The Main Reason Behind Poor Medication Adherence In Low-income Settings

Medication nonadherence is a huge concern and a study has highlighted the key reason behind poor medication adherence in low resourced communities.
medication adherence

A key factor associated with medication non-adherence in low-resourced settings has been published in a BMJ Medical Journal paper.

The paper highlights elements associated with poor medication adherence, zeroing in on cost and economic wealth factors that lead to sub-optimal hypertension and diabetes control.

WHO’s framework on factors influencing medication adherence

WHO categorizes the factors that affect medication adherence into 5 dimensions;

  • Socioeconomic: including level of monthly income, cost of transportation to health facility, monthly medication costs and International Wealth Index
  • Condition related: such as deterioration of conditions and presence of comorbidities
  • Patient-related factors: for example, psychologic factors, smoking, alcohol use, diet and physical activity
  • Therapy related: including number of prescription medications
  • Healthcare system-related factors: including time to travel to the health facility and health insurance
medication adherence
Determinants of medication adherence, adapted from the WHO dimensions of medication adherence, illustrating the study variables used in the analyses. (credit Gala P. et al)

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Transport costs: main factor leading to poor medication adherence

The paper noted that in lower- and middle-income countries (LMICs), factors such as socio-economic status, male gender, number of prescription medications, comorbidities, smoking/alcohol use, psychosocial stressors, lack of family support and poor provider–patient communication were the main contributors to sub-optimal adherence to medication.

The study, domiciled in Western Kenya, enrolled 1496 participants diagnosed with hypertension and/or diabetes who had received prescriptions for their conditions.

Sub-optimal adherence to the medication was reported in approximately 71% of the patients with the authors highlighting an association with economic factors.

On further analysis through multivariable linear regression modelling, they found that transportation costs were the major factor that led to poor adherence.

Gala and his colleagues state that the percentage of participants who reported not filling prescriptions or attending clinic visits due to healthcare procurement costs increased as monthly income and wealth decreased.

They also highlight the fact that medication costs had no significant association with medication adherence.  

A finding that potentially raises eyebrows.

Other measures of economic status, including monthly income and International Wealth Index (IWI), were also considered in the multivariable model and were found not to be associated with medication adherence.


Many countries in Africa are working towards Universal Health Coverage and a key success factor is proper and seamless access to essential medicines.

This study shows that transportation costs are potentially a huge road block towards achieving this UHC dream.

As the authors acknowledge, public health gatekeepers may need to design an innovative system that ensures reduction in patient costs through for example, community delivery strategies.

Taking a full spectrum approach when assessing cost-related factors affecting medication adherence in Africa is key in improving the overall continental health.

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