Magnitude and associated factors of poor medication adherence among diabetic and hypertensive patients visiting public health facilities in Ethiopia during the COVID-19 pandemic

Rodas Asrat Kassu,Gelila Bogale,Mebratu Abraha,Melsew Getnet,Hans-Peter Brunner-La Rocca,Zewdneh Shewamene,Mahteme Bekele,Tariku Shimels,Abrham Getachew

doi:10.1371/journal.pone.0249222

Rodas Asrat Kassu, Gelila Bogale + Show 7 more

Open Access

https://doi.org/10.1371/journal.pone.0249222

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Abstract

This study aims to assess the magnitude and associated factors of poor medication adherence among diabetic and hypertensive patients visiting public health facilities in Addis Ababa, Ethiopia during the COVID-19 pandemic. A multi-site cross-sectional design was conducted from 1st through 30th of August 2020 at public health facilities of the study area. Adult outpatients with T2DM and hypertension visiting hospitals and health centers were included in the study. A proportion to size allocation method was used to determine the required sample size per facility. Data was collected using the 8-item Morisky medication adherence scale. Descriptive statistics and binary logistic regression were used to analyze data. A 95% confidence interval and p≤0.05 statistical significance was considered to determine factors associated with poor medication adherence. A total of 409 patients were included in the present study. About 57% of the patients reported that the COVID-19 pandemic has posed negative impacts on either of their follow-up visits, availability of medications, or affordability of prices. And, 21% have reported that they have been affected in all aspects. The overall magnitude of poor medication adherence was 72%. Patients with extreme poverty were more likely to have good medication adherence (AOR: 0.59; 95%C.I: 0.36-0.97), whereas attendance to a health center (AOR: 1.71; 95%C.I: 1.02-2.85), presence of comorbidity (AOR: 2.05; 95%C.I: 1.13-3.71), and current substance use history (AOR: 11.57; 95%C.I: 1.52-88.05) predicted high odds of poor adherence. Over a three-fourth of the patients, in the study setting, have poor adherence to their anti-diabetic and antihypertensive medications. Health facility type, income level, comorbidity, and current substance use history showed a statistically significant association with poor adherence to medication. Stakeholders should set alternative strategies as perceived impacts of the COVID-19 pandemic on medication adherence are high in the study area.

Highlights

Adherence to anti-diabetic and antihypertensive medications is an area of interest with marked implications to affect patient management outcomes
Stakeholders should set alternative strategies as perceived impacts of the COVID-19 pandemic on medication adherence are high in the study area
There exist a total of 12 public hospitals [21] of which six are managed under the federal ministry of health (FMOH) whilst the rest five hospitals and 103 health centers are administered under the Addis Ababa health bureau (AAHB) [22]

Summary

Introduction

Adherence to anti-diabetic and antihypertensive medications is an area of interest with marked implications to affect patient management outcomes. The World Health Organization (WHO) defined adherence in 2001 as the extent to which a patient follows medical instructions [1] Whereas this concept accounts for a broader aspect in the medical practice, its correlation with the management and control of chronic illnesses as diabetes and hypertension is well documented. This is likely because, adherence in this group encompasses multiple dimensions, such as lifestyle changes, medications, patient attitudes, and provider-patient relationships among others [2, 3] with potential interaction in the longer or lifetime frames. Reports of adherence to antihypertensive medications from China (65.1%), Gambia (27%), and Seychelles (26%) showed the magnitude and relevance of the problem [8,9,10]

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