NDT Advance Access originally published online on December 13, 2007
Nephrology Dialysis Transplantation 2008 23(2):769; doi:10.1093/ndt/gfm507
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Adherence to therapy in sub-Saharan non-dialysed Africans with chronic kidney diseases—a real burden
Sir,
Poor adherence to medication regimens accounts for substantial morbidity, mortality and increased health care costs, especially in developing countries [1]. However, there is little evidence on adherence to therapy in non-dialysed black Africans with chronic renal diseases.
To assess adherence to drugs in patients with chronic renal diseases and to identify major barriers to adherence at the nephrology department of a teaching hospital in Dakar, Senegal. We included 118 patients with chronic renal diseases, followed between November 1st 2005 and January 31st 2006 in this study. Socio-demographic, clinical and therapeutic data were collected from medical records and patient interviews, performed by the same investigator using the same questionnaire. Rate of adherence (ROA) was defined as the percentage of the prescribed doses of the medication actually taken by the patient over a 4-week period and statistical analysis was done with SSPS 11.0. The major obstacles to adherence as reported by patients are noted in the following table 1.
|
Our results suggest that adherence to therapy is good for the majority of our patients whereas data from the clinical trials where patients are selected and closely followed show that ROA ranges between 43% and 78% [2]. For our study, ROA may be overestimated by self-reporting method of measure [3]. Complexity of drugs regimen and high cost of drugs are the main obstacles to adherence. They have also been reported in populations from different areas [2,4]. Patients with simple dosages (one pill, once daily) have better ROA than patients taking six doses daily [2]. Phytotherapy use is very common in a population with low social security cover and where modern care and drugs are often not accessible to the majority.
In conclusion, non-adherence to therapy is probably underestimated and should be regularly assessed by simple, accurate and inexpensive methods, in routine consultation of patients. Most of the barriers reported by our patients can be solved by improving communication between patients and health providers and accessibility of healthcare system. Costly new strategies comprising behavioural methods and electronic recall devices are often not adapted to clinical practice, particularly in developing countries.
Conflict of interest statement. None declared.
Nephrology and Dialysis department Hôpital
Aristide Le Dantec Dakar-Senegal
Avenue Pasteur BP 3001
Dakar-Etoile
Email: sidymseck{at}yahoo.fr; samakeur{at}hotmail.com
Notes
See http://ndtplus.oxfordjournals.org/
References
- Sabate E. Adherence to long-term therapies: evidence for action. (2003) Geneva: World Health Organization. Update. http://www.who.int/chronic_conditions/en/adherence_report.pdf. Accessed on 11 July 2005.
- Claxton AJ, Cramer J, Pierce C. A systematic review of the associations between dose regimens and medication compliance. Clin Ther (2001) 23:1296–1310.[CrossRef][Web of Science][Medline]
- Osterberg L, Blaschke T. Adherence to medication. N Engl J Med (2005) 353:487–497.
[Free Full Text] - Valentina P. Physicians, pharmacists and patients’ compliance with chronic treatment in Bulgaria. Pharmacoepidem and Drug Safe (2006) 8:607–612.
CiteULike 
Connotea 
Del.icio.us What's this?
Related articles in NDT:
- Adherence to therapy in sub-Saharan non-dialysed Africans with chronic kidney diseases—a real burden
NDT 2008 23: 1782.[Extract] [FREE Full Text]
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||