Anti-hypertensive medication access and affordability and their association with blood pressure control at a teaching hospital in Ghana

Harrison, Mark Amankwa; Marfo, Afia Frimpomaa Asare; Opare-Addo, Mercy Naa Aduele; Ankrah, Daniel; Acheampong, Franklin; Nelson, Frempomaa; Buabeng, Kwame Ohene

doi:10.11604/pamj.2021.39.184.27977

Cited by 9 publications

(12 citation statements)

References 26 publications

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“…In settings or facilities where CV medicines are available, affordability is often a challenge. In settings or facilities where medicines are affordable or supplied free, availability is often a challenge [ 8 – 10 ]. Seven out of 11 studies reported availability less than 80%.…”

Section: Resultsmentioning

confidence: 99%

Access to cardiovascular medicines in low- and middle-income countries: a mini review

Harrison

Marfo

Annan

et al. 2023

glob health res policy

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Background Many cardiovascular (CV) medicines are required for long term. However, with their limited resources, low- and middle-income countries (LMICs) may have challenges with access to cardiovascular medicines. The aim of this review was to provide a summary of available evidence on access to cardiovascular medicines in LMICs. Methods We searched PubMed and Google scholar for English language articles on access to cardiovascular medicines for the period 2010–2022. We also searched for articles reporting measures for challenges in access to CV medicines from 2007 to 2022. Studies conducted in LMICs, and reporting availability and affordability were included for review. We also reviewed studies reporting affordability or availability using the World Health Organisation/Health Action International (WHO/HAI) method. Levels of affordability and availability were compared. Results Eleven articles met the inclusion criteria for review on availability and affordability. Although availability appears to have improved, many countries did not meet the availability target of 80%. Between economies and within countries, there are equity gaps in access to CV medicines. Availability is lower in public health facilities than private facilities. Seven out of 11 studies reported availability less than 80%. Eight studies which investigated availability in the public sector reported less than 80% availability. Overall, CV medicines, especially combined treatments are not affordable in the majority of countries. Simultaneous achievement of availability and affordability target is low. In the studies reviewed, less than 1–53.5 days wages were required to purchase one month supply of CV medicines. Failure to meet affordability was 9–75%. Five studies showed that, on average 1.6 days’ wages of the Lowest-Paid Government Worker (LPGW) was required to purchase generic CV medicines in the public sector. Efficient forecasting and procurement, increased public financing and policies to improve generic use, among others are measures for improving availability and affordability. Conclusions Significant gaps exist in access to cardiovascular medicines in LMICs, and in many low—and lower middle—income countries access to cardiovascular medicines is low. To improve access and achieve the Global Action Plan on non-communicable diseases in these countries, policy interventions must be urgently instituted.

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Section: Resultsmentioning

confidence: 99%

Access to cardiovascular medicines in low- and middle-income countries: a mini review

Harrison

Marfo

Annan

et al. 2023

glob health res policy

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“…Two studies were conducted in low-income countries, namely, Ethiopia [ 8 ] and Rwanda [ 9 ]. Eleven studies were conducted in lower-middle-income countries, which are Angola [ 10 ], Tanzania [ 11 ], Senegal [ 12 ], Cameron [ 13 ], Nigeria [ 14 , 15 ], Ghana [ 16 , 17 ], Nepal [ 18 , 19 ], and Vietnam [ 20 ]. Whereas ten studies were undertaken in upper-middle-income countries, comprising China [ 21 , 22 , 23 , 24 , 25 , 26 ] and one study each for Brazil [ 27 ], Botswana [ 28 ], Iraq [ 29 ], and Peru [ 30 ].…”

Section: Resultsmentioning

confidence: 99%

Disparities in Prevalence and Barriers to Hypertension Control: A Systematic Review

Elnaem

Mosaad²,

Abdelaziz

et al. 2022

IJERPH

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Controlling hypertension (HTN) remains a challenge, as it is affected by various factors in different settings. This study aimed to describe the disparities in the prevalence and barriers to hypertension control across countries of various income categories. Three scholarly databases—ScienceDirect, PubMed, and Google Scholar—were systematically examined using predefined search terms to identify potentially relevant studies. Original research articles published in English between 2011 and 2022 that reported the prevalence and barriers to HTN control were included. A total of 33 studies were included in this systematic review. Twenty-three studies were conducted in low and middle-income countries (LMIC), and ten studies were from high-income countries (HIC). The prevalence of hypertension control in the LMIC and HIC studies ranged from (3.8% to 50.4%) to (36.3% to 69.6%), respectively. Concerning barriers to hypertension control, patient-related barriers were the most frequently reported (n = 20), followed by medication adherence barriers (n = 10), lifestyle-related barriers (n = 8), barriers related to the affordability and accessibility of care (n = 8), awareness-related barriers (n = 7), and, finally, barriers related to prescribed pharmacotherapy (n = 6). A combination of more than one category of barriers was frequently encountered, with 59 barriers reported overall across the 33 studies. This work reported disparities in hypertension control and barriers across studies conducted in LMIC and HIC. Recognizing the multifactorial nature of the barriers to hypertension control, particularly in LMIC, is crucial in designing and implementing customized interventions.

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“…The effect of patients’ access to hypertension care on hypertension outcomes was explored in 38% (15/39) of the included studies within seven SSA countries [34, 35, 37, 38, 47, 48, 50–52, 54, 58, 63, 64, 66, 67]. The general trend was that the lower cost of care was significantly associated with better hypertension outcomes.…”

Section: Resultsmentioning

confidence: 99%

“…Nineteen cross-sectional studies were conducted in Ethiopia (n=3) [50][51][52], Nigeria (n=2) [53,54], Botswana (n=1) [55], Democratic Republic of Congo (n=1) [56], Swaziland now called Eswatini (n=2) [57,58], Namibia (1) [59], South Africa (n=3) [60][61][62], Ghana (n=4) [63][64][65][66] , Kenya (n=2) [67,68]. We additionally identified one quality improvement report from Botswana [69].…”

Section: Country and Design Of Included Studiesmentioning

confidence: 99%

Health System Determinants of Hypertension Care and Outcomes in Sub-Saharan Africa: A Systematic Review

Byiringiro

Ogungbe

Commodore‐Mensah

et al. 2022

Preprint

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BackgroundHypertension is a significant global health problem, particularly in Sub-Saharan Africa (SSA). Despite the effectiveness of medications and lifestyle interventions in reducing blood pressure, shortfalls across health systems continue to impede progress in achieving optimal hypertension control rates. The current review explores health system factors contributing to hypertension outcomes in SSA.MethodsThe World Health Organization health systems framework guided the literature search and discussion of findings. We searched PubMed, CINAHL, and Embase databases for studies published between January 2010 and June 2022 and followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We assessed studies for risk of bias using the tools from Joanna Briggs Institute.ResultsThirty-nine studies clustered in 10 SSA countries met inclusion criteria. Health system determinants included human resource factors such as providers’ knowledge and adherence to hypertension treatment guidelines (n=21) and task sharing and shifting strategies (n=10). The second health system factors explored in service delivery were the health facility type and capacity (n=7) and hypertension service accessibility by cost, place, and time of services (n=15). A quarter of the included studies explored supply chain management for access to essential equipment and medicines. An additional set of studies addressed quality improvement strategies involving cross-integration of services (n=7) and various strategies of gauging the systems for better hypertension outcomes (n=8).ConclusionA combination of multiple rather than solo system interventions may yield significant improvements in blood pressure outcomes. Health information management and leadership involvement were less explored. Additional research on health system determinants of hypertension is needed to drive global improvements in hypertension outcomes. Future research would benefit from more rigorous implementation type interventional studies comprehensively assessing health system factors that contribute to better hypertension outcomes.

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Anti-hypertensive medication access and affordability and their association with blood pressure control at a teaching hospital in Ghana

Cited by 9 publications

References 26 publications

Access to cardiovascular medicines in low- and middle-income countries: a mini review

Access to cardiovascular medicines in low- and middle-income countries: a mini review

Disparities in Prevalence and Barriers to Hypertension Control: A Systematic Review

Health System Determinants of Hypertension Care and Outcomes in Sub-Saharan Africa: A Systematic Review

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