Predictors of non-adherence to antihypertensive medications: A cross-sectional study from a regional hospital in Afghanistan

Muhammad Haroon Stanikzai; Mohammad Hashim Wafa; Essa Tawfiq; Massoma Jafari; Cua Ngoc Le; Abdul Wahed Wasiq; Bilal Ahmad Rahimi; Ahmad Haroon Baray; Temesgen Anjulo Ageru; Charuai Suwanbamrung

doi:10.1371/journal.pone.0295246

Predictors of non-adherence to antihypertensive medications: A cross-sectional study from a regional hospital in Afghanistan

PLoS One. 2023 Dec 27;18(12):e0295246. doi: 10.1371/journal.pone.0295246. eCollection 2023.

Authors

Muhammad Haroon Stanikzai^{1

2

3}, Mohammad Hashim Wafa⁴, Essa Tawfiq⁵, Massoma Jafari⁶, Cua Ngoc Le^{1

2}, Abdul Wahed Wasiq⁷, Bilal Ahmad Rahimi⁸, Ahmad Haroon Baray³, Temesgen Anjulo Ageru^{1

2}, Charuai Suwanbamrung^{1

2}

Affiliations

¹ Public Health Research Program, School of Public Health, Walailak University, Thai Buri, Thailand.
² Excellent Center for Dengue and Community Public Health (EC for DACH), Walailak University, Thai Buri, Thailand.
³ Faculty of Medicine, Department of Public Health, Kandahar University, Kandahar, Afghanistan.
⁴ Faculty of Medicine, Neuropsychiatric and Behavioral science Department, Kandahar University, Kandahar, Afghanistan.
⁵ The Kirby Institute, UNSW Sydney, Sydney, Australia.
⁶ McMaster University, Hamilton, Ontario, Canada.
⁷ Faculty of Medicine, Department of Internal Medicine, Kandahar University, Kandahar, Afghanistan.
⁸ Department of Pediatrics, Faculty of Medicine, Kandahar University, Kandahar, Afghanistan.

Abstract

Background: Non-adherence to antihypertensive medications (AHMs) is a widespread problem. Cardiovascular morbidity and mortality reduction is possible via better adherence rates among hypertensive patients.

Objectives: This study aimed to assess the prevalence of non-adherence to AHMs and its predictors among hypertensive patients who attended Mirwais Regional Hospital in Kandahar, Afghanistan.

Methods: A cross-sectional study using random sampling method was conducted among hypertensive patients, aged ≥18 years in Mirwais Regional Hospital at a 6-month follow-up between October and December 2022. To assess non-adherence to AHMs, we employed the Hill-Bone Medication Adherence scale. A value below or equal to 80% of the total score was used to signify non-adherence. A multivariable binary logistic regression model was used to identify predictors of non-adherence to AHMs.

Results: We used data from 669 patients and found that 47.9% (95%CI: 44.1-51.8%) of them were non-adherent to AHMs. The majority (71.2%) of patients had poorly controlled blood pressure (BP). The likelihood of non-adherence to AHMs was significantly higher among patients from low monthly-income households [Adjusted odds ratio (AOR) 1.70 (95%CI: 1.13-2.55)], those with daily intake of multiple AHMs [AOR 2.02 (1.29-3.16)], presence of comorbid medical conditions [AOR 1.68 (1.05-2.67), lack of awareness of hypertension-related complications [AOR 2.40 (1.59-3.63)], and presence of depressive symptoms [AOR 1.65 (1.14-2.38)].

Conclusion: Non-adherence to AHMs was high. Non-adherence to AHMs is a potential risk factor for uncontrolled hypertension and subsequent cardiovascular complications. Policymakers and clinicians should implement evidence-based interventions to address factors undermining AHMs adherence in Afghanistan.

Copyright: © 2023 Stanikzai et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

MeSH terms

Adolescent
Adult
Afghanistan / epidemiology
Antihypertensive Agents* / therapeutic use
Cross-Sectional Studies
Hospitals
Humans
Hypertension* / drug therapy
Hypertension* / epidemiology
Medication Adherence

Substances

Antihypertensive Agents

Grants and funding

This study was financially supported by the Excellent Center for Dengue and Community Public Health, School of Public Health [WU-COE-66-16], and the Walailak University. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.