Adherence to Antihypertensive Medication and Its Associated Factors Among Patients with Hypertension Attending a Tertiary Hospital in Mogadishu, Somalia: A Cross-Sectional Study.

内容摘要

Hypertension is the leading modifiable risk factor for cardiovascular disease and premature mortality worldwide. In Somalia, the national hypertension control rate is estimated at only 10%, yet antihypertensive medication adherence remains unstudied. This study determined the prevalence of medication adherence and its independent predictors among hypertensive outpatients in Mogadishu. A hospital-based cross-sectional study was conducted between January and April 2024 at Mogadishu Somali-Turkey Training and Research Hospital. In total, 373 adult hypertensive patients on antihypertensive treatment for at least six months were recruited by simple random sampling. Adherence was assessed using the validated 8-item Morisky Medication Adherence Scale (MMAS-8), a self-reported instrument; scores of 6-8 were classified as high or moderate adherence (adherent) and scores below 6 as low adherence (non-adherent). Multivariable binary logistic regression was used to identify independent predictors (p < 0.05). Of 373 participants (54.2% male; 45.8% aged &#x2265;65 years), 63.5% demonstrated high or moderate adherence and 36.5% exhibited low adherence. Multivariable logistic regression identified four independent predictors of adherence. T2DM (AOR = 0.458; 95% CI: 0.279-0.752; p = 0.002) and high-salt diet consumption (AOR = 0.460; 95% CI: 0.271-0.780; p = 0.004) were independently associated with lower odds of adherence. Ischemic heart disease (IHD) was associated with 2.15 times higher odds of adherence (AOR = 2.151; 95% CI: 1.214-3.811; p = 0.009). Divorced marital status was also associated with higher odds of adherence compared with married status (AOR = 3.077; 95% CI: 1.211-7.817; p = 0.018). More than one-third of patients exhibited low adherence. T2DM and IHD showed opposing associations with adherence, reflecting the contrasting motivational dynamics of these comorbidities. High-salt dietary intake and divorced marital status were additional independent predictors. These findings, interpreted within the context of the observational design and self-reported measurement, underscore the need for patient-centred, integrated interventions addressing comorbidity burden and dietary behaviour to improve antihypertensive adherence in Somalia. Future prospective research using objective adherence measures is recommended.