ; Sidy Ali, Abdallahi ; Perier, Marie-Cécile ; Azizi, Michel ; Empana, Jean Philippe ; Jouven, Xavier ; Antignac, Marie</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c726t-ee2e75f872a8a2b6e9409998cbdf0543e53b424d7ee7916fa867c19759e8b0463</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><topic>Adhesion</topic><topic>Adult</topic><topic>Africa South of the Sahara - epidemiology</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Alternative medicine</topic><topic>Analysis</topic><topic>Antihypertensive agents</topic><topic>Antihypertensive Agents - adverse effects</topic><topic>Antihypertensive Agents - therapeutic use</topic><topic>Antihypertensives</topic><topic>Biology and Life Sciences</topic><topic>Blood pressure</topic><topic>Calcium Channels - genetics</topic><topic>Cardiology</topic><topic>Cardiology and cardiovascular system</topic><topic>Complications and side effects</topic><topic>Cross-Sectional Studies</topic><topic>Demographic aspects</topic><topic>Demographics</topic><topic>Demography</topic><topic>Developing countries</topic><topic>Developing Countries - economics</topic><topic>Dosage and administration</topic><topic>Drug therapy</topic><topic>Drugs</topic><topic>Economic factors</topic><topic>Female</topic><topic>Hospitals</topic><topic>Human health and pathology</topic><topic>Humans</topic><topic>Hypertension</topic><topic>Hypertension - drug therapy</topic><topic>Hypertension - economics</topic><topic>Hypertension - epidemiology</topic><topic>Income</topic><topic>Internal medicine</topic><topic>LDCs</topic><topic>Life Sciences</topic><topic>Low income groups</topic><topic>Male</topic><topic>Medical personnel</topic><topic>Medical research</topic><topic>Medication Adherence</topic><topic>Medicine and Health Sciences</topic><topic>Middle Aged</topic><topic>Multivariate analysis</topic><topic>Patient compliance</topic><topic>Patients</topic><topic>Pharmaceutical sciences</topic><topic>Pharmacology</topic><topic>Pharmacy</topic><topic>Physical Sciences</topic><topic>Physicians</topic><topic>Poverty - economics</topic><topic>Prevalence</topic><topic>Public health</topic><topic>Regression analysis</topic><topic>Research and Analysis Methods</topic><topic>Santé publique et épidémiologie</topic><topic>Social factors</topic><topic>Socioeconomic Factors</topic><topic>Socioeconomics</topic><topic>Surveys</topic><topic>Surveys and Questionnaires</topic><topic>Systematic review</topic><topic>Traditional medicine</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Macquart de Terline, Diane</creatorcontrib><creatorcontrib>Kane, Adama</creatorcontrib><creatorcontrib>Kramoh, Kouadio Euloge</creatorcontrib><creatorcontrib>Ali Toure, Ibrahim</creatorcontrib><creatorcontrib>Mipinda, Jean Bruno</creatorcontrib><creatorcontrib>Diop, Ibrahima Bara</creatorcontrib><creatorcontrib>Nhavoto, Carol</creatorcontrib><creatorcontrib>Balde, Dadhi M</creatorcontrib><creatorcontrib>Ferreira, Beatriz</creatorcontrib><creatorcontrib>Dèdonougbo Houenassi, Martin</creatorcontrib><creatorcontrib>Ikama, Méo Stéphane</creatorcontrib><creatorcontrib>Kingue, Samuel</creatorcontrib><creatorcontrib>Kouam Kouam, Charles</creatorcontrib><creatorcontrib>Takombe, Jean Laurent</creatorcontrib><creatorcontrib>Limbole, Emmanuel</creatorcontrib><creatorcontrib>Mfeukeu Kuate, Liliane</creatorcontrib><creatorcontrib>N'guetta, Roland</creatorcontrib><creatorcontrib>Damorou, Jean Marc</creatorcontrib><creatorcontrib>Sesso, Zouwera</creatorcontrib><creatorcontrib>Sidy Ali, Abdallahi</creatorcontrib><creatorcontrib>Perier, Marie-Cécile</creatorcontrib><creatorcontrib>Azizi, Michel</creatorcontrib><creatorcontrib>Empana, Jean Philippe</creatorcontrib><creatorcontrib>Jouven, Xavier</creatorcontrib><creatorcontrib>Antignac, Marie</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Gale In Context: Opposing Viewpoints</collection><collection>Gale In Context: Science</collection><collection>ProQuest Central (Corporate)</collection><collection>Animal Behavior 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Collection</collection><collection>Environmental Science Collection</collection><collection>Genetics Abstracts</collection><collection>MEDLINE - Academic</collection><collection>Hyper Article en Ligne (HAL)</collection><collection>Hyper Article en Ligne (HAL) (Open Access)</collection><collection>PubMed Central (Full Participant titles)</collection><collection>Directory of Open Access Journals</collection><jtitle>PloS one</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Macquart de Terline, Diane</au><au>Kane, Adama</au><au>Kramoh, Kouadio Euloge</au><au>Ali Toure, Ibrahim</au><au>Mipinda, Jean Bruno</au><au>Diop, Ibrahima Bara</au><au>Nhavoto, Carol</au><au>Balde, Dadhi M</au><au>Ferreira, Beatriz</au><au>Dèdonougbo Houenassi, Martin</au><au>Ikama, Méo Stéphane</au><au>Kingue, Samuel</au><au>Kouam Kouam, Charles</au><au>Takombe, Jean Laurent</au><au>Limbole, Emmanuel</au><au>Mfeukeu Kuate, Liliane</au><au>N'guetta, Roland</au><au>Damorou, Jean Marc</au><au>Sesso, Zouwera</au><au>Sidy Ali, Abdallahi</au><au>Perier, Marie-Cécile</au><au>Azizi, Michel</au><au>Empana, Jean Philippe</au><au>Jouven, Xavier</au><au>Antignac, Marie</au><au>Li, Yan</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Factors associated with poor adherence to medication among hypertensive patients in twelve low and middle income Sub-Saharan countries</atitle><jtitle>PloS one</jtitle><addtitle>PLoS One</addtitle><date>2019-07-10</date><risdate>2019</risdate><volume>14</volume><issue>7</issue><spage>e0219266</spage><epage>e0219266</epage><pages>e0219266-e0219266</pages><issn>1932-6203</issn><eissn>1932-6203</eissn><abstract>Over the past few decades, the prevalence of hypertension has dramatically increased in Sub-Saharan Africa. Poor adherence has been identified as a major cause of failure to control hypertension. Scarce data are available in Africa.
We assessed adherence to medication and identified socioeconomics, clinical and treatment factors associated with low adherence among hypertensive patients in 12 sub-Saharan African countries.
We conducted a cross-sectional survey in urban clinics of both low and middle income countries. Data were collected by physicians on demographics, treatment and clinical data among hypertensive patients attending the clinics. Adherence was assessed by questionnaires completed by the patients. Factors associated with low adherence were investigated using logistic regression with a random effect on countries.
There were 2198 individuals from 12 countries enrolled in the study. Overall, 678 (30.8%), 738 (33.6%), 782 (35.6%) participants had respectively low, medium and high adherence to antihypertensive medication. Multivariate analysis showed that the use of traditional medicine (OR: 2.28, 95%CI [1.79-2.90]) and individual wealth index (low vs. high wealth: OR: 1.86, 95%CI [1.35-2.56] and middle vs. high wealth: OR: 1.42, 95%CI [1.11-1.81]) were significantly and independently associated with poor adherence to medication. In stratified analysis, these differences in adherence to medication according to individual wealth index were observed in low-income countries (p<0.001) but not in middle-income countries (p = 0.17). In addition, 26.5% of the patients admitted having stopped their treatment due to financial reasons and this proportion was 4 fold higher in the lowest than highest wealth group (47.8% vs 11.4%) (p<0.001).
This study revealed the high frequency of poor adherence in African patients and the associated factors. These findings should be useful for tailoring future programs to tackle hypertension in low income countries that are better adapted to patients, with a potential associated enhancement of their effectiveness.</abstract><cop>United States</cop><pub>Public Library of Science</pub><pmid>31291293</pmid><doi>10.1371/journal.pone.0219266</doi><tpages>e0219266</tpages><orcidid>https://orcid.org/0000-0003-4272-1597</orcidid><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1932-6203 |
| ispartof | PloS one, 2019-07, Vol.14 (7), p.e0219266-e0219266 |
| issn | 1932-6203 1932-6203 |
| language | eng |
| recordid | cdi_plos_journals_2256214544 |
| source | PLoS (Open access); PubMed Central (Open access); MEDLINE; Full-Text Journals in Chemistry (Open access); Directory of Open Access Journals; EZB Electronic Journals Library |
| subjects | Adhesion Adult Africa South of the Sahara - epidemiology Aged Aged, 80 and over Alternative medicine Analysis Antihypertensive agents Antihypertensive Agents - adverse effects Antihypertensive Agents - therapeutic use Antihypertensives Biology and Life Sciences Blood pressure Calcium Channels - genetics Cardiology Cardiology and cardiovascular system Complications and side effects Cross-Sectional Studies Demographic aspects Demographics Demography Developing countries Developing Countries - economics Dosage and administration Drug therapy Drugs Economic factors Female Hospitals Human health and pathology Humans Hypertension Hypertension - drug therapy Hypertension - economics Hypertension - epidemiology Income Internal medicine LDCs Life Sciences Low income groups Male Medical personnel Medical research Medication Adherence Medicine and Health Sciences Middle Aged Multivariate analysis Patient compliance Patients Pharmaceutical sciences Pharmacology Pharmacy Physical Sciences Physicians Poverty - economics Prevalence Public health Regression analysis Research and Analysis Methods Santé publique et épidémiologie Social factors Socioeconomic Factors Socioeconomics Surveys Surveys and Questionnaires Systematic review Traditional medicine |
| title | Factors associated with poor adherence to medication among hypertensive patients in twelve low and middle income Sub-Saharan countries |
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