Ensuring patients’ adherence to anti hypertension medications to prevent complications of hypertension remains a major challenge to public health in many developing countries. Poor adherence to treatment is the single most important reason for uncontrolled hypertension, serious complications and wastage of health care resources. Several factors, which may be patient or health system related, continue to militate against compliance behavior [9
Only 64.6% of the study subjects were found to be adherent to their treatment. It is higher than what has been reported from Malaysia (44.2%) and Gambia 27% [10
]. The adherence to antihypertensive treatment found in the current study was also higher than that of 57% found in the study done in Pakistan [15
]. This difference is possibly because more than half (59.6%) of the patients in the current study receive free medical care and drugs whereas in the other study patients had to pay for their treatment. However, it is lower than the studies done in Egypt (74.1%), another part of Pakistan (77%) and Scotland (91%) [8
]. This might be due to better access and care to patients in these countries. It is also supported by the findings of this study that, for 71.3% of the non adherents, the hypertension treatment and care service was not accessible.
In this study, significant association between sex and adherence level was observed. Accordingly, men were found to be less adherent when compared to women. This finding is in line with a study done in India [12
], where men had almost threefold increase in risk of non-adherence as compared to women. This can be explained by the fact that; men are burdened by the outdoor activities which make them busy and make them forget their medications. Alcohol consumption, a commonly practice by males, could also be a barrier for their treatment adherence.
Longer distance was a big barrier for adherence to treatment recommendations especially when it was accompanied by poor infrastructure (e.g. lack of transportation) and poverty. Distance from the hospital was another variable found to be significantly and independently associated with the adherence status of the respondents. Those patients from distant areas were less likely to be adherent as compared to study subjects who are closer. This finding is supported by the study done in India [12
]. Patients who take long to come to the clinic have certain characteristics that promote non-adherence, which also delayed them from coming for review and possibly collecting drugs from the hospital when they refill the antihypertensive.
Co-morbidities can worsen the conditions of the patient and make them unable to adhere to their antihypertensive medications. This study revealed that the numbers of co morbidities among HTN patients had significant associations on adherence behavior. Patients with no and one co morbidities were more likely to adhere to their treatment than those with two and above co morbidities. Patients with more number of co morbidities could suffer from serious complications and complex treatment regimens which were favorable conditions not to adhere to their medications.
Right knowledge about HTN and its treatment creates a clear understanding and avoids confusion about the treatment and the disease condition. Knowledge about HTN and its treatment was found to be positively associated with adherence behavior. Patients with better awareness were more likely to adhere to their treatment. A similar study from Pakistan and Gaza demonstrated that patients who were aware of their diseases and treatments had better adherence compared to those who did not [17
]. However, in contrast to this finding, studies from some developed world indicated no association between knowledge and adherence [18
In this study, blood pressure control level was associated with adherence behavior. Those with controlled blood pressure were observed to be adherent. This finding is in line with the study done in Greece [19
]. It might be attributable to better outcome of the treatment, may offer the patient good satisfactions and creates strong motivation towards the treatment. However, bad outcome (uncontrolled BP) could make the patient hopeless and low satisfaction and hence urged them to stop their treatment.