Medication non-adherence and its associated factors among heart failure patients in Africa: A systematic review and meta-analysis

@article{abebe2026medication,
  title = {{Medication non-adherence and its associated factors among heart failure patients in Africa: A systematic review and meta-analysis}},
  author = {Tesfaye Birhanu Abebe and Teklestadik Teklesillasie Alemayehu and Tadele Mesfin Demelash and Hailemaryam Yohannes Asefa and Zena Admasu Yferu and Leul Wondemu Sebsebe and Redeat Dereje Tilahun and Wasihun Nigdu Mengestu and Melake Getahun Fikru and Nardos Teshome Gurmu and Abera Girma Beyena and Gebremariam Wulie Geremew and Yohana Moges Mehari and Temesgen Getachew Shiferaw and Hana Girma Abera and Diro Ajema Cheka and Bezawit Dereje Tilahun and Yilkal Abebaw Wassie},
  journal = {Global health research and policy},
  year = {2026},
  month = jun,
  doi = {10.1016/j.ghrp.2026.06.007},
  url = {https://europepmc.org/article/PMC/PMC13722073},
  note = {CC BY},
}

TY  - JOUR
TI  - Medication non-adherence and its associated factors among heart failure patients in Africa: A systematic review and meta-analysis
AU  - Tesfaye Birhanu Abebe
AU  - Teklestadik Teklesillasie Alemayehu
AU  - Tadele Mesfin Demelash
AU  - Hailemaryam Yohannes Asefa
AU  - Zena Admasu Yferu
AU  - Leul Wondemu Sebsebe
AU  - Redeat Dereje Tilahun
AU  - Wasihun Nigdu Mengestu
AU  - Melake Getahun Fikru
AU  - Nardos Teshome Gurmu
AU  - Abera Girma Beyena
AU  - Gebremariam Wulie Geremew
AU  - Yohana Moges Mehari
AU  - Temesgen Getachew Shiferaw
AU  - Hana Girma Abera
AU  - Diro Ajema Cheka
AU  - Bezawit Dereje Tilahun
AU  - Yilkal Abebaw Wassie
PY  - 2026
DA  - 2026/06/26
JO  - Global health research and policy
DO  - 10.1016/j.ghrp.2026.06.007
UR  - https://europepmc.org/article/PMC/PMC13722073
AB  - 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.  Methods: 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.  Results: 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).  Conclusions: 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.
SN  - 2397-0642
ER  -