{ "abstract": "Background: Medication non-adherence is a critical determinant of poor outcomes in heart failure, a condition posing a significant public health burden across Africa. Unique regional challenges such as healthcare resource constraints, economic disparities, and diverse healthcare systems exacerbate this issue. However, a consolidated estimate of non-adherence prevalence and its associated factors across the continent remains unknown.\n\nMethods: This systematic review and meta-analysis followed PRISMA guidelines (PROSPERO: CRD420251139486). A comprehensive search of databases (PubMed/MEDLINE, African Journal Online, and Google Scholar) was conducted for studies published between 2000 and 2025. Observational studies reporting non-adherence prevalence or associated factors among African heart failure patients were included. Study quality was assessed using the Joanna Briggs Institute (JBI) critical appraisal checklists for cross-sectional and cohort studies. Data were extracted and pooled using a random-effects model in STATA 17.\n\nResults: Seventeen studies (n = 6276 patients) from multiple African regions were included. The pooled prevalence of medication non-adherence among heart failure patients in Africa was 41.88% (95% CI: 25.43–58.34). Extreme heterogeneity (I² = 99.7%) was explored via subgroup analyses, revealing significant regional variation with Western Africa showing the highest prevalence (77.59%). Meta-analysis of associated factors identified lack of health insurance as the strongest predictor (OR = 4.27, 95% CI: 1.62–11.26). Other significant factors included polypharmacy (OR = 2.58, 95% CI: 2.00–3.33) and presence of comorbidities (OR = 1.76, 95% CI: 1.31–2.35). No publication bias was detected (Egger's test: p = 0.267).\n\nConclusions: Approximately two in five heart failure patients in Africa are non-adherent to their medication, with prevalence rates varying significantly by region. This rate is exacerbated by financial, clinical, and therapy-related factors. Concerted multi-faceted interventions are urgently needed across the continent. Recommendations include expanding health insurance coverage, implementing medication subsidy programs, strengthening therapy simplification strategies, and developing context-specific adherence support strategies tailored to regional healthcare contexts and patient populations.", "abstract_shown": true, "affiliations": [ "School of Medicine, Collage of Health Science, Salale University, Fitche, Ethiopia", "School of Pharmacy, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia", "School of Medicine, Asrat Woldeyes Health Science Campus, Debre Berhan University, Debre Berhan, Ethiopia", "School of Medicine, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia", "School of medicine, Asella Referral and Teaching Hospital, Arsi University, Arsi, Ethiopia", "School of medicine, College of Health Science, Mekelle University, Mekelle, Ethiopia", "Department of Internal Medicine, St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia", "Department of Medical Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia" ], "article_type": "research article", "arxiv": null, "author_total": 18, "authors": [ { "affs": [ 0 ], "name": "Tesfaye Birhanu Abebe" }, { "affs": [ 1 ], "name": "Teklestadik Teklesillasie Alemayehu" }, { "affs": [ 2 ], "name": "Tadele Mesfin Demelash" }, { "affs": [ 3 ], "name": "Hailemaryam Yohannes Asefa" }, { "affs": [ 2 ], "name": "Zena Admasu Yferu" }, { "affs": [ 3 ], "name": "Leul Wondemu Sebsebe" }, { "affs": [ 3 ], "name": "Redeat Dereje Tilahun" }, { "affs": [ 3 ], "name": "Wasihun Nigdu Mengestu" }, { "affs": [ 3 ], "name": "Melake Getahun Fikru" }, { "affs": [ 3 ], "name": "Nardos Teshome Gurmu" }, { "affs": [ 4 ], "name": "Abera Girma Beyena" }, { "affs": [ 1 ], "name": "Gebremariam Wulie Geremew" }, { "affs": [ 5 ], "name": "Yohana Moges Mehari" }, { "affs": [ 3 ], "name": "Temesgen Getachew Shiferaw" }, { "affs": [ 3 ], "name": "Hana Girma Abera" }, { "affs": [ 6 ], "name": "Diro Ajema Cheka" }, { "affs": [ 3 ], "name": "Bezawit Dereje Tilahun" }, { "affs": [ 7 ], "name": "Yilkal Abebaw Wassie" } ], "bibtex": "https://research.draconitic.com/paper/apc0p8qer9yrn.bib", "cited_by": 0, "doi": "10.1016/j.ghrp.2026.06.007", "fulltext_url": "https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13722073/?tool=EBI", "id": "apc0p8qer9yrn", "issns": [ "2397-0642" ], "landing_url": "https://europepmc.org/article/PMC/PMC13722073", "language": "eng", "licence": "CC-BY", "licence_label": "CC BY", "licence_source": "article", "licence_url": "https://creativecommons.org/licenses/by/4.0/", "metadata_licence": null, "native_subjects": [ [ "heading", "Research Article" ], [ "openalex", "2714|Medication Adherence and Compliance" ] ], "openalex": "W7166059206", "pdf_url": "https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13722073/pdf/?tool=EBI", "pmcid": "PMC13722073", "pmid": "42964796", "published": "2026-06-26", "publisher": "Wuhan University", "ris": "https://research.draconitic.com/paper/apc0p8qer9yrn.ris", "sources": [ { "first_seen": "2026-10-31T12:21:46Z", "native_id": "PMC:PMC13722073", "source": "europepmc", "url": "https://europepmc.org/article/PMC/PMC13722073" }, { "first_seen": "2026-11-03T12:22:39Z", "native_id": "PMC13722073", "source": "pmc", "url": "https://doi.org/10.1016/j.ghrp.2026.06.007" } ], "subjects": [ { "field": "medicine", "origin": "openalex:2714|Medication Adherence and Compliance", "subfield": "general" } ], "title": "Medication non-adherence and its associated factors among heart failure patients in Africa: A systematic review and meta-analysis", "title_text": "Medication non-adherence and its associated factors among heart failure patients in Africa: A systematic review and meta-analysis", "type": "peer-reviewed", "updated_at": "2026-11-03T12:22:39Z", "url": "https://research.draconitic.com/paper/apc0p8qer9yrn", "venue": "Global health research and policy", "versions": [] }