Determinants Of Non-Adherence to Antihypertensive Medications Among Hypertensive Patients at the Kade Government Hospital in the Eastern Region of Ghana; A Facility-Based Study

Abstract

Background: Non-adherence to antihypertensive medications is a leading driver of uncontrolled hypertension and its associated cardiovascular complications, particularly in sub-Saharan Africa. In Ghana, facility-level data on non-adherence and its determinants remain scarce, especially from district hospitals in the Eastern Region. This study was conducted to address this evidence gap at Kade Government Hospital in the Kwaebibirem Municipality. Objectives: This study aimed to determine the prevalence of non-adherence to antihypertensive medications and to identify the sociodemographic and patient-related determinants of nonadherence among hypertensive patients attending Kade Government Hospital in the Eastern Region of Ghana. Methods: A facility-based cross-sectional study was conducted among 220 hypertensive patients attending the hypertension and diabetes clinic at Kade Government Hospital over a five-week period. Participants were selected using systematic random sampling. Data were collected through structured interviewer-administered questionnaires via Kobo Collect and analyzed using STATA version 18. Non-adherence to antihypertensive medication was measured using the validated 8- item Morisky Medication Adherence Scale (MMAS-8), with scores below 7 classified as nonadherent. Descriptive statistics and both univariate and multivariable logistic regression analyses were performed to identify determinants of non-adherence. Results: The prevalence of non-adherence to antihypertensive medications was 93.6%, with only 6.4% (95% CI: 3.1%–9.6%) of respondents classified as adherent. The majority of respondents were male (81.8%) and aged 46–65 years (69.1%). In the crude logistic regression analysis, respondents with tertiary education had significantly higher odds of non-adherence compared with those with JHS/Middle School education (cOR = 15.14; 95% CI: 1.56–147.21; p = 0.019). Additionally, farmers (cOR = 0.12; 95% CI: 0.02–0.62; p = 0.012), artisans (cOR = 0.11; 95% CI: 0.02–0.53; p = 0.006), and business owners/traders (cOR = 0.12; 95% CI: 0.02–0.64; p = 0.013) had significantly lower odds of non-adherence compared with retired respondents. However, none of these associations remained statistically significant in the multivariable adjusted analysis. Conclusion: Non-adherence to antihypertensive medications is extremely prevalent at Kade Government Hospital, affecting nearly all (93.6%) patients in the study. Although no independent determinants were confirmed in the multivariable adjusted analysis, crude findings suggest that tertiary educational level was associated with higher odds of non-adherence, while informal occupational groups showed lower odds relative to retired respondents. Urgent, multifaceted interventions targeting health literacy, occupational barriers, community engagement, and improved medication access are needed to reduce the burden of non-adherence and improve hypertension control outcomes in the Kwaebibirem Municipality.