Factors Associated with Adherence to Anti-Hypertensive Medication Among Patients Attending a Primary Health Centre in Ndola, Zambia: A Cross-Sectional Study
Sikantongwe, N., Musonda, E., Mabaso, F., Chibwaya, E., Sikantongwe, E., Mapiki, C.
cardiovascular medicine
Quick verdict
Zambian cross-sectional study (n=237) finds 41.4% adherence and six predictors; plausible, but scale arithmetic and abstract direction errors weaken trust.
Summary
This cross-sectional study enrolled 237 hypertensive patients attending Railway Surgery Urban Health Centre in Ndola, Zambia (July–September 2025), measuring adherence via an interviewer-administered modified Hill-Bone Compliance Scale (Cronbach's alpha 0.78) and analysing socio-demographic, clinical, and health-system correlates with chi-square tests and backward-stepwise multivariable logistic regression. Only 41.4% of patients were classified as adherent (score ≤16); the mean score was 19.8 (SD 4.6). Younger age, lower education, and lower income were associated with poorer adherence, as were comorbidities (AOR 0.51), side effects (AOR 0.36), and taking three or more pills daily (AOR 0.34); older age (AOR 2.89–3.24), secondary/tertiary education (AOR 2.84–3.56), and monthly income ≥K1,000 (AOR up to 5.89) predicted better adherence. Reported barriers included medication stock-outs (38.4%), transport-related missed appointments (35.4%), and counselling under five minutes (49.8%). The authors conclude that non-adherence is largely unintentional and recommend supply-chain strengthening, counselling improvements, and regimen simplification. Limitations include reliance on self-reported adherence without clinical verification, a single urban centre, an internal inconsistency between the stated nine scale items and the reported 8–32 score range, a sample-size calculation based on hypertension prevalence rather than expected adherence, and purely descriptive treatment of health-system factors.
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Assessment at a glance
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4 strengths · 5 weaknesses · 0 author questions
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Key claims under review
- Only 41.4% of hypertensive patients at Railway Surgery Urban Health Centre were adherent to antihypertensive medication (Hill-Bone score ≤16).
- Age ≥51 years, secondary/tertiary education, and monthly income ≥K1,000 independently increase the odds of adherence, while comorbidities, side effects, and regimens of three or more pills daily decrease them.
- Most non-adherence is unintentional, driven by running out of pills, being away from home, and forgetting rather than deliberate decisions to stop.
- Health-system barriers — medication stock-outs (38.4%), transport-related missed appointments (35.4%), and inadequate counselling time (49.8% under five minutes) — compound individual-level non-adherence.
Strengths
Validated local instrument with documented reliability
Modified Hill-Bone scale adapted from Mweene et al. (2010) with reported Cronbach's alpha 0.78, forward-backward Bemba translation by independent bilingual translators, and a 15-patient pretest (Methods, Validity and Reliability).
Unusually complete regression reporting
Table 6 gives both crude and adjusted odds ratios with 95% CIs for all six predictors; diagnostics include EPV 16.3, VIF<2, Hosmer–Lemeshow p=0.393, Nagelkerke R²=0.28, and AUC 0.76.
High response rate with transparent recruitment
Multi-level framing of adherence barriers
Weaknesses
Internal inconsistency in the outcome instrument
Abstract inverts the direction of three adjusted odds ratios
Sample size computed from the wrong parameter
Health-system factors never linked to adherence
The 'mostly unintentional' claim rests on one item
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Scope & Claims
This is a non-certified medRxiv preprint (posted 2026-09-17) of a facility-based cross-sectional survey at Railway Surgery Urban Health Centre, Ndola, Zambia (data collected July–September 2025; n=237). The primary claim: adherence to antihypertensive medication is 41.4% (Hill-Bone ≤16), with six independent associates — age 51+ (AOR 2.89–3.24), secondary/tertiary education (AOR 2.84–3.56), income ≥K1,000 (AOR 2.21–5.89), comorbidities (AOR 0.51), side effects (AOR 0.36), and 3+ pills/day (AOR 0.34). A secondary claim is that most non-adherence is unintentional. Health-system barriers (stock-outs 38.4%, transport-related missed appointments 35.4%, counselling <5 minutes in 49.8%) are framed as compounding factors, though explicitly 'not a specific objective.'
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Frequently asked questions
What percentage of hypertensive patients in this Zambia study were adherent to medication?
41.4% (98 of 237) were classified as adherent on the modified Hill-Bone scale (score ≤16); 58.6% were non-adherent. The mean adherence score was 19.8 (SD 4.6).
Which factors predicted poor adherence to antihypertensive medication?
After multivariable adjustment, having comorbidities (AOR 0.51), experiencing medication side effects (AOR 0.36), and taking three or more pills daily (AOR 0.34) reduced the odds of adherence; younger age, lower education, and lower income were also associated with poorer adherence.
What questionnaire was used to measure adherence?
A modified nine-item Hill-Bone Compliance Scale, interviewer-administered and translated into Bemba (Cronbach's alpha 0.78). Items are scored 1–4, with adherent defined as a total score ≤16.
Is this medRxiv preprint peer reviewed?
No. It was posted on medRxiv in September 2026 without peer-review certification, and the preprint itself states it should not be used to guide clinical practice.
About this review
This is an AI-generated preliminary review by Evolve.Pub, produced from the openly available text of the paper. It is not peer review and does not represent the authors' views. The canonical record of the paper is at the publisher link above.
- Chart-axis artifacts are interleaved with Tables 4–6 in the extracted text; embedded figures could not be evaluated.
- The abstract is truncated mid-sentence ('Interventions should focus on .'); wording may extend beyond what was extractable.
- The reference list contains dangling fragments (e.g., '-11-14', '-15') suggesting typesetting or extraction corruption; citation hygiene could not be fully audited.
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