https://orcid.org/0000-0001-8013-0785
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.
Abbreviations
AOR, adjusted odds ratios; BMI, body mass Index; BP, blood pressure; CI, confidence interval; COR, crude odds ratios; DBP, diastolic blood pressure; EA, enumeration area; HBP, high blood pressure; HDL, high-density lipoprotein; LDL, low-density lipoprotein; mmHg, mmHg millimeter mercury; mmol/l, mmol/l millimole per liter; NCDs, non-communicable diseases; OR, odds ratio; SBP, systolic blood pressure; SPSS, Statistical Package for the Social Sciences; WHO, World Health Organization; DASH, Dietary Approaches to Stop Hypertension.
Statement of Human and Animal Rights
All the procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2008 (5).
Data Sharing Statement
This study is part of a bigger project to assess multiple themes on hypertension in Asmara City, Eritrea. These include factors associated with hypertension, complications, patients’ knowledge, adherence to medications, among others. Further publications are expected from the dataset, which prevents us from making it public right now. However, the dataset supporting the conclusions of this article is available from the corresponding author on reasonable request.
Ethical Approval
The protocol was approved by the Research and Ethics Committee of the University of South Africa (UNISA). In addition, permission was obtained from the National Ethics Committee of the Department of Human Resource Development and Research/Ministry of Health and the Hospital Director, Halibet National Referral Hospital. Ethical approval for the study was obtained from Eritrean Ministry of Health (MOH) research ethics committee. In addition, requisite permission was obtained from the hospital director and local administration. Participants were recruited voluntarily after signing a consent form signed. This was only undertaken after the participants were provided with information on the study objective, study procedures, possible adverse effects, and the right to refuse or terminate their participation in the study at any time/stage. Information on the maintenance of data confidentiality and integrity was also provided. To ensure data confidentiality and privacy, personal identifiers such as names were not collected. Finally, all the procedures were conducted in accordance with the Declaration of Helsinki.
Acknowledgments
The authors would like to thank various personnel who helped in accomplishment of this study directly or indirectly. We would also like to thank the patients too for their consent and patience during data collection.
Author Contributions
All authors made substantial contributions to conception and design, acquisition of data, or analysis and interpretation of data; took part in drafting the article or revising it critically for important intellectual content; agreed to submit to the current journal; gave final approval of the version to be published; and agree to be accountable for all aspects of the work.
Disclosure
The authors declared no conflicts of interest for this work.