Family support and medication adherence among residents with hypertension in informal settlements of Nairobi, Kenya: a mixed-method study

Xiong, Shangzhi; Peoples, Nicholas; Østbye, Truls; Olsen, Michael Hecht; Zhong, Xuefeng; Wainaina, Caroline; Fan, Shujun; Wambui, David; Yan, Lijing L.

doi:10.1038/s41371-022-00656-2

Cited by 7 publications

(10 citation statements)

References 46 publications

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“…The high costs of medications for hypertension and T2D are unaffordable to the majority of the patients who have to meet these expenses out of pocket payments. This situation is made worse by the long-term treatment and comorbidities that impose a lifetime financial burden on poor households, strained family support and leads to poor adherence to medication 35. A study in Malawi estimated that a 1 month course of medication for a patient with HTN could cost as much as 18-days’ daily wage 33.…”

Section: Discussionmentioning

confidence: 99%

Perceived health system facilitators and barriers to integrated management of hypertension and type 2 diabetes in Kenya: a qualitative study

Otieno¹,

Agyemang²,

Wainaina³

et al. 2023

BMJ Open

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ObjectiveUnderstanding the facilitators and barriers to managing hypertension and type 2 diabetes (T2D) will inform the design of a contextually appropriate integrated chronic care model in Kenya. We explored the perceived facilitators and barriers to the integrated management of hypertension and T2D in Kenya using the Rainbow Model of Integrated Care.DesignThis was a qualitative study using data from a larger mixed-methods study on the health system response to chronic disease management in Kenya, conducted between July 2019 and February 2020. Data were collected through 44 key informant interviews (KIIs) and eight focus group discussions (FGDs).SettingMultistage sampling procedures were used to select a random sample of 12 study counties in Kenya.ParticipantsThe participants for the KIIs comprised purposively selected healthcare providers, county health managers, policy experts and representatives from non-state organisations. The participants for the FGDs included patients with hypertension and T2D.Outcome measuresPatients’ and providers’ perspectives of the health system facilitators and barriers to the integrated management of hypertension and T2D in Kenya.ResultsThe clinical integration facilitators included patient peer support groups for hypertension and T2D. The major professional integration facilitators included task shifting, continuous medical education and integration of community resource persons. The national referral system, hospital insurance fund and health management information system emerged as the major facilitators for organisational and functional integration. The system integration facilitators included decentralisation of services and multisectoral partnerships. The major barriers comprised vertical healthcare services characterised by service unavailability, unresponsiveness and unaffordability. Others included a shortage of skilled personnel, a lack of interoperable e-health platforms and care integration policy implementation gaps.ConclusionsOur study identified barriers and facilitators that may be harnessed to improve the integrated management of hypertension and T2D. The facilitators should be strengthened, and barriers to care integration redressed.

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Section: Discussionmentioning

confidence: 99%

Perceived health system facilitators and barriers to integrated management of hypertension and type 2 diabetes in Kenya: a qualitative study

Otieno¹,

Agyemang²,

Wainaina³

et al. 2023

BMJ Open

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“…This microsampling approach also eliminates the need of phlebotomy thereby enabling self and/or remote collection of the DBS [23]. In Kenya, to date, the assessment of adherence to antihypertensives has been conducted using questionnaires [24,25], patient self-reports and pill counts [26,27] and clinical marker monitoring [26] and these investigations have revealed adherence to these CVD medications ranges from 67% to 94% [24][25][26][27].…”

Section: Plos Onementioning

confidence: 99%

“…This is the first study conducted in Kenya to gain knowledge about adherence to CVD medications in Kenya using a direct and objective bioanalytical testing method. Previous medication adherence assessment studies in Kenya used indirect methods only [24][25][26][27] thus, there is no previous data about the level of non-adherence found by direct methods to compare with in Kenya. The level of medication adherence reported in this study is not concordant and considerably lower than those reported using the indirect and subjective measures of medication adherence in Kenya previously [24][25][26][27].…”

Section: Plos Onementioning

confidence: 99%

“…Previous medication adherence assessment studies in Kenya used indirect methods only [24][25][26][27] thus, there is no previous data about the level of non-adherence found by direct methods to compare with in Kenya. The level of medication adherence reported in this study is not concordant and considerably lower than those reported using the indirect and subjective measures of medication adherence in Kenya previously [24][25][26][27]. This is likely to be attributed to the fact that indirect measures are subject to overestimation of adherence.…”

Section: Plos Onementioning

confidence: 99%

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Utilizing quantitative dried blood spot analysis to objectively assess adherence to cardiovascular pharmacotherapy among patients at Kenyatta National Hospital, Nairobi, Kenya

Wata

Ogwu²,

Dunford³

et al. 2023

PLoS ONE

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The burden of cardiovascular disease (CVD) is rising in Kenya and non-adherence to cardiovascular pharmacotherapy is a growing global public health issue that leads to treatment failure, an increased risk of cardiac events and poor clinical outcomes. This study assessed adherence to selected cardiovascular therapy medications among CVD patients attending outpatient clinics at Kenyatta National Hospital, Kenya by determining drug concentration(s) in patient dried blood spot (DBS) samples. Patients who had been taking one or more of the five commonly prescribed CVD medications (amlodipine, atenolol, atorvastatin, losartan, and valsartan) for at least six months were enrolled. Each patient completed a short questionnaire about their medication history and then provided a finger-prick blood spot sample from which drug concentrations were determined by liquid chromatography-high resolution mass spectrometry analysis. Two hundred and thirty-nine patients (62.3% female) participated in the study. The median number of medications used by patients was 2 (IQR 75%-25% is 3–1). Less than half (117; 49.0%) of patients were adherent to their prescribed CVD pharmacotherapy. Binary regression analysis revealed a significant correlation between non-adherence and the number of medications in the treatment regimen (Odds Ratio (OR) 1.583; 95%CI: 0.949–2.639; P-value = 0.039) and that gender was not an independent predictor of medication adherence (OR 1.233; 95%CI: 0.730–2.083; P-value = 0.216). Valuable information about adherence to each medication in the patient’s treatment regimen was obtained using quantitative DBS analysis showing that adherence to CVD medications was not uniform. DBS sampling, due its minimally invasive nature, convenience and ease of transport is a useful alternative matrix to monitor adherence to pharmacotherapies objectively, when combined with hyphenated mass spectrometry analytical techniques. This information can provide physicians with an evidence-based novel approach towards personalization and optimization of CVD pharmacotherapy and implementing interventions in the Kenyan population, thereby improving clinical outcomes.

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“…The few studies that have been done indicate that between 43% and 85.4% of hypertensive patients have suboptimal medication adherence. [9][10][11][12] The factors contributing to non-adherence in the Kenyan context have also not been conclusively addressed in the existing studies. Synthesis of research conducted elsewhere indicates that non-adherence to antihypertensive medication is influenced by several determinants, including patient's knowledge about hypertension, affordability of medications and therapy related factors such as complexity of treatment regimens and medication adverse effects, among other factors.…”

Section: Introductionmentioning

confidence: 99%

Prevalence and Correlates of Medication Non-adherence among Hypertensive Patients on Follow-up in Central Kenya

Mutua

Agina

Mwanzo

2023

Int. J. Transl Med Res Public Health

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Background and Objective: Poor adherence to antihypertensive medications is a major barrier to blood pressure control among patients living with hypertension. In Kenya, a significant number of hypertensive patients have uncontrolled blood pressure, but data on medication adherence among this patient population is scarce. This study sought to determine the prevalence and correlates of medication non-adherence among hypertensive patients on follow-up in two referral hospitals in central Kenya. Methods: We undertook a cross-sectional study comprising of 339 hypertensive patients undergoing follow-up care in two referral hospitals located in Nyeri County between October and December 2019. Medication adherence was assessed using a validated medication adherence questionnaire. Medication adherence was a dichotomous variable (adherent vs non-adherent), with the prevalence of non-adherence being measured as a proportion. Independent predictors of medication non-adherence were identified by fitting a multiple logistic regression model, where adjusted odds ratios (AORs) were computed for various covariates and interpreted at a 5% level of significance and 95% confidence interval (CI). Results: The study sample largely comprised of the female gender (65.2%) and elderly people (mean age, 65 years +/- 12). Nearly half (46.6%) of the hypertensive patients interviewed were non-adherent to their medications. The factors associated with non-adherence were: having poor hypertension knowledge (AOR, 5.6, 95% CI, 3.3, 9.4); being on more than one antihypertensive medication (AOR, 2.8, 95% CI, 1.7, 4.7) and being on two or more daily doses of medications (AOR, 2.3, 95% CI, 1.3, 4.1). Conclusion and Implications for Translation: Non-adherence to prescribed medications is highly prevalent among hypertensive patients in central Kenya, and it should therefore be identified as a public health concern. Strategies aimed at optimizing medication adherence among hypertensive patients in this region may consider focusing on educational interventions to increase hypertension knowledge and also on simplification of treatment regimens. Copyright © 2023 Mutua, et al. Published by Global Health and Education Projects, Inc. This is an open-access article distributed under the terms of the Creative Commons Attribution License CC BY 4.0.

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Family support and medication adherence among residents with hypertension in informal settlements of Nairobi, Kenya: a mixed-method study

Cited by 7 publications

References 46 publications

Perceived health system facilitators and barriers to integrated management of hypertension and type 2 diabetes in Kenya: a qualitative study

Perceived health system facilitators and barriers to integrated management of hypertension and type 2 diabetes in Kenya: a qualitative study

Utilizing quantitative dried blood spot analysis to objectively assess adherence to cardiovascular pharmacotherapy among patients at Kenyatta National Hospital, Nairobi, Kenya

Prevalence and Correlates of Medication Non-adherence among Hypertensive Patients on Follow-up in Central Kenya

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