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

In 30 seconds

This systematic review and random-effects meta-analysis pooled observational studies of medication adherence among people with heart failure in Africa. Across 17 studies involving 6,276 patients, estimated non-adherence prevalence was 41.88% (95% CI: 25.43-58.34). Prevalence varied substantially by region, reaching 77.59% in Western Africa. Lack of health insurance was the strongest reported associated factor (OR = 4.27, 95% CI: 1.62-11.26); polypharmacy and comorbidities were also associated with non-adherence. The findings indicate a substantial burden, but marked between-study heterogeneity limits the precision of a single continent-wide estimate.

Key findings

• Pooled medication non-adherence prevalence was 41.88% (95% CI: 25.43-58.34) across 17 studies and 6,276 patients.
• Western Africa had the highest reported regional prevalence, at 77.59%.
• Lack of health insurance was associated with non-adherence (OR = 4.27, 95% CI: 1.62-11.26).
• Polypharmacy (OR = 2.58, 95% CI: 2.00-3.33) and comorbidities (OR = 1.76, 95% CI: 1.31-2.35) were also associated with non-adherence.

Why it matters

Medication non-adherence may undermine heart failure management, and this synthesis suggests it affects a substantial proportion of patients across African settings. The associations with insurance status, medication burden, and comorbidities point to financial and clinical circumstances that may shape adherence. Regional variation also cautions against assuming that one prevalence estimate or support approach applies uniformly across the continent.

What to keep in mind

The pooled estimate had extreme heterogeneity (I² = 99.7%), indicating substantial variation across studies and limiting the interpretability of a single overall prevalence. The included evidence was observational, so associated factors should not be interpreted as causal.