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Research Article | DOI: https://doi.org/10.31579/2641-0419/444
1 Department of Medicine Yekatite 12 Hospital Medical College, Addis Ababa, Ethiopia
2 Department of Medicine Sante Medical College Addis Ababa, Ethiopia
3 Department of Medicine, Addis Ababa University, College of Medicine and Health Science, Addis Ababa, Ethiopia.
4 Department of Medicine: Zhengzhou University College of medicine Henan province China
5 Department of Medicine, University of Gonder, College and Health Science, Ethiopia
6 Department of Medicine: Wachemo University Nigist Eleni Mohammed Memorial Comprehensive Specialized Hospital Hosaena, Ethiopia
7 Department of Medicine Jimma University Oromia Region, Ethiopia
8 Department of Medicine: Debre Tabor University College of Health Sciences, School of Medicine.
*Corresponding Author: Kidist Kenea Madessa - Department of Medicine Yekatite 12 Hospital Medical College, Addis Ababa, Ethiopia.
Citation: Kidist K. Madessa, Zemene Y. Afework, Lemlem T. Ergano, Tsion W. Asfaw, Wintana T. Desta, et al., (2025), Adherence to Antihypertensive Medications and Determinants Among Patients at Yekatit 12 Hospital, 2022 G.C, J Clinical Cardiology and Cardiovascular Interventions, 8(2); DOI: 10.31579/2641-0419/444
Copyright: © 2025, Kidist Kenea Madessa. 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.
Received: 18 January 2025 | Accepted: 29 January 2025 | Published: 07 February 2025
Keywords: assessment; adherence; antihypertensive medications; determinants
Background: Hypertension is a major global issue, with high morbidity and mortality rates. It is estimated to be 6% in Ethiopia and 30% in Addis Ababa. Adherence is the degree to which a person's medication-taking behaviour corresponds to the health care provider's medical advice. It encompasses both dosage frequency and timing of ingestion. Poor adherence is connected with poor illness outcomes and a waste of healthcare expenditures.
Objective: To assess the extent of Adherence to antihypertensive medications and the reasons for non-adherence among hypertensive patients.
Methodology: An institution-based cross-sectional study was conducted at Yekatit12 Hospital Medical College using structured questionnaires from February to May 2022 G.C. The collected data was processed and analyzed using computer software using SPSS version 21.0, presented in tables and figures and then interpreted based on the findings.
Results: - Of 127 respondents, 78 (61.9%) and 49 (38.8%) were Female and Male, respectively. The majority of the study participants, 73 (57.6%), were in the age group of 50-64. In a more significant proportion of patients, 88(69.4%), the cost of drugs was covered by themselves. At least one side effect of hypertensive medications had been reported by 60 (80%) of participants. Of the 127 study subjects, 79 (62.2%) were adherent, (37.8%) were non-adherent to their antihypertensive medication. The majority of patients (41.2%) reported stopping their medication when they felt better & only (10.2%) of them reported financial problems with stopping their medication.
Conclusion and Recommendation: - In general, these hypertensive individuals did not take their medications as prescribed. To enhance the patient's quality of life, pharmacists and other medical specialists must to work together. They must emphasize the value of following their hypertension treatment plan, its advantages, and the possibility of problems.
1.1 General Background
Hypertension is defined as elevated systolic blood pressure (SBP), diastolic blood pressure (DBP), or both. It is a global challenge, with hypertension (HTN) or high blood pressure (systolic BP ≥140 mmHg and diastolic BP ≥90 mmHg) ranking third as a cause of disability-adjusted life years. [1-4]. Hypertension causes 7.1 million premature deaths each year worldwide and accounts for 13% of all deaths globally. Analysis of the global burden of hypertension revealed that over 26% of the world's adult population had hypertension in 2000 [4, 5].
According to the Seventh Report of the Joint National Committee (JNC) on Hypertension, there are approximately 50 million hypertensive individuals in the United States only and 1 billion worldwide [6]. The prevalence of hypertension in Ghana has been increasing over the past years [7, 8]. In 2002, the prevalence rate was estimated at 35% of Ghanaians in the 40 – 45 age group and 40% in those above 55. The prevalence will be approximately 6% in those below 40 years. In this age group, the prevalence will be higher in males than females [7]. It has been identified as the most common cause of heart failure, stroke, chronic renal disease and spontaneous sudden deaths in Ghana [8].
In Sub-Saharan Africa, hypertension has also emerged as a serious public health problem. A meta-analysis of hypertension studies in the region reported that hypertension is more prevalent in urban than rural areas in all countries of the region. Also, hypertension is a significant public health problem in Sub-Saharan Africa, but unfortunately, most countries of the region lack the resources to detect, prevent and treat the disease [9]. Effects of Westernization, urbanization, changes in dietary patterns and sedentary lifestyles are among the factors fueling the epidemic of hypertension in sub-Saharan Africa [10]. In developing countries, morbidity and mortality are increasing from time to time due to a change in lifestyle and sedentary life. In Africa, 15% of the population has hypertension. Although there is a shortage of extensive data, 6% of the Ethiopian population has been estimated to have HTN. Approximately 30% of adults in Addis Ababa have hypertension above 140/90 mmHg or reported use of antihypertensive medication [11, 12].
There are effective medical therapies for hypertension management. However, only 37% of hypertensive patients in a 2003-2004 survey were reported to have their blood pressure controlled. Despite the development of many effective antihypertensive drugs, targets to reduce morbidity and mortality due to high blood pressure are reached in only a minor of patients in clinical practice. Many people with age indifference are attacked by this "silent killer," which results in target organ damage as a complication. [13]. The World Health Organization (WHO) describes poor Adherence as the most important cause of uncontrolled blood pressure and well documented that uncontrolled blood pressure increases the risk of ischemic heart disease 3-to 4-fold and the overall cardiovascular risk by 2-to 3-fold [13]
Nonadherent behavior depends on interacting variables related to patients' illness and environment. Adherence to life modifications and avoidance of non-recommended behaviors are necessary to control blood pressure [14]. Failure to adhere to medications can lead to poor blood pressure control and increased risk of cardiovascular complications like coronary artery disease, cerebrovascular disease, congestive heart failure, chronic renal failure and peripheral vascular disease [15]. There are many problems affecting human health worldwide. Hypertension and related complications are important health problems. Hypertension sufferers' non-adherence to their pharmacological regimen and lifestyle results in uncontrolled hypertension and consequent complications such as cardiovascular, renal and cerebrovascular diseases [16]. Poor Adherence is one of the biggest obstacles in therapeutic blood pressure control. The problem of non-adherence to medical treatment remains a challenge for the medical professions and social scientists, as a result, substantial numbers of patients do not get the maximum benefit of medical treatment, resulting in poor health outcomes, lower quality of life and increased health care costs. In spite of many advances made in adherence research, non-adherence rates have remained nearly unchanged in the last decades [17]. Prescribers uniformly underestimate the problems of non-adherence in their patients. If a healthcare professional cannot detect non-adherence, they can't correct the problem. Hence, it becomes imperative to measure and evaluate patient adherence reliably. This can be done by self-reporting, pill counting, and, in some cases, measuring serum or urine drug levels. Self-reporting is the most practicable and widely used tool [18]. Poor adherence to antihypertensive medication is frequently associated with a negative illness outcome and a waste of limited healthcare resources. In Ethiopia, particularly in the research area, little is known about adherence rates and associated factors. As a result, the purpose of this study is to analyze adherence to antihypertensive medication and related factors among patients on follow-up at Yekatit 12 Hospital Medical College in 2022.
1.2. Objectives
1.2.1 General objective
To investigate Adherence to antihypertensive medication regimens at Yekatit 12 Hospital Medical College from February to May 2022 G.C.
1.2.2 Specific Objectives:
1.3 Significance of The Study
As there have been no sufficient studies conducted about the Adhesion of hypertensive patients to their antihypertensive therapy, this study aimed to be a source of information on the prevalence of Adhesion to antihypertensive therapy and the factors that affect Adhesion to antihypertensive therapy.
This study can also increase awareness among prescribers, pharmacists, other healthcare professionals, and health managers in developing strategies to minimize non-adherence to antihypertensive medicines.
2.1 Study area &Study period
2.1.1 Study area
The study was conducted at Yekatit 12 Hospital and Medical College's, internal medicine department. Yekatit 12 Hospital was established in 11923G. Until the Ethiopian revolution of the 11970s, it was known as Haile Selassie I Hospital, named after Emperor Haile Selassie I. The hospital serves over 5 million people in its central 5 Departments in the catchment area.
Addis Ababa was chosen as the study setting due to its diverse population, representing various socioeconomic backgrounds and cultural contexts. The city is known for its well-established healthcare infrastructure, making it a suitable location to access a significant number of emergency patients. An institutional-based cross-sectional study will be carried out in the study was conducted at Yekatit 12 Hospital and Medical College's Internal Medicine Department. Yekatit 12 Hospital was established in 11923G. Until the Ethiopian revolution of the 11970s, it was known as Haile Selassie I Hospital, named after Emperor Haile Selassie I. In addition, Yekatit 12 Hospital Medical College maintains electronic medical record systems, which streamline the process of collecting data for this study. These records contain detailed information on patient demographics, medical history, investigation results, diagnoses and disease progress over time. The hospital serves over 5 million people in its central 5 Departments in the catchment area.
Addis Ababa was chosen as the study setting due to its diverse population, representing various socioeconomic backgrounds and cultural contexts. The city is known for its well-established healthcare infrastructure, making it a suitable location to access a significant number of emergency patients. An institutional-based cross-sectional study will be carried out in Yekatit 12 hospital medical colleges from February to May at 2022 G.C.
2.1.2 Study period
This study was conducted at Yekatit 12 hospital medical colleges from February to May 2022 G.C.
2.2 Study design
A retrospective cross-sectional study design was used among hypertensive patients on follow-up in Yekatit 12 hospital medical colleges from February to May 2022 G.C.
2.3 Population
2.3.1 Source population
All hypertensive patients who are on the antihypertensive medication in Yekatit 12 hospital medical colleges.
2.3.2 Study population
All adult hypertensive patients on antihypertensive medication who were visiting at Yekatit 12 hospital medical colleges from February to May 2022 G.C.at the chronic ambulatory care unit and fulfilling the inclusion criteria throughout the study period were used.
2.4 Inclusion and exclusion criteria
2.4.1 Inclusion criteria
Hypertensive patients who are on follow-up as outpatients, at the age of 18 or above and less than 80, have been on medication for at least 6 months.
2.4.2 Exclusion criteria
Hypertensive patients who are admitted to inpatient wards, pregnancy-related hypertensive patients, and patients who have been on medication for less than six months.
2.5 Sample Size Determination and Sampling Techniques.
This study included all hypertensive patients at Yekatit 12 hospital medical colleges from February to May 2022 G.C. who had follow-up and fulfilled the inclusion criteria.
2.6 Data Collection Method
Data was collected using a structured standard questionnaire, which contains questions descriptive of the demographic status of the patient and factors affecting Adherence to antihypertensive medication was used as a data collection instrument.
2.7 Study Variables
2.7.1 Independent Variables
2.7.2 Dependent Variables
2.8 Definitions of terms
Adherence- is the extent to which a person's medication-taking behavior coincides with the healthcare provider's medical advice
Fully Adherent - Those who take adequate amounts of medications in accordance with prescribed regimens.
Partially Adherent - Those who take many doses but not regularly enough to control their disease.
Non-adherent - Those who take few or no doses.
Over-adherent - Involves taking doses too.
Hypertension is defined as persistent systolic blood pressure equal to and greater than 140 mmHg and/or diastolic blood pressure equal to and greater than 90 mmHg.
A hypertensive patient refers to a person diagnosed with hypertension, as defined above.
Factors are conditions of hypertensive patients that influence the development and course of the disease.
Lifestyle: attitudes, habits and behaviors of hypertension patients.
2.9 Data quality control
The principal investigator collected the data. Before starting the data collection, the data collection format was cross-matched with available information on records; then, the study questions were rearranged as necessary. The incomplete chart was discarded.
2.10 Data collection process& analysis
All the necessary data was collected using the structured standard questionnaire. The questionnaire was presented to each patient as an interview with proper explanation. Patient medication charts were reviewed carefully to assess the characteristics of hypertension and antihypertensive treatment.
The collected quantitative data was checked for completeness, accuracy, and consistency, ensuring no instructions were missed during the entry process. Frequencies, proportions and summaries were used to describe the study population into relevant variables. Then, the Data was coded, entered, and analyzed using a Statistical package for social science.
2.11 Ethical considerations
The Ethical Review Committee of the Yekatit 12 Hospital Public Health Department provided a formal letter of permission. Each questionnaire's cover page included an introduction to the study, a method of inquiry, and a confidentiality letter. The participants were informed that they had complete freedom to participate or not participate in the study, and that they might withdraw at any moment during the interview. Strict secrecy was maintained by utilizing codes instead of the patient's name, and no information was shared with anybody not directly involved in the study without the patient's permission.
2.12 Limitation of the study
This study has the following limitations: self-reporting was the only method of measuring Adherence. This method has the disadvantages of recall bias and eliciting only socially acceptable responses, which may overestimate Adherence. In addition, it didn't consider HTN patients who did not fulfill the study's inclusion criteria. Hence, the generalizability is limited to similar patients on chronic illness follow-up care for at least six months and a short study period.
3.1. Socio-demographic characteristics
A total of 127 patients were interviewed using a standardized structured questionnaire. Among these, 78 (61.2%) were females & 49 (38.8%) were males. Most of the study participants, 73 (57.6%), were 50-64. Sixty-seven respondents (52.2%) were currently married, whereas only 3(2.7%) were widowed. Most of the respondents, 71 (55.9%), were Muslim, and 88 (69.4%) participants were Oromo. A significant number, 48 (37.6%) of the respondents did attend formal education until secondary school, while 9(7.1%) were illiterate. Of the total respondents, 37(29.1%) were employed, and only 28(22%) were farmers. The monthly income of the majority of the respondents, 46(36.2%), was 500-1000 birr, whereas 45(35.4%) had a monthly income greater than 2000 birr. 52 (40.9%) were from Jimma town and 31(24.4%) and 44(34.6%) came from other urban and rural areas respectively. Details on the socio- demographic characteristics can be obtained from Table 1.
| Sociodemographic characteristic | Frequency | Percentage | |
| Sex | Male | 49 | 38.6% |
| Female | 78 | 61.4% | |
| Age | 18-24 | 5 | 3.9% |
| 25-49 | 42 | 32.5% | |
| 50-64 | 73 | 57.6% | |
| >64 | 7 | 5.9% | |
| Marital status | Married | 67 | 52.2% |
| Single | 39 | 31.8% | |
| Divorce | 17 | 13.3% | |
| Widowed | 4 | 3.1% | |
Ethnicity
| Oromo | 88 | 69.4% |
| SNNP | 26 | 20.4% | |
| Amhara | 10 | 7.8% | |
| Other | 3 | 2.4% | |
Religion
| Protestant | 18 | 13.7% |
| Orthodox | 37 | 29.1% | |
| Muslim | 71 | 55.9% | |
| Others(catholic) | 1 | 0.7% | |
| Education level | Uneducated/illiterate | 9 | 7.1% |
| Primary school | 30 | 23.9% | |
| Secondary school | 49 | 37.6% | |
| Graduate/above | 39 | 30.2% | |
| Occupation | Housewife | 14 | 11% |
| Employed | 37 | 29.1% | |
| Farmer | 28 | 22% | |
| Daily laborer | 9 | 7.1% | |
| Merchants | 21 | 16.5% | |
| Students | 15 | 11.8% | |
| No job | 3 | 2.4% | |
| Residence | Jimma town | 52 | 40.9% |
| Other urban area | 31 | 24.4% | |
| Rural area | 44 | 34.6% | |
| Monthly income | 500-1000 | 46 | 36.5% |
| 1000-2000 | 36 | 28.5% | |
| >2000 | 45 | 35.3% | |
Table 1: Sociodemographic characteristics of hypertensive patients at the chronic ambulatory at Yekatit 12 hospital medical colleges from February to May 2022 G.C.
3.2 Percentage of drug adherence
Figure 1: Percentage of respondents' Adherence to antihypertensive medication at the chronic ambulatory in Yekatit 12 hospital medical colleges from February to May 2022 G.C.
Based on the MMAS majority, 79(62.2%) of the 127 patients were adherent to their antihypertensive medication (MMAS>=3), whereas 48(37.8%) were non-adherent. About 99% of patients believe that medication adherence is essential; 45 adherent respondents were male, 37 were female, 17 non-adherent respondents were male, and 28 were female.
3.3 Reason for Non-adherence
Figure 2: Reason for Non-adherence of hypertensive patients at chronic ambulatory care in Yekatit 12 hospital medical colleges from February to May 2022 G.C.
The most common reason cited by the respondents for being non-adherent was feeling better, which accounts for 52(41.2%). 37(28.9%) forgetfulness,36(28.4%) when feeling worse, 13(10.2%) lack of money, and 6(5.1%) negligence were other reasons stated by patients. 3 (2.7%) stopped their medication due to medication adverse effects. Among 127 respondents, 125(98.4%) of the patients responded that lifestyle is essential for treating hypertension.
| Variable | Possible response | Frequency | Percentage |
| cost of drug | Free of payment | 39 | 30.6% |
| Self /by using charge | 88 | 69.4% | |
| follow up | Every 1month | 65 | 50.6% |
| Every 2month | 36 | 28.6% | |
| Every 3month | 19 | 14.5% | |
| Have no regular follow-up | 8 | 6.3% | |
| Distance from health center | <30> | 50 | 39.3% |
| 30min -1hr | 40 | 31.4% | |
| 1-2hr | 28 | 22% | |
| >2hr | 9 | 7% |
Table 2: Distribution of medication cost and related factors among hypertensive in Yekatit 12 hospital medical colleges from February to May 2022 G.C.
Regarding who covers the cost of drugs, 88 (69.4%), a large proportion of patients replied that they cover it by themselves. At the same time, 39(30.6) got free of charge. Among the patients on follow-up, 53(41.2%) took antihypertensive medication over one year & 15(11.8%) took medication for six months. 89(69.9%) of patient perform exercise, most of the patient 50(39.3%) travel less than 30min to reach health center.
3.4. Contraindicated substance
| Variable | Frequency | Percentage |
| Animal fat | 7 | 5.1% |
| Salt | 31 | 24.3% |
| Coffee | 22 | 16.9% |
| Alcohol | 26 | 20.9% |
| Smoke cigarette | 15 | 11.9% |
| Chew-chat | 53 | 41.6% |
Table 3: Distribution of contra indicated substance taken by patient on follow-up at chronic ambulatory care in Yekatit 12 hospital medical colleges from February to May 2022 G.C
Among 127 Participants, 74(58.3%) of the patients stopped taking contra-indicated substances, but 41.7% still taking contraindicate substances. Among 127 participant 0nly 15(11.9%) were smoker, from this only 2(1.6%) smoke always.
| Duration of HTN medication | Frequency | Percentage |
| 6 months | 3 | 2.4% |
| 6-12 month | 15 | 11.8% |
| One year | 39 | 30.5% |
| >one year | 70 | 55.3% |
Table 4: The duration of patients taking antihypertensive medication in Yekatit 12 hospital medical colleges from February to May 2022 G.C.
From 127 participants, 102(80%) had regular follow-up, and 8(6.3%) had no regular follow-up.
| Age of respondents | |||
| 18-24 years | 25-49 years | 50-64 years | >64 years | |
| Adherent | 3 | 29 | 42 | 5 |
| Non-Adherent | 2 | 13 | 30 | 3 |
| Total | 5 | 42 | 72 | 8 |
Table 5: Adherence and age Cross tabulation
Ensuring patients' Adherence to anti-hypertension medication to prevent complications of hypertension remains a major challenge to public health in many developing countries. Poor Adherence to treatment is the single most important reason for uncontrolled hypertension, serious complications and the wastage of health care resources. Several factors, which may be patient or health system-related, continue to militate against adherence behaviour [3]. The majority of participants in this study, 78 (61.2%), were female, while 57, 6 % of the study subjects were between 50 and 64, and 7. were illiterate.
This goes in line with a study done in Malaysia in which females are (62.8%), but in a study done in Malaysia, 69.2% of the study subjects were at the age≥50 years [19]. A large proportion of the subjects, 67(52.2%), were married, which is almost similar to the reported figure from Gondar, Ethiopia (20), in which 60.7% were married and lower than the reported figure from Nigeria [21], in which 78.4% were married. Most of the subjects lack family support for their Adherence. Only 36(28.6%) patients get family support to buy medication, and 69.4% pay their medication expenses alone. At the same time, 30.6% of the subjects get the medication free. In a study done in Pakistan [22], the availability of a support system was greater (54%), while payment of medical expenses was higher (93.8% of the patients paid their medication by themselves, and 37% of them got medication expenses covered by the family). Of 127, only 3(2.7%) stopped their medication due to medication adverse effects; this is relatively low when compared with a study done in Finland in which 33%of participants stopped their medication due to adverse effects of medication; this variation may be due to increasing patient awareness about disease & medication use
The majority of patients (55.3%) in this study had been on antihypertensive medication for more than one year. Similarly, in the study conducted in Ghana, more than half of the patients (53%) had been on antihypertensive medication for more than one year [6]. However, in another study done in Brazil [23], more than half (55%) of the study subjects had been receiving treatment for more than three years. This shows that patients in our country do not have the trend of long-term medical follow-ups in comparison with those in Brazil.
Only 62.2% of the study participants were adherent, while 37.8% % were non-adherent. This was similar to the study conducted in Malaysia [19], in which 53.4% were adherents. It is however almost similar to the study done in Gondar [20] (64.6%) were adherent and from the study done in Nigeria [34] which was based on patients' self-report adherence rating, (64.4%) of the patients adhered strictly to their medications while (35.5%) not adherents to their medication.
This study is relatively high compared to the survey done in Adama Referral Hospital. Of 365 participants, 217 (59.5%) adhered to medication, while the rest did not. This variation is May due to increased patient awareness about disease and medication use.
A study in Seychelles reported magnitudes of adherents engaged in physical exercise were (50%), but in this study, 88(69.3%) of the patients performed the exercise. In this study15 (11.9%) smoke cigarettes. It is a relatively similar study on Seychelles, where 15.84% were smokers. 32(24.3%) respondents used salt, which is identical to the study done on Seychelles (24.51%), were used salt.
From the total of 127 participants, only 26(20.9%) drank alcohol. This is in line with the study done in Hawasa Referral Hospital. Out of 104 respondents, 21 (20.9% %) ingested alcohol, and 52(41.6%) chewed chat. This is relatively high compared with the study done in Hawasa Referral Hospital, in which only 14(13.46%) chewed chat. This is because there is a high prevalence of chat in Jimma. Regarding perception, all respondents (100%) think that changing lifestyle-modifying regimens is essential in improving disease. This is a similar study done in Hawasa Referral Hospital.
In this study, Adhesion is assessed using the interview method. This method is simple and practical. However, its output might be overestimated. To prevent this, questions in the MMAS are phrased to avoid "yes saying" bias by reversing the wording of the questions about how patients might experience failure in following their medication regimen. It should be noted that not only entirely non-adherent patients are in trouble. The level of non-adherence is even more dangerous as it might lead the patient not to think the medications are working. Co-morbidities can worsen the conditions of the patient and make them unable to adhere to their antihypertensive medications.
Right knowledge about HTN and its treatment creates a clear understanding and avoids confusion about the treatment and the disease condition. Knowledge about HTN and its treatment was positively associated with adherence behavior. Patients with better awareness were more likely to adhere to their treatment. A similar study from Pakistan and Gaza demonstrated that patients who were aware of their diseases and treatments had been attributable to better outcomes of the treatment, which may offer the patient good satisfaction and create strong motivation towards the treatment. However, a lousy outcome (uncontrolled BP) could make the patient hopeless and low satisfaction and hence urge them to stop their treatment.
Poor adherence to antihypertensive medication is typically associated with a worse illness outcome and a waste of limited healthcare resources. In Ethiopia, particularly in the research area, little is known regarding the adherence status and associated factors. As a result, the purpose of this study is to analyze the adherence status and associated factors for antihypertensive medication among patients on follow-up at Yekatit 12 Hospital Medical College in 2022.
The study estimated that 62.2% of patients adhered to antihypertensive treatment and 37.8% did not. This has several ramifications for the country's health-care system and pharmacy practices. The ideas below are intended to help health institutions provide better drug counseling and develop greater adherence rates.
Abbreviation
AIDS Acquired Immunodeficiency Syndrome
AKU-ADS Aga Khan University Anxiety and Depression Scale
AKUH Aga Khan University Hospital
BP Blood Pressure
GPHA Ghana Ports and Harbors Authority
HTN Hypertension
JNC Joint National Commit
MMAS Morisky Medication Adherence Scale
mmHg Millimeter Mercury
NHSP National Health Survey of Pakistan
SNNPR South Nation nationality people Region
WHO World Health Organization
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Thank you very much for publishing my Research Article titled “Comparing Treatment Outcome Of Allergic Rhinitis Patients After Using Fluticasone Nasal Spray And Nasal Douching" in the Journal of Clinical Otorhinolaryngology. As Medical Professionals we are immensely benefited from study of various informative Articles and Papers published in this high quality Journal. I look forward to enriching my knowledge by regular study of the Journal and contribute my future work in the field of ENT through the Journal for use by the medical fraternity. The support from the Editorial office was excellent and very prompt. I also welcome the comments received from the readers of my Research Article.
Dear Erica Kelsey, Editorial Coordinator of Cancer Research and Cellular Therapeutics Our team is very satisfied with the processing of our paper by your journal. That was fast, efficient, rigorous, but without unnecessary complications. We appreciated the very short time between the submission of the paper and its publication on line on your site.
I am very glad to say that the peer review process is very successful and fast and support from the Editorial Office. Therefore, I would like to continue our scientific relationship for a long time. And I especially thank you for your kindly attention towards my article. Have a good day!
"We recently published an article entitled “Influence of beta-Cyclodextrins upon the Degradation of Carbofuran Derivatives under Alkaline Conditions" in the Journal of “Pesticides and Biofertilizers” to show that the cyclodextrins protect the carbamates increasing their half-life time in the presence of basic conditions This will be very helpful to understand carbofuran behaviour in the analytical, agro-environmental and food areas. We greatly appreciated the interaction with the editor and the editorial team; we were particularly well accompanied during the course of the revision process, since all various steps towards publication were short and without delay".
I would like to express my gratitude towards you process of article review and submission. I found this to be very fair and expedient. Your follow up has been excellent. I have many publications in national and international journal and your process has been one of the best so far. Keep up the great work.
We are grateful for this opportunity to provide a glowing recommendation to the Journal of Psychiatry and Psychotherapy. We found that the editorial team were very supportive, helpful, kept us abreast of timelines and over all very professional in nature. The peer review process was rigorous, efficient and constructive that really enhanced our article submission. The experience with this journal remains one of our best ever and we look forward to providing future submissions in the near future.
I am very pleased to serve as EBM of the journal, I hope many years of my experience in stem cells can help the journal from one way or another. As we know, stem cells hold great potential for regenerative medicine, which are mostly used to promote the repair response of diseased, dysfunctional or injured tissue using stem cells or their derivatives. I think Stem Cell Research and Therapeutics International is a great platform to publish and share the understanding towards the biology and translational or clinical application of stem cells.
I would like to give my testimony in the support I have got by the peer review process and to support the editorial office where they were of asset to support young author like me to be encouraged to publish their work in your respected journal and globalize and share knowledge across the globe. I really give my great gratitude to your journal and the peer review including the editorial office.
I am delighted to publish our manuscript entitled "A Perspective on Cocaine Induced Stroke - Its Mechanisms and Management" in the Journal of Neuroscience and Neurological Surgery. The peer review process, support from the editorial office, and quality of the journal are excellent. The manuscripts published are of high quality and of excellent scientific value. I recommend this journal very much to colleagues.
Dr.Tania Muñoz, My experience as researcher and author of a review article in The Journal Clinical Cardiology and Interventions has been very enriching and stimulating. The editorial team is excellent, performs its work with absolute responsibility and delivery. They are proactive, dynamic and receptive to all proposals. Supporting at all times the vast universe of authors who choose them as an option for publication. The team of review specialists, members of the editorial board, are brilliant professionals, with remarkable performance in medical research and scientific methodology. Together they form a frontline team that consolidates the JCCI as a magnificent option for the publication and review of high-level medical articles and broad collective interest. I am honored to be able to share my review article and open to receive all your comments.
“The peer review process of JPMHC is quick and effective. Authors are benefited by good and professional reviewers with huge experience in the field of psychology and mental health. The support from the editorial office is very professional. People to contact to are friendly and happy to help and assist any query authors might have. Quality of the Journal is scientific and publishes ground-breaking research on mental health that is useful for other professionals in the field”.
Dear editorial department: On behalf of our team, I hereby certify the reliability and superiority of the International Journal of Clinical Case Reports and Reviews in the peer review process, editorial support, and journal quality. Firstly, the peer review process of the International Journal of Clinical Case Reports and Reviews is rigorous, fair, transparent, fast, and of high quality. The editorial department invites experts from relevant fields as anonymous reviewers to review all submitted manuscripts. These experts have rich academic backgrounds and experience, and can accurately evaluate the academic quality, originality, and suitability of manuscripts. The editorial department is committed to ensuring the rigor of the peer review process, while also making every effort to ensure a fast review cycle to meet the needs of authors and the academic community. Secondly, the editorial team of the International Journal of Clinical Case Reports and Reviews is composed of a group of senior scholars and professionals with rich experience and professional knowledge in related fields. The editorial department is committed to assisting authors in improving their manuscripts, ensuring their academic accuracy, clarity, and completeness. Editors actively collaborate with authors, providing useful suggestions and feedback to promote the improvement and development of the manuscript. We believe that the support of the editorial department is one of the key factors in ensuring the quality of the journal. Finally, the International Journal of Clinical Case Reports and Reviews is renowned for its high- quality articles and strict academic standards. The editorial department is committed to publishing innovative and academically valuable research results to promote the development and progress of related fields. The International Journal of Clinical Case Reports and Reviews is reasonably priced and ensures excellent service and quality ratio, allowing authors to obtain high-level academic publishing opportunities in an affordable manner. I hereby solemnly declare that the International Journal of Clinical Case Reports and Reviews has a high level of credibility and superiority in terms of peer review process, editorial support, reasonable fees, and journal quality. Sincerely, Rui Tao.
Clinical Cardiology and Cardiovascular Interventions I testity the covering of the peer review process, support from the editorial office, and quality of the journal.
Clinical Cardiology and Cardiovascular Interventions, we deeply appreciate the interest shown in our work and its publication. It has been a true pleasure to collaborate with you. The peer review process, as well as the support provided by the editorial office, have been exceptional, and the quality of the journal is very high, which was a determining factor in our decision to publish with you.
The peer reviewers process is quick and effective, the supports from editorial office is excellent, the quality of journal is high. I would like to collabroate with Internatioanl journal of Clinical Case Reports and Reviews journal clinically in the future time.
Clinical Cardiology and Cardiovascular Interventions, I would like to express my sincerest gratitude for the trust placed in our team for the publication in your journal. It has been a true pleasure to collaborate with you on this project. I am pleased to inform you that both the peer review process and the attention from the editorial coordination have been excellent. Your team has worked with dedication and professionalism to ensure that your publication meets the highest standards of quality. We are confident that this collaboration will result in mutual success, and we are eager to see the fruits of this shared effort.
Dear Dr. Jessica Magne, Editorial Coordinator 0f Clinical Cardiology and Cardiovascular Interventions, I hope this message finds you well. I want to express my utmost gratitude for your excellent work and for the dedication and speed in the publication process of my article titled "Navigating Innovation: Qualitative Insights on Using Technology for Health Education in Acute Coronary Syndrome Patients." I am very satisfied with the peer review process, the support from the editorial office, and the quality of the journal. I hope we can maintain our scientific relationship in the long term.
Dear Monica Gissare, - Editorial Coordinator of Nutrition and Food Processing. ¨My testimony with you is truly professional, with a positive response regarding the follow-up of the article and its review, you took into account my qualities and the importance of the topic¨.
Dear Dr. Jessica Magne, Editorial Coordinator 0f Clinical Cardiology and Cardiovascular Interventions, The review process for the article “The Handling of Anti-aggregants and Anticoagulants in the Oncologic Heart Patient Submitted to Surgery” was extremely rigorous and detailed. From the initial submission to the final acceptance, the editorial team at the “Journal of Clinical Cardiology and Cardiovascular Interventions” demonstrated a high level of professionalism and dedication. The reviewers provided constructive and detailed feedback, which was essential for improving the quality of our work. Communication was always clear and efficient, ensuring that all our questions were promptly addressed. The quality of the “Journal of Clinical Cardiology and Cardiovascular Interventions” is undeniable. It is a peer-reviewed, open-access publication dedicated exclusively to disseminating high-quality research in the field of clinical cardiology and cardiovascular interventions. The journal's impact factor is currently under evaluation, and it is indexed in reputable databases, which further reinforces its credibility and relevance in the scientific field. I highly recommend this journal to researchers looking for a reputable platform to publish their studies.
Dear Editorial Coordinator of the Journal of Nutrition and Food Processing! "I would like to thank the Journal of Nutrition and Food Processing for including and publishing my article. The peer review process was very quick, movement and precise. The Editorial Board has done an extremely conscientious job with much help, valuable comments and advices. I find the journal very valuable from a professional point of view, thank you very much for allowing me to be part of it and I would like to participate in the future!”
Dealing with The Journal of Neurology and Neurological Surgery was very smooth and comprehensive. The office staff took time to address my needs and the response from editors and the office was prompt and fair. I certainly hope to publish with this journal again.Their professionalism is apparent and more than satisfactory. Susan Weiner
My Testimonial Covering as fellowing: Lin-Show Chin. The peer reviewers process is quick and effective, the supports from editorial office is excellent, the quality of journal is high. I would like to collabroate with Internatioanl journal of Clinical Case Reports and Reviews.
My experience publishing in Psychology and Mental Health Care was exceptional. The peer review process was rigorous and constructive, with reviewers providing valuable insights that helped enhance the quality of our work. The editorial team was highly supportive and responsive, making the submission process smooth and efficient. The journal's commitment to high standards and academic rigor makes it a respected platform for quality research. I am grateful for the opportunity to publish in such a reputable journal.
My experience publishing in International Journal of Clinical Case Reports and Reviews was exceptional. I Come forth to Provide a Testimonial Covering the Peer Review Process and the editorial office for the Professional and Impartial Evaluation of the Manuscript.
I would like to offer my testimony in the support. I have received through the peer review process and support the editorial office where they are to support young authors like me, encourage them to publish their work in your esteemed journals, and globalize and share knowledge globally. I really appreciate your journal, peer review, and editorial office.
Dear Agrippa Hilda- Editorial Coordinator of Journal of Neuroscience and Neurological Surgery, "The peer review process was very quick and of high quality, which can also be seen in the articles in the journal. The collaboration with the editorial office was very good."
I would like to express my sincere gratitude for the support and efficiency provided by the editorial office throughout the publication process of my article, “Delayed Vulvar Metastases from Rectal Carcinoma: A Case Report.” I greatly appreciate the assistance and guidance I received from your team, which made the entire process smooth and efficient. The peer review process was thorough and constructive, contributing to the overall quality of the final article. I am very grateful for the high level of professionalism and commitment shown by the editorial staff, and I look forward to maintaining a long-term collaboration with the International Journal of Clinical Case Reports and Reviews.
To Dear Erin Aust, I would like to express my heartfelt appreciation for the opportunity to have my work published in this esteemed journal. The entire publication process was smooth and well-organized, and I am extremely satisfied with the final result. The Editorial Team demonstrated the utmost professionalism, providing prompt and insightful feedback throughout the review process. Their clear communication and constructive suggestions were invaluable in enhancing my manuscript, and their meticulous attention to detail and dedication to quality are truly commendable. Additionally, the support from the Editorial Office was exceptional. From the initial submission to the final publication, I was guided through every step of the process with great care and professionalism. The team's responsiveness and assistance made the entire experience both easy and stress-free. I am also deeply impressed by the quality and reputation of the journal. It is an honor to have my research featured in such a respected publication, and I am confident that it will make a meaningful contribution to the field.
"I am grateful for the opportunity of contributing to [International Journal of Clinical Case Reports and Reviews] and for the rigorous review process that enhances the quality of research published in your esteemed journal. I sincerely appreciate the time and effort of your team who have dedicatedly helped me in improvising changes and modifying my manuscript. The insightful comments and constructive feedback provided have been invaluable in refining and strengthening my work".
I thank the ‘Journal of Clinical Research and Reports’ for accepting this article for publication. This is a rigorously peer reviewed journal which is on all major global scientific data bases. I note the review process was prompt, thorough and professionally critical. It gave us an insight into a number of important scientific/statistical issues. The review prompted us to review the relevant literature again and look at the limitations of the study. The peer reviewers were open, clear in the instructions and the editorial team was very prompt in their communication. This journal certainly publishes quality research articles. I would recommend the journal for any future publications.
Dear Jessica Magne, with gratitude for the joint work. Fast process of receiving and processing the submitted scientific materials in “Clinical Cardiology and Cardiovascular Interventions”. High level of competence of the editors with clear and correct recommendations and ideas for enriching the article.
We found the peer review process quick and positive in its input. The support from the editorial officer has been very agile, always with the intention of improving the article and taking into account our subsequent corrections.
