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CARDIOVASCULAR JOURNAL OF AFRICA • Volume 28, No 6, November/December 2017



Medication adherence among cardiac patients in

Khartoum State, Sudan: a cross-sectional study

Abdelmoneim Awad, Nahid Osman, Siham Altayib



Non-adherence to medication among cardiac

patients is often the major risk factor for poor clinical outcomes,

increased mortality rates and higher healthcare costs. The litera-

ture evaluating the prevalence of and reasons for non-adher-

ence in resource-poor settings is extremely limited compared to

resource-rich settings. There is a scarcity of data about medica-

tion adherence in Sudan hence this study was performed to

identify prevalence, predictors and barriers of non-adherence to

medication among cardiac patients in Khartoum State.


A descriptive, cross-sectional survey was performed

using a pre-tested, self-administered questionnaire on a

sample of 433 randomly selected cardiac patients attending

the largest three cardiac centres located in Khartoum State.

Descriptive and multivariate logistic regression analyses were

used for data analysis.


The response rate was 89.1%. The mean (



number of chronic diseases among respondents was 2.3 (



and that of medication use was 4.2 (


1.9). The mean (



duration of medication use among participants was 6.4 (



years. Optimal adherence was defined as having a score of

greater than six on the eight-item Morisky medication adher-

ence scale. Using this cut-off point, 49% (95% CI: 43.9–54.1)

of respondents had optimal adherence and 51% (95% CI:

45.9–56.1) had poor adherence. Respondents with a high level

of education, low and middle income levels, and those taking

five or more medications daily were found to be significantly

more non-adherent to medication use than those with low

to intermediate education levels (



0.001), those with high

income levels (



0.001), and those taking one to four medica-

tions daily (



0.039). The top four barriers for poor medica-

tion adherence among the study participants were the high cost

of drugs, polypharmacy and lack of pharmacist and physician

communication with patients about their drug therapy.


The current findings highlight the need for

urgent, multifaceted interventions, given the burden of cardio-

vascular diseases and the clinical and economic consequences

of medication non-adherence. These interventions include

affordable medications, easy-to-use medication regimens with

fewer daily doses, ongoing communication between patients

and healthcare providers, and improvement of the patient–

provider partnership.


non-adherence, adherence, cardiac patients, cardio-

vascular medications, Khartoum State, Sudan

Submitted 23/9/16, accepted 8/3/17

Published online 24/3/17

Cardiovasc J Afr



: 350–355

DOI: 10.5830/CVJA-2017-016

Cardiovascular diseases (CVDs) are the leading cause of deaths

in both developed and developing countries. There is a rapid

increase in the burden of CVDs in Africa and it is currently a

public health concern. In Sudan, CVDs are estimated to cause

12.0% of all mortalities.


Cardiovascular diseases have been

consistently reported as one of the top 10 causes of hospital

mortality in Sudan.


Cardiovascular disease is one of the most preventable causes

of death in the world, due to the fact that the majority of its

risk factors are preventable or controllable.


In 2006, a survey

of risk factors for coronary heart disease among the population

in Khartoum State showed a high prevalence of low physical

activity (86.6%), overweight and obesity (53.9%), hypertension

(23.6%), dyslipidaemia (19.8%), diabetes (19.2%) and smoking



Non-adherence to cardiovascular medications has become

increasingly documented across patient populations and

cardiovascular drug classes. A meta-analysis of 20 studies

involving 376 162 patients illustrates a non-adherence prevalence

of 43% throughout multiple drug classes, as measured by

pharmacy refill data.


This is comparable to the average prevalence

of non-adherence to both cardiovascular and non-cardiovascular

medications in developed countries, 50% as

indicated by the

World Health Organisation.


Non-adherence to cardiovascular

medications has been associated with poor clinical outcomes,

including re-admissions to hospital, subsequent myocardial

infarction, increased mortality rates and increased healthcare



Several studies have been conducted in developed countries

to determine adherence to cardiovascular medications,


have shown the prevalence of non-adherence to cardiovascular

medications, the association between non-adherence and

outcomes, the reasons for non-adherence, and the interventions

to improve medication adherence.


By contrast, data related to

the prevalence of non-adherence to cardiovascular medications

from developing countries is limited, even though its prevalence

in these regions is increasing at more than twice the rate observed

in developed countries.


A systematic review of studies conducted

in developing countries shows that adherence to cardiovascular

medications is suboptimal and appears comparable to that

observed in developed countries. The overall adherence to

cardiovascular medications pooled across studies was 57.5%.


Department of Pharmacy Practice, Faculty of Pharmacy,

Kuwait University, Kuwait

Abdelmoneim Awad, PhD,

Department of Pharmacy Practice, Faculty of Pharmacy,

Qassim University, Saudi Arabia

Nahid Osman, PhD

Department of Clinical Pharmacy, Faculty of Pharmacy,

National University, Khartoum, Sudan

Siham Altayib, MSc