Pharmacology & Pharmacy, 2013, 4, 701-709
Published Online December 2013 (
Open Access PP
Improving Adherence to Prescribed Antidiabetics and
Cardiovascular Medications in Primary Health Care
Centers in Nyala City, South Darfur State-Sudan*
Ahmed Dahab Ahmed1,2, Asim Ahmed Elnour3,4#, Mirghani Abd Elrahman Yousif 5,
Farah Hamad Farah6, Hasab Alrasoul Akasha Ahmed Osman7, Abobakr Abasaeed8,9
1Revolving Drug Fund (RDF), Ministry of Health (MOH), Nyala, Sudan; 2Department of Pharmaceutics, Faculty of Pharmacy,
Gezira University, Medani, Sudan; 3Consultant Clinical Pharmacist, Al Ain Hospital, Abu Dhabi Health Services Company (SEHA),
Al Ain, UAE; 4Department of Pharmacology, College of Medicine and Health Sciences, UAE University, Al Ain, UAE; 5College of
Pharmacy, Clinical Pharmacy, Taif University, Taif, KSA; 6College of Pharmacy and Health Sciences, Ajman University of Sciences
and Technology, Ajman, UAE; 7The Epidemiological Laboratory (Epi-Lab), Khartoum, Sudan; 8Social and Clinical Pharmacy De-
partment, Faculty of Pharmacy, Charles University, Hradec Kralove, Czech Republic; 9Registration and Drug Control Department,
Ministry of Health, Abu Dhabi, UAE.
Received October 28th, 2013; revised November 28th, 2013; accepted December 12th, 2013
Copyright © 2013 Ahmed Dahab Ahmed et al. This is an open access article distributed under the Creative Commons Attribution
License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Aims: Prospective pharmacist’s interventions aimed to improve patient’s knowledge and behaviors to adhere to medi-
cations in patients with type 2 diabetes with or without cardiovascular medical conditions in primary health care (PHCs)
centers in Nyala city, South Darfur State, Sudan. Methodology and Materials: 300 patients were enrolled for assessing
adherence with the Brief Medication Questionnaire (BMQ) in ten PHCs in Nyala city. We assessed patients’ responses
to BMQ pre- and post-interventions plan by: complex interventions, humanitarianism and disease outcomes determined
by health-related outcomes (SF-36), glycosylated hemoglobin (HbA1c) and blood pressure. Results: BMQ scores have
improved significantly in four screens (pre- and post-interventions): regimen [4.6 ± 0.2 to 1.8 ± 0.1; P = 0.001], belief
[1.6 ± 0.3 to 0.3 ± 0.3; P = 0.007], recall [1.7 ± 0.2 to 0.6 ± 0.2; P = 0.043] and access screens [1.8 ± 0.1 to 0.4 ± 0.1; P
= 0.005]; which have indicated an improved patients’ adherence to medications. Percentage of subjects reaching target
of post prandial blood glucose (PPBG) have increased from 28.0% to 49.3%; [P = 0.02] post interventions. PPBG mean
values have decreased significantly from [11.1 ± 0.6 mmol/L to 8.1 ± 0.8 mmol/L; P = 0.001]. Percentage of subjects
with improved blood pressure control have increased significantly from [50.3% to 89.0%; P = 0.001]. Significant dif-
ferences existed between baseline and post-baseline scores on four of eight SF-36 sub-domains. Conclusions: Pharma-
cist provided patient education and behavioral interventions were effective in increasing medications knowledge and
raising adherence issues in patients with type 2 diabetes with or without cardiovascular chronic medical conditions.
Keywords: Adherence; Darfur; Medications; Nyala; PHCs; Sudan
1. Introduction
According to a medical literature review published re-
cently in the Annals of Internal Medicine, approximately
50 percent of medications for chronic disease are not
taken as prescribed. Failure to take prescribed medica-
tions was estimated to cause 10 percent of hospitaliza-
tions and 125,000 deaths annually. The total cost to the
US health system from poor medication adherence was
put at $100 billion to $289 billion per year. Several stud-
ies have shown a low adherence rate [1]. In Saudi Arabia
and Egypt, for example, adherence rates of only 34.2%
and 15.9% have been reported, respectively; [2]. A sys-
tematic review indicates that adherence to cardiovascular
medications in resource-limited countries is sub-optimal
and appears very similar to that observed in resource-rich
*No conflict of interest.
#Corresponding author.
Improving Adherence to Prescribed Antidiabetics and Cardiovascular Medications in
Primary Health Care Centers in Nyala City, South Darfur State-Sudan
countries. Efforts to improve adherence in resource-lim-
ited settings should be a priority given the burden of
heart disease in this context, the central role of medica-
tions in their management, and the clinical and economic
consequences of non-adherence [3]. In China, gender
difference had been observed for the adherence of anti-
hypertensive medications [4].
The scope of problems due to medications non-ad-
herence is enormously rising. In Sudan, there were very
rare scientific articles published about medications ad-
herence. The current needs for medications adherence
provide good opportunity to implement an interventional
adherence programs in health setup in Sudan. In early
2000, El Zubair and co-workers conducted cross-sec-
tional study of hypertensive patients in Sudan and esti-
mated drug adherence. Factors associated with adherence,
status of BP control and occurrence of complications
were assessed. Adherence was 59.6% as measured with
the pill count method. They found 92.0% of compliant
patients had controlled BP in comparison with 18.0% of
non-compliant patients, and 30.1% of the compliant pa-
tients had complications in comparison with 46.3% of the
non-compliant patients. While the adherence rate was
reasonable, 36.8% of patients were non-compliant be-
cause they could not afford to buy antihypertensive drugs.
These patients experienced uncontrolled BP and other
complications [5]. We aimed to design approaches (be-
havioral and educational) that improve patient’s knowl-
edge and behaviors as to adhere to antidiabetics and car-
diovascular medications. We have imposed continuous
structured program for improving adherence to medica-
tions and implemented sequentially as a policy in ten
primary health care centers (PHC’s) in Nyala, South
Darfur State, Sudan. The main objective was to promote
awareness and explore reasons for non-adherence to
antidiabetics and cardiovascular medications. We em-
phasized pharmacist’s role in improving patient’s adher-
ence to antidiabetics and cardiovascular medications.
2. Methodology
Study design: A multi-centre prospective intervention
(pre and post) clinical trial. It was ethically approved by
the Ethics Committee in Faculty of Pharmacy at Gezira
University, Ministry of health (MOH) in South Darfur
State and director of primary health care clinics (PHC’s).
Setting: It was performed in 10 PHC’s in Nyala city
which is located in the western provinces of Sudan,
South Darfur State, Sudan.
Patient enrollment: The eligible randomly selected
population was composed of all patients with diabetes
type 2 with or without cardiovascular diseases visiting
the PHC’s in Nyala city. The estimated sample size fol-
lowed the procedure outlined in similar setting [6].
Outcome measures: The study primary outcome
measures were improvements in SF-36, HbA1c and blood
pressure. The secondary outcomes were improvement to
responses to the BMQ (at baseline, at 3 and 6 months
post interventions plan).
2.1. Tools Used to Measure Outcome
The interventions plan was in the form of: behavioral
interventions involved the use of tools to change pa-
tient’s skill, dosage schedule changes, written refill, pill
count, communications with healthcare providers and
counseling. Educational interventions involved teaching
the patients about the medications and diseases through
written communications (handouts, brochures, booklets
and posters), public campaigns and direct consultations
in the clinics by using face-to-face education sessions.
2.2. Brief Medication Questionnaire (BMQ) and
The validated BMQ is more sensitive in identifying and
diagnosing adherence problems [7]. It consists of four
sub-scales (regimen, beliefs, recalls and access screens).
The tool includes 5-items regimen screen that asks pa-
tients how they took each medication in the past week, a
2-items belief screen that asks about drug effects and
bothersome features, and a 2-items recall screen about
potential difficulties remembering. While 2-item, access
screen evaluates the patient difficulty in buying and re-
filling their medications in time. The higher the score
(positive screen) in each aspect indicates an increased
potential for adherence problems (or barrier to adher-
ence). Whereas a negative screen indicates that there was
decreased non-adherence or non-barrier to adherence.
We used SF-36 to determine improvements in health-
related quality of life-HRQoL [8].
3. Results
A total of 350 eligible patients with diabetes with or
without cardiovascular diseases were enrolled, of which
300 patients 85.7% have successfully completed the
study. Thirty patients 8.6% were considered drop outs
because of the irregular follow up and twenty patients
5.7% were not reachable. Our results indicated a high
participants’ response rate of 85.0% and a high number
of illiterate 19.7% and unemployed subjects 31.0%.
More than two third of patients were either overweight or
obese 67.0%. The number of patients with diabetes and
coexisting cardiovascular diseases was high 46.0%,
while the number of patients with coexisting diabetes and
hypertensions exceeds 24.7%. The socio-demographic
haracteristics were shown in Table 1. c
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Improving Adherence to Prescribed Antidiabetics and Cardiovascular Medications in
Primary Health Care Centers in Nyala City, South Darfur State-Sudan
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Table 1. Socio-demographic characteristics of enrolled population (N = 300).
Parameter Frequency (N) Percentage (%)
Age (mean age ± SD, 49.7 ± 1.2 years)
18 to44 75 25.0
45 to 60 197 65.7*
>60 28 9.3
Male (Mean age ± SD 50.8 ± 4.5 years) 148 49.3
Female (Mean age ± SD 49.6 ± 4.4 years) 152 50.7*
Marital status
Married 276 92.0*
Unmarried 24 8.0
Educational level
Illiterate 59 19.7
Preliminaryschool 91 30.3*
Secondary school 85 28.3
University graduate 63 21.0
Post university degrees 2 0.7
Occupation/work status
Government employee 111 37.0*
Private employee 26 8.7
Skilled labor 47 15.7
Business 17 5.6
Unemployed 93 31.0
Retired 6 2.0
Chronic medical condition
Diabetes 162 54.0*
Diabetes and hypertension 74 24.7
Diabetes and cardiovascular diseases 64 21.3
Income per month (Sudanese Ginaih/Pound)
1 - 499 (6000 per year) 116 38.7
500 - 1000 (6000 and <12,000 per year) 152 50.7*
>1000 (>12,000 per year) 32 10.6
Body max index (Kg/m2)
Under weight < 22 1 0.3
Normal weight 25 98 32.7
Over weight > 25 to < 30 186 62.0*
Obesity > 30 15 5.0
Total (at each sub row) 300 (100)
ey: N = Frequency; (%) = Percentage; *The highest percentage achieved in raw.
Improving Adherence to Prescribed Antidiabetics and Cardiovascular Medications in
Primary Health Care Centers in Nyala City, South Darfur State-Sudan
3.1. Brief Medication Questionnaire (BMQ)
Adherence Measure
At baseline assessment, nearly half of participants 147,
49.7% were able to name their medications. However, at
3rd assessment more than two thirds 241, 80.3%; P =
0.002 have reported that they knew their medications
names. The number of patients who reported that they
did not missed their medication was increased from 71,
23.7% to 184, 61.3% and to 236, 78.7%; P = 0.001 at
stages 1, 2 and 3; respectively. More than 90.0% of re-
spondents have stated that they were aware about their
chronic medical conditions; P = 0.459. At baseline 163,
54.3%; P = 0.001 of patients had a concern or doubt
when asked how well the medications worked for them.
The number of patients who said that their medication
bother them, was 48, 16.0%; 25, 8.3% and 8, 2.6%; P =
0.015 at stages 1, 2 and 3; respectively. There were 81,
27.0%; 55, 18.3% and 33, 11.0%; P = 0.03 who admitted
that their medications caused side effects (barrier to ad-
herence). 105, 35.0%; 75, 25.0% and 55, 18.3%; P =
0.02 have agreed that it was at least somewhat hard to
remember all the doses at assessment 1, 2 and 3; respec-
tively. Results revealed 125, 41.7%; 99, 33.0% and 65,
21.6%; P = 0.04 have indicated that it was at least some-
what hard to pay for their medications at assessment 1, 2
and 3; respectively. There were 106, 35.3%; 72, 24.0%
and 36, 12.0% at stages 1, 2 and 3, respectively; have
said that it was at least somewhat hard to get their refill
in time, this barrier to adherence was decreasing signifi-
cantly; P = 0.042. Also 120, 40.0%; 143, 47.6% and 136,
45.3% at stages 1, 2 and 3, respectively; have reported
that it was at least somewhat hard to read the print on the
container; P = 0.285. 226, 75.3% at baseline, 241, 80.4%
at 2nd and 280, 93.3% at 3rd assessment, have stated that
their dosage times were convenient; P = 0.006. There
were 41, 13.6%; 21, 7.0% and 3, 1.0% have stopped tak-
ing some of their medications in the past six months dur-
ing the assessment stages 1, 2 and 3, respectively; P =
0.01. Furthermore, n = 226, 75.3%; 177, 59.5%, and 105,
35.0%, responded that, they did not know how well did
their medications worked for them; P = 0.01.
3.2. BMQ Adherence Measure by Scoring
The responses to each screen were detailed in Table 2.
To determine correlations between screen and demo-
graphic parameters, person correlation coefficient was
used at 6 months post interventions, Table 3. The per-
centage of patients achieved controlled PPBG were
28.0%, 37.0% and 49.3%, moderately controlled 21.0%,
Table 2. Comparison of the BMQ mean scores of the four screens at different assessments intervals.
BMQ Screen scores (Mean ± SD) (N = 300) Assessment 1 Assessment 2 Assessment 3 P value
Regimen Screen 4.6 ± 0.2 2.9 ± 0.1 1.8 ± 0.1 0.001*
Belief Screen 1.6 ± 03 0.9 ± 0.2 0.3 ± 0.3 0.007*
Recall Screen 1.7 ± 0.2 1.1 ± 0.3 0.6 ± 0.2 0.043*
Access Screen 1.8 ± 0.1 1.0 ± 0.2 0.4 ± 0.1 0.005*
Key: *P < 0.05.
Table 3. Correlation between the BMQ screen and demographic parameters at final stage (N = 300).
Patient socio-demographic parameter (final assessment, stage 3) Regimen Belief Recall Access Total
Correlation coefficient 0.54 0.11 0.06 0.16 0.4
Education P value 0.001* 0.049* 0.329 0.004* 0.001*
Correlation coefficient 0.38 0.16 0.08 0.14 0.32
Occupation P value 0.001* 0.007* 0.154 0.017* 0.001*
Correlation coefficient 0.05 0.05 0.13 0.11 0.08
Body max index P value 0.371 0.396 0.026* 0.062 0.145
Correlation coefficient 0.32 0.14 0.00 0.03 0.2
Income P value 0.001* 0.014* 0.961 0.64 0.001*
Correlation coefficient 0.13 0.04 0.05 0.06 0.12
Age P value 0.029* 0.521 0.391 0.267 0.036
Total number of study patients (at each sub row) 300 300 300 300 300
ey: *P < 0.05.
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Improving Adherence to Prescribed Antidiabetics and Cardiovascular Medications in
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27.0% and 31.0%, poorly controlled 18.0%, 15.0% and
12.0% and uncontrolled 33.0%, 21.0% and 7.7% at
stages 1, 2 and 3; respectively. A significant decrease in
patients PPBG mean values was observed from baseline,
at 3 and 6 months 11.1 ± 0.6 mmol/L; 9.4 ± 0.5 mmol/L
and 8.1 ± 0.8 mmol/L; P = 0.001; respectively. The per-
centage of patients who reached target PPBG levels
(controlled) increased from 28.0% at baseline to 49.3%
at 6 months post interventions. At baseline, HbA1c mean
was 10.5 ± 1.2 and patients adhered to medications has a
mean HbA1c of 7.6 ± 0.2. At baseline, BP levels were
SBP 135.7 and DBP 81.8 mmHg, improved to SBP 123.3
and DBP 77.6 mmHg] after 6 months, P = 0.001. The
percentage of patients with improved BP controlled lev-
els was 50.3% vs. 89.0%; P = 0.001 at baseline and post
baseline; respectively. While the percentage of patients
with improved BP adequate levels decreased 22.7% vs.
4.7%; P = 0.01, inadequate 18.3% vs. 4.7%; P = 0.03,
with markedly poor 8.7% vs.1.7%; P = 0.04 at baseline
and 6 months post baseline; respectively. Analysis re-
vealed that significant differences existed between base-
line and post baseline scores on SF-36 domains; Table 4.
4. Discussions
The main study findings were significant improved BMQ
scores in four screens (pre and post interventions):
Regimen, Belief, Recall and Access screens; which have
indicated an improved patients’ adherence to medications.
The percentages of subjects reached target post prandial
blood glucose (PPBG) have increased post interventions.
PPBG mean values have decreased significantly. The
percentages of subjects with improved blood pressure
control have increased significantly. Remarkable differ-
ences existed between baseline and post baseline scores
on four of eight SF-36 sub domains.
4.1. The Participant’s Responses to BMQ
Adherence Measure
The percentage of patients who knew their prescribed
medications names have increased from 50.0% at base-
line to more than 80.0% post interventions. There was
increase in the number of patients who have reported that
they did not miss their medications. Almost all partici-
pants indicated that they have previous idea about their
disease. Although not tested, but it was anticipated that
knowledge test may reveal the precise idea about their
knowledge. This finding had been reported in a previous
study [9].
The pharmacist’s interventions has led to decline in
the number of patients who have had a concern or doubt
about how well their medications worked for them. The
percentage of patients who reported that their prescribed
medications worked very well, have improved at 6
months post interventions. This finding strongly supports
the sprouting role of pharmacist in patient’s medications
education. These findings were in line with previous re-
cent study [10] and earlier study [11]. The improved ad-
herence to medications was evident in the decrease in
percentage of patients experiencing medications bother-
some. More prominent achievement was gained in the
declined percentage of patients for those who admitted
that their medications caused side effects. The patients
expressed their concerns about the cost of medications.
However, simplifying the regimen with combinations
therapy was offered as a solution to the increased cost.
The percentage of patients who have stopped taking their
medications in the past six months have reduced from
baseline, to 2nd assessment and to final assessment. The
percentage of patients who have missed to take their
medications decreased at 6 months post interventions.
These findings were attributed to continued education,
Table 4. Descriptive statistics and comparison of SF36 mean scores ± SD (N = 300).
SF36 sub domain scale (Mean ± SD) Stage 1 Stage 2 Stage 3 P value
Physical functioning 65.5 ± 25.4 69.0 ± 25.8 74.3 ± 19.9 0.001*
Role limitations due to physical health 53.8 ± 36.0 47.9 ± 41.5 48.7 ± 42.0 0.142
Role limitations due to emotional problems 56.1 ± 38.8 66.7 ± 41.3 58.2 ± 42.6 0.004*
Energy/fatigue 59.8 ± 22.4 59.8 ± 24.1 66.1 ± 20.4 0.001*
Emotional well-being 68.9 ± 23.0 82.7 ± 20.6 86.8 ± 14.1 0.001*
Social functioning 58.1 ± 24.7 60.6 ± 25.6 60.5 ± 24.4 0.387
Pain 61.1 ± 25.0 62.5 ± 26.8 62.0 ± 22.8 0.770
General health 51.3 ± 10.4 49.9 ± 10.2 50.3 ± 10.7 0.252
Key: *P < 0.05.
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Improving Adherence to Prescribed Antidiabetics and Cardiovascular Medications in
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improved skills, available information and discussions
with patients as they were involved to ask and talk freely.
4.2. BMQ Adherence Measure by Scoring
Post pharmacist’s interventions, there was a significant P
< 0.05, improvement in scores in all BMQ four screens
[regimen, belief, access and recall screens] from baseline
throughout the assessment intervals which have indicated
an improved patients’ medications adherence. This was a
positive finding and supports the fact entailing the im-
portance of pharmacist in patient education tailored to
medications adherence. In this respect the study supports
the findings drawn in a similar study using the same
BMQ instrument [9]. Patients have received a multiple
dose regimen (2 or more times/day) and have reported
difficulty remembering their medications at the start of
the study, which entails the presence of recall barriers.
The pharmacist interventions in this respect regarding
simplification of regimen, use of combinations and pri-
oritize dispensing chronic medications to patients on
chronic diseases as our population facilitated this barrier
with resultant improved adherence to medications.
4.3. Barriers to Medication Adherence
The results indicated the presence of side effects to
medications among few participants. However, the re-
ported problems in medications decreased significantly
post pharmacist’s interventions. This finding was in line
with many other studies [12-14]. Another barrier to
medications adherence was that some patients reported
not remembering all the doses of their medications which
was consistent with previous study [15]. The issue of
medications cost was another barrier to adherence to
medications and was increasing throughout the assess-
ment intervals. This finding complies with a previous
study [16]. The refill problem was raised by patients as
barrier to medications adherence, however; it was in
contrast with a previous study [17]. In the latter study
patients refill barrier was decreasing. A considerable
number of patients find it difficult to read the label on
their medications which may be attributed to high num-
ber of illiterate patients in the study population. A re-
markable finding was the increasing number of patients
reporting their dosage times were convenient. These
findings dictated the importance of policies for refill,
labeling and convenient dosing for improving adherence
and to halt medications non-adherence.
Also there was no written policy for non-adherence
risk reduction and for assessing any suspected medica-
tions non-adherence in all of the surveyed facilities. This
might explain why even serious risks of non-adherence
to medications were underreported. All these facts taken
together would also indicated the decreased level of
awareness about medications adherence safety concerns,
which were recognized and implemented in most of the
developed countries and some of the underdeveloped
ones. Medications adherence is important in order to
achieve better treatment outcomes in chronic diseases
such as diabetes, hypertension and other cardiovascular
4.4. Post Prandial Blood Glucose (PPBG) and
A clinical study by Avignon and co-workers showed that
PPBG (post-lunch) is a better predictor of HbA1c than
FPG 7.2 mmol/L before breakfast [18]. Postprandial
hyperglycemia has been associated with increased risk of
micro vascular [19] and macro vascular complications
[20]. In this respect the results revealed a remarkable
increase in the percentage of patients who have reached
target PPBG levels from 28.0% at baseline to 49.3% after
6 months. Whether or not this has been associated with
reduced microvascular or macrovascular complications
deserve more attention in future studies in our population.
Although the level of HbA1c decreased; but the target
was not reached <7.0%. This may be due to the fact that
some patients failed to regularly monitor their HbA1c
which may have affected the final results.
4.5. Mean Values of Blood Pressure (BP)
The number of patients with controlled BP has increased
from 50.0% to 89.0% within the study period. This was
in agreement with previously published study [21]. The
medications discontinuation rate in our population at the
end of the final follow up was very low, 1.0%. This may
be attributed to the fact that patients were informed at
each clinic visit to adhere to their medications and this
was reinforced in each clinic visit. Furthermore, many
patients has been switched to combinations therapy and
ensured that it contains an ACE inhibitor. Our results
lend support to the findings reported few years ago by
4.6. Results of Short Form Health Survey
The largest improvements in HRQoL were for the
physical functioning score and the emotional wellbeing
scores (improved health). This finding was in concor-
dance with that previously reported [23]. The provision
of pharmacist education to patients with type 2 diabetes
with or without cardiovascular diseases has resulted in
improvement in terms of their HRQoL. The outcome of
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Improving Adherence to Prescribed Antidiabetics and Cardiovascular Medications in
Primary Health Care Centers in Nyala City, South Darfur State-Sudan
the pharmacist’s interventions on patient’s HRQoL de-
monstrated the relationship between this outcome meas-
ure and adherence to medications. Improvement in
HRQoL may in part be attributed to the increased contact
of these patients with the pharmacist, improved adher-
ence to medications and resultant clinical improvement
in patients’ clinical outcomes. The current study lend
support for the adoption of assessing HRQoL as an out-
come for evaluating health education programs in pa-
tients with diabetes type 2 with or without cardiovascular
diseases; who were on multiple medications.
4.7. Impact of Education on Adherence
Patient education on medication adherence is one of the
main issues of interventions in the literature to enhance
medication adherence [24]. In many of the surveyed fa-
cilities; health care providers appreciated the importance
of education to patients in order to enhance the therapeu-
tic success. The current study results demonstrated that a
collaborative approach between the pharmacist and
healthcare providers can facilitate implementing medica-
tions adherence concepts which were expected to con-
tribute to improved patient outcomes. During the study
period, patients were asked to visit their clinic regularly,
in order to get controlled (target) blood glucose and BP
levels. As patients adhered to see their physicians regu-
larly they showed improvements in the therapeutic out-
comes. However, patients have shown significant de-
crease in the BP and blood glucose levels. This was due
to continued pharmacist’s interventions and follow up.
This was also in agreement with previously published
study [25]. This finding dictates the importance of edu-
cating and training the patients about the different forms
of medications adherence barriers. Non-adherence to
long-term medications in chronic diseases is a worldwide
problem. It has been estimated that 40.0% to 50.0%
chronic disease patients are non-adherence to their pre-
scribed treatment [26]. Non-adherence to medications is
a major concern in the management of chronic disease
such as hypertension [27,28]. The issue of the risk of
medications non-adherence was not been identified in
most of the surveyed PHCs facilities. However, most of
the PHCs facilities in developed countries have imple-
mented policies for medications adherence. In summary;
this improved adherence to medications was associated
with good control of blood glucose and BP, coupled with
other positive effects observed in patient knowledge and
reduction in difficulties in taking antihypertensive medi-
cations. The study highlighted that some patients lack
knowledge about their medications, their respective dis-
ease type and its management as the main reasons for
poor adherence. This finding was in concordance with
recent published study [29]. This negative attitude places
the pharmacist to play more vital role in responding to
queries and in raising the awareness about medications
adherence among patients and healthcare providers alike.
4.8. Current Study Limitations
There was a limitation with the current study, that medi-
cation adherence was measured using BMQ a screening
behavioral measure, we anticipate that extent of adher-
ence to medications may not be precisely estimated by
this method.
4.9. What Is New
The pharmacist managed medications adherence, sig-
nificantly improved patients’ glycaemia control, blood
pressure control and HbA1c. The findings of this study
provide evidence of the effectiveness of pharmacists’
educational and behavioral interventions in medication
5. Conclusion
There is a need for further research to highlight medica-
tions non-adherence and barriers to patients’ adherence,
in order to identify the type of interventions that may be
needed for improving adherence and to evaluate whether
improvements in awareness, knowledge and adherence
are sustained in the longer term. We concluded that, the
pharmacist’s education and behavioural interventions
were effective in increasing the medications knowledge
and raising adherence issues in patients with type 2 dia-
betes with or without cardiovascular diseases.
6. Acknowledgements
The authors wish to thank all participating patients, phy-
sicians, pharmacists and nursing staff of primary health
care facilities in Nyala, south Darfur state-Sudan; for
their support. We applauded the contribution of: Dr.
Mohammed Mandour [former General Director of Cen-
tral Medical Supplies (CMS), Khartoum-Sudan], Profes-
sor AbuBakr Gurashi and Professor. El Hadi Mohammad
(Dean Faculty of Pharmacy, University of Gezira).
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Primary Health Care Centers in Nyala City, South Darfur State-Sudan
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