Sikantongwe NancyMusonda ElliotMabaso FlorenceSikantongwe ErickChibwaya ElipiliousMapiki Chileleko2026-09-2310.64898/2026.09.11.26362862https://pubs.cidrz.org/handle/123456789/13756<jats:title>ABSTRACT</jats:title> <jats:sec> <jats:title>Background</jats:title> <jats:p>Hypertension is a leading modifiable risk factor for cardiovascular disease and premature death worldwide. Despite effective pharmacological therapy, poor adherence to anti-hypertensive medication remains the primary barrier to achieving blood pressure control, with non-adherence rates reaching 45-65% in sub-Saharan African settings. In Zambia, uncontrolled hypertension contributes substantially to hospital morbidity and mortality, yet context-specific data on adherence barriers remain limited. This study assessed factors associated with adherence to anti-hypertensive medication among patients attending Railway Surgery Urban Health Centre in Ndola, Zambia.</jats:p> </jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>A cross-sectional study was conducted among 237 hypertensive patients attending Railway Surgery Urban Health Centre in Ndola. A structured, interviewer-administered questionnaire assessed socio-demographic characteristics, clinical factors, and medication adherence using the modified Hill-Bone Compliance Scale. Data were analysed using descriptive statistics, chi-square tests, and multivariable logistic regression (p&lt;0.05).</jats:p> </jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>The overall adherence rate was 41.4%, with 58.6% of participants classified as non-adherent. The mean adherence score was 19.8 (SD=4.6) out of a possible 32. The most common reasons for non-adherence were running out of pills (mean=2.6), being away from home (mean=2.5), and forgetting to take medication (mean=2.4). Age (p=0.006), education level (p=0.001), and monthly income (p=0.001) were significantly associated with adherence. Clinical factors significantly associated with poorer adherence included presence of comorbidities (p=0.027), experience of side effects (p&lt;0.001), and medication regimen complexity (p=0.007). Multivariable analysis identified age ≥51 years (AOR=2.89-3.24), secondary/tertiary education (AOR=2.84-3.56), monthly income ≥K1,000 (AOR=2.21-5.89), absence of comorbidities (AOR=0.51), absence of side effects (AOR=0.36), and simpler regimens (AOR=0.34) as factors independently associated with adherence. Health system barriers included long distances, reliance on public transport, missed appointments due to transport problems (35.4%), medication stock-outs (38.4%), and inadequate counselling time (49.8% received &lt;5 minutes).</jats:p> </jats:sec> <jats:sec> <jats:title>Conclusion</jats:title> <jats:p>Adherence to anti-hypertensive medication at Railway Surgery Urban Health Centre is suboptimal, with multiple socio-demographic, clinical, and health system factors associated with non-adherence. Interventions should focus on regimen simplification, proactive side effect management, enhanced patient education, and addressing systemic barriers including medication supply and transport access.</jats:p> </jats:sec>https://doi.org/10.64898/2026.09.11.26362862