Why the study?
Medication non-adherence leads to poor heart failure outcomes, but a consolidated estimate of non-adherence prevalence and associated factors across Africa remains unknown.
Medication non-adherence affects approximately 42% of heart failure patients in Africa, highlighting the urgent need for interventions addressing financial barriers such as lack of health insurance.
Substantial non-adherence in African HF patients warrants targeted adherence programs; extends regional estimates but leaves optimal interventions open.
Background Medication non-adherence is a critical determinant of poor outcomes in heart failure, a condition posing a significant public health burden across Africa. Unique regional challenges such as healthcare resource constraints, economic disparities, and diverse healthcare systems exacerbate this issue. However, a consolidated estimate of non-adherence prevalence and its associated factors across the continent remains unknown. Method This systematic review and meta-analysis followed PRISMA guidelines (PROSPERO: CRD420251139486). A comprehensive search of databases (PubMed/MEDLINE, African Journal Online, and Google Scholar) was conducted for studies published between 2000 and 2025. Observational studies reporting non-adherence prevalence or associated factors among African heart failure patients were included. Study quality was assessed using the Joanna Briggs Institute (JBI) critical appraisal checklists for cross-sectional and cohort studies. Data were extracted and pooled using a random-effects model in STATA 17. Result Seventeen studies (n=6,276 patients) from multiple African regions were included. The pooled prevalence of medication non-adherence among heart failure patients in Africa was 41.88% (95% CI: 25.43-58.34). Extreme heterogeneity (I² = 99.7%) was explored via subgroup analyses, revealing significant regional variation with Western Africa showing the highest prevalence (77.59%). Meta-analysis of associated factors identified lack of health insurance as the strongest predictor (OR = 4.27, 95% CI: 1.62-11.26). Other significant factors included polypharmacy (OR = 2.58, 95% CI: 2.00-3.33) and presence of comorbidities (OR = 1.76, 95% CI: 1.31-2.35). No publication bias was detected (Egger's test: p=0.267). Conclusion Approximately two in five heart failure patients in Africa are non-adherent to their medication, with prevalence rates varying significantly by region. This rate is exacerbated by financial, clinical, and therapy-related factors. Concerted multi-faceted interventions are urgently needed across the continent. Recommendations include expanding health insurance coverage, implementing medication subsidy programs, strengthening therapy simplification strategies, and developing context-specific adherence support strategies tailored to regional healthcare contexts and patient populations.
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Abebe et al. (2026) studied this question.
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