FACTORS FOR NON-ADHERENCE TO ANTIHYPERTENSIVE DRUGS AMONG FEDERAL CIVIL SERVANTS ATTENDING FEDERAL STAFF HOSPITALS AND CLINICS, ABUJA, NIGERIA


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TABLE OF CONTENTS

OPERATIONAL DEFINITIONS
SUMMARY

CHAPTER ONE - INTRODUCTION

CHAPTER TWO - LITERATURE REVIEW
2.1       Socio-Demographic Factors Affecting Non-Adherence to Antihypertensive Drugs
2.2       Knowledge about Hypertension and its Treatment
2.3       Drug Related Factors Affecting Non-Adherence to Antihypertensive Drugs
2.4       Healthcare Service Delivery Factors Affecting Non-Adherence to Antihypertensive Drugs

CHAPTER THREE - METHODOLOGY
3.1       Study Area
3.2       Study Design
3.3       Study Population
3.3.1    Inclusion Criteria
3.3.2    Exclusion Criteria
3.4       Sample Size Determination
3.5       Sampling Technique
3.6       Study Instruments
3.7       Data Collection Methods
3.8       Data Management
3.8.1 Measurement of variables
3.8.2 Data analysis
3.9       Ethical Considerations
3.10     Limitations

CHAPTER FOUR - RESULTS

CHAPTER FIVE - DISCUSSION

CHAPTER SIX - CONCLUSIONS AND RECOMMENDATIONS
REFERENCES



SUMMARY

Non-adherence to antihypertensive drugs is the most important cause of uncontrolled blood pressure. Uncontrolled blood pressure leads to the development of complications of hypertension. Hospital records at Federal Staff Hospitals (FSH) and Clinics, Abuja showed that hypertensive patients seen have been increasing on a yearly basis from January 2011 to June 2013. This study was conducted in order to identify factors associated with non-adherence to antihypertensive drugs among Federal Civil Servants in order to provide improved management plans suited for them.

Four hundred and twenty four hypertensive patients at two Federal Staff Hospitals and two Federal Staff Clinics in Abuja participated. A descriptive cross sectional study was carried out from August 2013 to June 2014. Participants 18 years and above, who had been on antihypertensive drugs in at least the previous one month and must have been Federal Civil Servants were included in the study. Patients were selected by systematic sampling.

Ethical clearance was obtained from the National Health Research Ethics Committee, Federal Ministry of Health Abuja.

The Morisky Green test for non-adherence was used to assess non-adherence to drugs. Information was collected regarding socio-demographic, drug related and healthcare service delivery factors to patient non-adherence using an interviewer administered questionnaire. Univariate, bivariate and multivariate analysis was conducted using Epi info soft ware.

The level of non-adherence was 69.1%. Factors that were independently associated with non-adherence were; being a Junior Civil Servant (OR 2.9: 95% CI 1.1-7.7), exhaustion of drugs before the next clinic appointment (OR 5.9: 95% CI 2.8-12.5), buying drugs in private pharmacies and open market (OR 1.9: 95%CI 1.03-3.3) and total time spent counselling less than five minutes (OR 1.8: 95%CI 1.02-3.2).


Ensuring patients come back to the hospital to refill their drugs, improving counselling techniques and making prescribed antihypertensive drugs constantly available in the hospital, could improve the level of non-adherence to antihypertensive drugs among patients attending Federal Staff Hospitals and Clinics.





CHAPTER ONE – INTRODUCTION

1.1         Background

Hypertension affects approximately one billion people worldwide (4.5% of the current global burden of disease). Three hundred and forty million of these in economically-developed and 340 million in economically-developing countries1 The World Heart Federation reports that in the developed world, about 330 million people have hypertension, and about 640 million in the developing world. Estimates indicate that up to three quarters of the worlds hypertensive population will be in economically developing countries by the year 2025.2,3 A previous study done on the prevalence of hypertension in Nigeria showed the prevalence rate of hypertension to be 22%.4

Hypertension is the leading cause of mortality and the third largest cause of disability, and is poorly controlled worldwide.1 Hypertension is the leading global risk for mortality, responsible for 12.8% (7.5 million) of total deaths worldwide.5

Hypertension is defined as a sustained diastolic pressure greater than 90 mmHg accompanied by an elevated systolic pressure greater than 140 mmHg.6 There are two types of hypertension, primary or essential hypertension and secondary hypertension. In primary hypertension, there is no known cause for the high blood pressure and it manifests gradually over time. In secondary hypertension however, the high blood pressure is caused by an underlying condition. It starts suddenly and can cause higher blood pressure than primary or essential hypertension. Some diseases that can cause high blood pressure include kidney diseases and adrenal gland tumours. Drugs that cause high blood pressure include birth control pills, cocaine and amphetamines.7

There are many drugs that are used to treat hypertension. These include alpha blockers, angiotensin converting enzyme inhibitors, angiotensin receptor blockers, beta blockers....

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