Factors influencing treatment adherence amongst hypertesive patients at Queen Elizabeth central hospital, Blantyre, Malawi

Abstract

Background Hypertension is a global public health problem, a risk factor for 80.0% of cardiovascular diseases, accountable for 6.0% of deaths. Although much literature exists about hypertension risk factors and disease burden, treatment adherence remains a challenge, in both developed and developing countries, especially in sub Sahara Africa. Objective This study aimed to establish treatment adherence levels, and identify factors influencing adherence levels among hypertension patients at Queen Elizabeth Central Hospital (QECH) in Blantyre, Malawi. Methods A quantitative, descriptive, cross-sectional study was used and structured interviews were conducted with 480 eligible randomly selected hypertension patients treated at the QECH hypertension clinic. The Morisky Medication Adherence Scale was used to measure patients’ adherence levels. Descriptive statistics, univariate and multivariate analyses were computed using Stata version 13.0 with 5% level of significance. Findings Out of the 480 respondents, 77.7%, were females, the mean age was 54.9 years (SD 11.6) and 42.7% had low, 39.6% had moderate and 17.7% had high anti-hypertensive treatment adherence levels. In adjusted analyses; respondents whose parents were on hypertension treatment were 2.8 times more likely to have high adherence levels compared to those whose parents were not on such treatment (adjusted odds ratio [OR] 2.36; 95% confidence interval [CI]: 1.19; 4.67; p=0.014). Respondents who were knowledgeable about hypertension had 1.43 increased OR of high adherence levels compared to respondents who lacked such knowledge (OR 1.43; 95% CI: 1.08, 1.81; p=0.012). Lower levels of adherence were significantly associated with taking herbs during the preceding three months (OR 0.53;95% CI: 0.34, 0.81; p=0.004); and long waiting times to get medication refills, resulting in 48% reduced adjusted odds ratio of having high adherence levels (OR 0.62; 95% CI: 0.38, 1.03; p=0.063). Conclusions Only 17.7% of the respondents had high rates of adherence at the QECH hypertension clinic. Further research is required to develop interventions to increase patients’ anti-hypertensive treatment adherence at the QECH clinic.