Factors Associated with Adherence to Anti-Hypertensive Medication Among Patients Attending a Primary Health Centre in Ndola, Zambia: A Cross-Sectional Study
This cross-sectional study of 237 hypertensive patients in Ndola, Zambia, reveals a suboptimal medication adherence rate of 41.4% driven by a complex interplay of socio-demographic factors, clinical challenges like side effects and comorbidities, and significant health system barriers including drug stock-outs and transport difficulties.
Original paper licensed under CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). This is an AI-generated explanation of a preprint that has not been peer-reviewed. It is not medical advice. Do not make health decisions based on this content. Read full disclaimer
High blood pressure is often called a "silent killer" because it frequently shows no warning signs until it causes serious damage to the heart, brain, or kidneys. While doctors can prescribe effective medicines to lower this pressure, the treatment only works if patients actually take it. In many parts of the world, especially in sub-Saharan Africa, a significant number of people stop taking their medication or forget to take it as directed, leaving their health at risk. This gap between having a prescription and following it is a major public health challenge, turning a manageable condition into a life-threatening one. Understanding why people struggle to stick to their treatment plans is essential for saving lives, as the reasons are often a complex mix of personal circumstances, the nature of the illness, and the way the healthcare system functions.
Researchers recently set out to uncover these specific reasons in Ndola, Zambia, by listening directly to patients at a local community health center. They focused on a group of 237 adults who had been diagnosed with high blood pressure and were currently taking medication. Instead of just looking at medical records, the team conducted face-to-face interviews, asking patients about their daily lives, their education, their income, and their experiences with the clinic. They used a standard set of questions to measure how well patients were following their doctors' advice, categorizing them as either adherent, meaning they took their medicine as prescribed, or non-adherent. The study took place over three months in 2025, capturing a snapshot of the real-world challenges these patients face every day.
The results revealed a sobering reality: only about 41 percent of the patients were successfully sticking to their medication regimen, while nearly 60 percent were not. The most common reasons for missing doses were not a deliberate choice to stop treatment, but rather practical hurdles. Patients frequently ran out of pills, found themselves away from home without their medication, or simply forgot to take a dose. The study found that the likelihood of taking medicine correctly was strongly tied to a patient's age, education, and income. Older patients, those with higher levels of schooling, and those with a steady monthly income were significantly more likely to be adherent. Conversely, younger adults, those with less formal education, and those with little to no income struggled the most.
Beyond personal circumstances, the physical experience of taking the medicine played a huge role. Patients who suffered from side effects, such as dizziness or frequent urination, were far less likely to continue their treatment. The complexity of the daily routine also mattered; patients who had to swallow three or more pills a day were much less likely to succeed than those taking just one. Furthermore, the healthcare system itself presented barriers. Many patients reported that the clinic was far away, requiring them to rely on public transport, and over a third had missed an appointment simply because they could not afford the fare or find a ride. Nearly 40 percent of patients had experienced a time when the clinic ran out of their specific medication, forcing them to go without. Additionally, nearly half of the patients said they spent less than five minutes talking to a doctor or nurse about their treatment, leaving them with little time to ask questions or understand how to manage their condition.
The study suggests that solving this problem requires more than just telling patients to take their pills. It points to a need for a multi-layered approach that addresses the specific hurdles identified. This includes ensuring that clinics never run out of stock, helping patients manage side effects so they do not feel forced to stop, and simplifying medication routines so they are easier to follow. It also calls for better communication between doctors and patients, giving people enough time to understand their treatment, and finding ways to support those who cannot afford the cost of transport or medicine. By tackling these practical and systemic issues, health workers can help turn the tide against uncontrolled high blood pressure, ensuring that the medicine available actually reaches the people who need it most.
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