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The 29th of September marks a global commemoration of the World Heart Day. This year’s thematic focus is on creating healthy heart environment. This entails ensuring that everyone has the chance to make healthy heart choices wherever they live, work and play. Since 2009, PharmAccess and research partners in the Kwara Health Insurance program have been involved in studies evaluating the impact of health insurance programs in redressing the health challenges in rural Nigeria, particularly within Kwara State. One of the studies explored challenges related to access to quality healthcare for people with heart diseases and treatment adherence in low resource settings.

Enrollee in Kwara program Aishatu Atahiru receives antenatal care in 2013 - (c) Photo credit Adolphus Opara LOWRES

These extensive studies among insured patients in rural Nigeria have shown that access to free better quality healthcare is not the only essential factor in ensuring treatment adherence. A combination of medication and behavioral changes is required to reduce hypertension and the risk of cardiovascular disease (CVD). Side-effects of the pills, and religious factors influencing the trust and willingness to use pills, are just but a few of the challenges affecting treatment processes. As one woman with controlled hypertension states,
“I use only the drugs prescribed to me, but ordinarily, as a member of Christ Apostolic Church Christian faith, I really do not use drugs if not that this is really important. I believe in faith healing.”
Behavior related factors are difficult to change. For instance, while a high intake of salt and too little exercise are risk factors for developing CVD, perceptions regarding these behaviors and its consequences are deeply rooted in the society.
“People often see being fat as synonymous with affluence, comfort and peace of mind; they also sometimes associate fatness in a woman with beauty. Some of us women prefer to be fat or robust believing that by so doing; we will be more attractive to our husbands and men generally”, another woman said.
The development of the Cardiovascular Health Education Program (CHEP) has proved to be successful in several studies in Nigeria already. Many people participated in the offered program. Better treatment adherence with the result of a reduction in blood pressure were observed at the end of the educational program.
The study on poor adherence to hypertension treatment shows that adapting to local practices can help. Giving tips on local foods which are affordable and available to compose healthy meals as well as on normal daily activities that offer opportunities for getting exercise are examples of local and pragmatic solutions. “Exercising is good for hypertension; although I cannot farm, I exercise by washing clothes in the river and axing woods to make fire for cooking”, a respondent remarked during the study.
The studies exploring local factors that inhibit treatment adherence, offer opportunities to understand these challenges and create interventions that are relevant to local circumstances. The following briefs give an insight into the key results and implications of the studies:

1. What inhibits and supports adherence to hypertension treatment among insured patients in rural Nigeria?

2. Education for high blood pressure treatment adherence amongst hypertensive Nigerians