Adherence Level and Adequacy of Blood Pressure Control Among Hypertensive Patients Attending a Tertiary Hospital in Somalia.

Abstract

Background: Hypertension is a prevalent condition that affects approximately one billion of people globally, leading to increased cardiovascular morbidity and mortality. Poor adherence to prescribed therapy contributes to inadequate hypertension control. Despite several studies conducted on the level of adherence of hypertension in Africa, some countries such as Somalia have not been adequately researched. Objective: To assess the adherence level, adequacy of blood pressure control, and determinants of non-adherence to antihypertensive medications among hypertensive patients in Somalia. Methods: The study was a cross-sectional study conducted at the medical out-patient clinic at the Somali-Turkish training and research hospital in Mogadishu. The adherence level was evaluated using the Morisky Medication Adherence Scale (MMAS-8), while the adequacy of blood pressure control was evaluated by measuring blood pressure level. Socio-demographic, patient-related, and therapy related determinants for non-adherence to antihypertensive medications were evaluated using a researcher-designed questionnaire. Results: Out of the 334 patients, 53% were female. The majority of the patients lived in urban areas, 55.4%, and nearly four out of five patients, 79.6%, were married. The majority of the patients were without employment, 61.7%, and had not received formal education, 63.5%. Additionally, the majority of patients, 73.1%, had low adherence to their medication regimen. Only 38.3% of patients had controlled blood pressure as measured during their last visit to the clinic. The older age groups of 55-64 years (P <0.001) and 65 years and above (P=0.034) were more likely to be non-adherent compared to younger patients. Similarly, patients with no formal education (P<0.001) and primary level (P=0.002) of education were more likely to be non-adherent compared to those with a tertiary level of education. Patients with diabetes were 2.1 times (P=0.007) more likely to be non-adherent compared to those without diabetes. Patients who had nonadherent to medication were 1.7 times (P<0.045) the odds of being uncontrolled BP. Conclusion: the study highlights the high prevalence of low adherence to antihypertensive medications and poor blood pressure control among hypertensive patients in Somalia. Several factors were found to be statistically significant in their impact on low adherence, included older age, lower education levels, diabetes, patients' knowledge about the long-term use of medication, belief that medication should only be taken when blood pressure is high, use of alternative therapies and side effect of medications