CARDIOVASCULAR JOURNAL OF AFRICA • Vol 21, No 2, March/April 2010
90
AFRICA
Health education
The medication adherence and knowledge on heart failure
survey contained questions in several sections on health educa-
tion provided by a doctor or a nurse. According to the patient’s
responses, the least amount of education was provided in rela-
tion to daily weight monitoring, with only 8% of participants
remembering this component of education. Dietary management
was also less memorable than education focusing on alcohol,
smoking and CHF in general (Fig. 4).
Knowledge on heart failure medication and
management
Overall, patient knowledge concerning their prescribed CHF
medication was poor: 56% could not name the effect or any side
effects of their medication. On average, only 10% of effects and
side effects of pills taken could be named by all participating
patients. However, in those patients who self-reported receiving
health education on CHF (70%, Fig. 4), the average knowledge
on CHF medication was twice as high as in patients without
health education. An average score of 69% was achieved on 10
questions concerning CHF management. Percentages on correct
answers for each of the 10 questions varied between 29 and 89%.
Again, patients who received education on CHF management
had a higher average knowledge (70%) than patients who had not
received information on CHF management (65%).
Discussion
To our knowledge, this represents the largest report to date on
the pattern of treatment adherence and knowledge in predomi-
nantly black African patients with CHF emanating from South
Africa. Indeed, it is one of the largest overall reports relating to
CHF from the continent.
11
This is particularly significant given
our recent reports of a higher-than-expected burden of CHF in
the urban South African community of Soweto,
13
and the likeli-
hood of an increase in both traditional and affluent forms of the
syndrome due to epidemiological transition.
13
How do our data compare with data derived from western
cohorts? Our findings on medication adherence are gener-
ally lower than reports emanating from high-income countries.
8
However, a study conducted in Zimbabwe attained results that
supported our findings:
11
Bhagat and Mazayi-Mupanemunda
found that 73% of the 22 investigated heart failure patients
were considered compliant with their prescribed medication.
11
Although adherence rates from several studies in the western
world vary from 71 to 99%, over half of the listed studies had
an adherence rate above 80%.
14-20
Alternatively, studies from
Sweden (71%) and the USA (73%) have reported similar rates to
the current study.
15,20
When looking at individual medication adherence to the five
basic medications prescribed for CHF, our results ranged from
64 to 79%. In a UK study, Struthers
et al
. found that 18, 34
and 58% of patients had adherence rates of
<
70%,
<
85% and
100%, respectively, to prescribed ACE inhibitors.
21
In contrast,
Monane
et al
. found that only 10% of their study patients were
fully compliant with prescribed digoxin therapy during one year
of follow-up.
22
With regard to adherence to appointment schedules, patients
80
70
60
50
40
30
20
10
0
Daily weight
monitoring
Healthy diet
Fluid intake
Moderate
alcohol intake
Regular
physical activity
Smoking
restriction
Information
on HF
% of given health education
8
39
36
70
60
73
70
Fig. 4. Percentage of health education given on various aspects of self-care behaviour and heart failure. Health educa-
tion on daily weight monitoring was given if a patient knew about this way of HF management. Health education given
on a healthy diet was accomplished when a patient was informed on the positive effect of a diet rich in vegetables
and fruits. Health education on fluid intake was given if a patient knew that there is a restriction of
<
two litres per day.
Health education on alcohol restriction meant informing patients to aim for a moderate alcohol intake (one beer or
one to two glasses of wine per day). Health education on physical activity was provided to those with stable CHF and
smokers were told about the benefits of refraining from smoking. Information on HF consisted of information about
the nature of the syndrome.
