Medication-related problems and contributing factors in patients with cardiovascular disorders in Ethiopia: a...

Cardiovascular diseases (CVDs) are a leading cause of mortality and disability globally. In Ethiopia, the management of CVDs faces significant challenges, particularly in addressing medication-related problems (MRPs). This systematic review and meta-analysis aims to assess the prevalence of MRPs among CVD patients in Ethiopia.

The review followed the PRISMA guidelines and was registered in the PROSPERO database (CRD42024501087). A comprehensive search was conducted across databases including PubMed, Hinari, Embase, and Scopus. Studies were included if they focused on the prevalence of MRPs among Ethiopian CVD patients, were observational in design, and were published in English. Quality assessment was performed using the JBI critical appraisal checklist. Data were analyzed using a weighted inverse random-effects model with subgroup analyses conducted based on various study characteristics. Heterogeneity was assessed using the I² statistic and further explored through univariate meta-regression and sensitivity analysis.

From 405 potential studies, 22 met the inclusion criteria, comprising 5700 patient cases and identifying 7780 MRPs. The pooled prevalence of MRPs among CVD patients in Ethiopia was 74% (95% CI 66-81, I² = 98.4%). The average number of MRPs per patient was 1.65 (95% CI 1.48-1.82, I² = 98.3%). Common MRPs included patient noncompliance (18%), ineffective drug therapy (16%), and the need for additional drug therapy (15%). Polypharmacy, poor involvement in therapeutic decisions, advanced age, the presence of comorbidities, and prolonged illness duration were identified as commonly reported contributing factors. Despite significant heterogeneity among studies (I² = 98.4%), subgroup analyses and univariate meta-regression did not identify sample size or study period as significant sources of this variability. Publication bias was suggested by Egger's regression test (p-value < 0.001), though trim-and-fill analysis indicated no adjustments were necessary. Sensitivity analysis confirmed the stability of the pooled prevalence estimate.

The high prevalence of MRPs among CVD patients in Ethiopia highlights the need for targeted interventions to optimize medication management and improve patient outcomes. Healthcare providers should focus on individualized care, regular medication reviews, and patient education to address these problems effectively.