Medication Adherence in Diabetes Management in Sub‐Saharan Africa: A Systematic Review of Determinants and Strategies for Improvement

BACKGROUND AND AIMS: Diabetes mellitus poses a significant public health challenge in Sub-Saharan Africa (SSA), exacerbated by healthcare limitations, socioeconomic disparities and sociocultural factors affecting disease management. Medication adherence is critical for glycaemic control but remains suboptimal in this region. This review synthesises evidence on adherence to antidiabetic medications in SSA, identifies key determinants and suggests strategies to improve adherence. METHODS: A systematic review was conducted following PRISMA 2020 guidelines by searching PubMed, Scopus, Web of Science and African Journals Online for studies published between January 2015 and May 2025. Studies involving diabetic patients in SSA and assessing medication adherence were included. Data were extracted using a standardized form, and methodological quality was assessed using the Newcastle-Ottawa Scale. RESULTS: Twenty-six studies with over 6500 participants from 10 SSA countries were included. Adherence rates varied from 13.9% to 84.5%, with most settings reporting moderate to low adherence. Key determinants of non-adherence included socioeconomic barriers, therapy-related factors, health system limitations, and sociocultural influences. CONCLUSION: Effective interventions need to be culturally sensitive and address these multidimensional barriers. Future research should focus on longitudinal and interventional designs.