What is the clinical evidence from this study?

Study design: Cross-Sectional. Population: Hypertension (n=120). Intervention: Antihypertensive therapy. Primary outcome: Proportion of patients with adherence levels to antihypertensive therapy ≥ 80% on the Hill-Bone blood pressure scale.

What does this research mean for the field?

Among patients receiving antihypertensive therapy in primary health care settings in Namibia, only 42.5% achieved acceptable adherence levels of 80% or greater, with family support and follow-up attendance acting as significant predictors of adherence. Novelty: ClaimNovelty.CONFIRMATORY. Consensus alignment: ConsensusAlignment.NEUTRAL.

October 14, 2017Open Access

Assessing Adherence to Antihypertensive Therapy in Primary Health Care in Namibia: Findings and Implications

MNM. M. NashilongoUniversity of Namibia BSBonifasius Siyuka SinguUniversity of Namibia FKFrancis KalemeeraUniversity of the West Indies

Key Result

Among patients receiving antihypertensive therapy in primary health care settings in Namibia, only 42.5% achieved acceptable adherence levels of 80% or greater.

Study Design

Type

Cross-Sectional (n=120)

Multicenter

Yes

Structured PICO

Population

120 adult patients (>18 years) with a confirmed diagnosis of hypertension who had completed at least one cycle (6 months) of antihypertensive medication refill at public primary health care facilities in four sub-urban townships of Windhoek, Namibia. Mean age 47.3 years, 57.5% female.

Intervention

Assessment of adherence to antihypertensive therapy using the modified Namibian version of the Hill-Bone compliance scale

Outcome

Proportion of patients with adherence levels to antihypertensive therapy ≥80% on the Hill-Bone blood pressure scalepatient reported

Adherence to antihypertensive therapy in Namibian primary care is sub-optimal, highlighting the need for standardized monitoring and support systems to maximize the benefits of universal access.

Limitations

Limited sample of hospitals included (only four clinics in the informal settlements of Windhoek)
Non-inclusion of the three clinics in the central business district of Windhoek

Abstract

INTRODUCTION: Namibia has the highest burden and incidence of hypertension in sub-Sahara Africa. Though non-adherence to antihypertensive therapy is an important cardiovascular risk factor, little is known about potential ways to improve adherence in Namibia following universal access. The objective of this study is to validate the Hill-Bone compliance scale and determine the level and predictors of adherence to antihypertensive treatment in primary health care settings in sub-urban townships of Windhoek, Namibia. METHODS: Reliability was determined by Cronbach's alpha. Principal component analysis (PCA) was used to assess construct validity. RESULTS: The PCA was consistent with the three constructs for 12 items, explaining 24.1, 16.7 and 10.8% of the variance. Cronbach's alpha was 0.695. None of the 120 patients had perfect adherence to antihypertensive therapy, and less than half had acceptable levels of adherence (≥ 80%). The mean adherence level was 76.7 ± 8.1%. Three quarters of patients ever missed their scheduled clinic appointment. Having a family support system (OR = 5.4, 95% CI 1.687-27.6, p = 0.045) and attendance of follow-up visits (OR = 3.1, 95% CI 1.1-8.7, p = 0.03) were significant predictors of adherence. Having HIV/AIDs did not lower adherence. CONCLUSIONS: The modified Namibian version of the Hill-Bone scale is reliable and valid for assessing adherence to antihypertensives in Namibia. There is sub-optimal adherence to antihypertensive therapy among primary health cares in Namibia. This needs standardized systems to strengthen adherence monitoring as well as investigation of other factors including transport to take full advantage of universal access.

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