Assessing Adherence to Antihypertensive Therapy in Primary Health Care in Namibia: Findings and Implications

Nashilongo, M. M.; Singu, B.; Kalemeera, F.; Mubita, M.; Naikaku, E.; Baker, A.; Ferrario, A.; Godman, B.; Achieng, L.; Kibuule, D.

doi:10.1007/s10557-017-6756-8

Cited by 87Medication Adherence and ComplianceBlood Pressure and Hypertension StudiesPharmacy and Medical Practices

Assessing Adherence to Antihypertensive Therapy in Primary Health Care in Namibia: Findings and Implications

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Nashilongo, M. M., Singu, B., Kalemeera, F., Mubita, M., Naikaku, E., Baker, A., Ferrario, A., Godman, B. +2 more·2017·Cardiovascular Drugs and Therapy

DOI 10.1007/s10557-017-6756-8PMC PMC5730630

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Abstract

INTRODUCTION: Namibia has the highest burden and incidence of hypertension in sub-Sahara Africa. Though non-adherence to antihypertensive therapy is an important cardiovascular risk factor, little is known about potential ways to improve adherence in Namibia following universal access. The objective of this study is to validate the Hill-Bone compliance scale and determine the level and predictors of adherence to antihypertensive treatment in primary health care settings in sub-urban townships of Windhoek, Namibia. METHODS: Reliability was determined by Cronbach's alpha. Principal component analysis (PCA) was used to assess construct validity. RESULTS: The PCA was consistent with the three constructs for 12 items, explaining 24.1, 16.7 and 10.8% of the variance. Cronbach's alpha was 0.695. None of the 120 patients had perfect adherence to antihypertensive therapy, and less than half had acceptable levels of adherence (≥ 80%). The mean adherence level was 76.7 ± 8.1%. Three quarters of patients ever missed their scheduled clinic appointment. Having a family support system (OR = 5.4, 95% CI 1.687-27.6, p = 0.045) and attendance of follow-up visits (OR = 3.1, 95% CI 1.1-8.7, p = 0.03) were significant predictors of adherence. Having HIV/AIDs did not lower adherence. CONCLUSIONS: The modified Namibian version of the Hill-Bone scale is reliable and valid for assessing adherence to antihypertensives in Namibia. There is sub-optimal adherence to antihypertensive therapy among primary health cares in Namibia. This needs standardized systems to strengthen adherence monitoring as well as investigation of other factors including transport to take full advantage of universal access.

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Patient adherence to hypertension treatment in other sub-Saharan African countries has been assessed through surveys, with adherence levels ranging from 17% in Kampala, Uganda to 61.8% in Ethiopia.
“These surveys have found levels of adherence ranging from 17% in a survey of 112 hypertensive patients in two city hospitals in Kampala, Uganda, to 61.8% of patients compliant with antihypertensive medications at Jimma University Specialised Hospital in Ethiopia.9,10”
From The outpatient management of hypertension at two Sierra Leonean health centres: A mixed-method investigation of follow-up compliance and patient-reported barriers to care (2020) · cites this paper as [11]
The Discussion compares adherence findings in Namibia with studies in other African countries, so the source supports the general point that adherence has been assessed elsewhere. It does not report the claimed 17% result from Kampala or 61.8% result from Jimma; searches for those figures and locations found no matching passage. Page numbers were not available in our copy. (LLM, conf=0.78)
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Better compliance to antihypertensive medications reduces cardiovascular risk
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“assessed the levels and predictors of adherence to antihypertensive medication, and validated a modified version of the Hill-Bone scale for compliance [9].”
Method
An Assesment of Adherence Treatment and Determinants among Hypertensive Patients Attending Primary Health Care in Medan City
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“Namibian primary healthcare facilities are strategically located among underprivileged communities and have a critical role in providing hypertensive Namibians with access to care (Nashilongo et al. 2017).”
Determining Health Beliefs Regarding Medication Use and Treatment Adherence Among Patients with Hypertension: A Descritive Study
Şahi̇n, A., Di̇rgar, E., & Çicihan, D. (2025) · Global Nursing Insights · doi:10.31125/globnursinsights.1687643
Adherencia al tratamiento de hipertensión arterial en pacientes mayores de 40 años en la Unidad de Atención Primaria de la comunidad El Llano, Baní, provincia Peravia durante el periodo febrero - marzo 2024
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Arabic translation and cultural adaptation of Hill-Bone compliance to high blood pressure therapy scale
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“…differences, the scale was determined to be suitable for our population in this study (Dennison, Peer et al., 2007, Karademir, Koseoglu et al., 2009, Koschack, Marx et al., 2010, Song, Han et al., 2011, Alsolami, Hou et al., 2013, Cheong, Tong et al., 2015, Nashilongo, Singu et al., 2017).”
Method
Evaluation of Medication Adherence and Associated Factors in Hypertensive Patients in Bangalore, India; A Cross-Sectional Study
Chaudhary, A. P., George, J., Kadowade, K., Faiyza, L., Anjum, R., M, U., & N, S. (2021) · International Journal of Pharmaceutical Investigation · doi:10.5530/ijpi.2021.4.76
Adherence of patients to antihypertensive drugs in the ambulance of family physician at Primary Health Care Centre Cetinje
Popović, M. (2023) · Medicinski glasnik Specijalne bolnice za bolesti štitaste žlezde i bolesti metabolizma · doi:10.5937/mgiszm2390007p
Treatment Adherence and its Association with Demographic Characteristics and Clinical Factors Among Patients with Hypertension: A Cross-Sectional, Descriptive-Correlational Study
Vafaei, A., Ghorbani, R., Zarvani, P., & Nobahar, M. (2026) · Vascular Health and Risk Management · doi:10.2147/vhrm.s646427

Authors: Nashilongo, M. M., Singu, B., Kalemeera, F., Mubita, M., Naikaku, E., Baker, A., Ferrario, A., Godman, B., Achieng, L., & Kibuule, D.
Affiliations: University of Namibia (NA)
London School of Economics and Political Science (GB)
Karolinska University Hospital (SE)
University of Nairobi (KE)
Corresponding author: Godman, B.
ORCID: Singu, B.
Kalemeera, F.
Mubita, M.
Ferrario, A.
Godman, B.
Kibuule, D.
Venue: Cardiovascular Drugs and Therapy
Publisher: Springer Science and Business Media LLC
Published: 2017-10-14
Volume: 31
Issue: 5-6
Pages: 565-578
ISSN: 0920-3206 (ISSN-L)
1573-7241
DOI: 10.1007/s10557-017-6756-8
PMC: PMC5730630
OpenAlex: W2743658562
Cited by: 87
References: 46
Citations by year: 2026: 2 · 2025: 7 · 2024: 5 · 2023: 10 · 2022: 8 · 2021: 16 · 2020: 19 · 2019: 13 · 2018: 5 · 2017: 2
FWCI: 11.10
Type: journal article
Language: en
Open access: hybrid
doi.org
Licence: cc-by
creativecommons.org/licenses/by/4.0 (unspecified)
Locations: Cardiovascular Drugs and Therapy (publishedVersion, cc-by)
PubMed Central (publishedVersion, cc-by)
PubMed (publishedVersion)
London School of Economics and Political Science Research Online (London School of Economics and Political Science) (acceptedVersion)
London School of Economics and Political Science Research Online (London School of Economics and Political Science) (submittedVersion, cc-by)
Strathprints: The University of Strathclyde institutional repository (University of Strathclyde) (submittedVersion, cc-by)
Greater South Information System
Funders: Karolinska Institute
Topics: Health Sciences › Medicine › Family Practice › Medication Adherence and Compliance
Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Blood Pressure and Hypertension Studies
Life Sciences › Pharmacology, Toxicology and Pharmaceutics › Pharmacology › Pharmacy and Medical Practices
Keywords: antihypertensive medication adherence, hypertension, scale validation, predictors of adherence, family support, follow-up visits, missed appointments, HIV/AIDS, universal health coverage, primary care
MeSH terms: Assessment of Medication Adherence, Antihypertensive Agents, Cross-Sectional Studies, Humans, Hypertension, Namibia, Primary Health Care, Drug Monitoring, Principal Component Analysis, Medication Adherence

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Assessing Adherence to Antihypertensive Therapy in Primary Health Care in Namibia: Findings and Implications

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