The Effects of Poor Self-Care Behaviors on Uncontrolled Hypertension in Ethiopia: A Systematic Review and Meta-Analysis

Abstract

Background and Aims

Hypertension affects nearly one in five adults in Ethiopia. Effective self-care behaviors, including medication adherence, regular physical activity, healthy dietary practices, weight management, moderation of alcohol intake, and avoidance of tobacco, are essential for optimal blood pressure (BP) control. Although individual studies have examined these behaviors, their combined contribution to uncontrolled hypertension in Ethiopia has not been comprehensively synthesized. This study aimed to evaluate the pooled effects of inadequate self-care behaviors on uncontrolled BP among hypertensive patients in Ethiopia.

Methods

A systematic review and meta-analysis were conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Electronic databases and gray literature sources were searched to identify observational studies reporting associations between self-care behaviors and uncontrolled hypertension in Ethiopia. Eligible studies were screened, and data were extracted using standardized tools. Study quality was assessed using the Joanna Briggs Institute (JBI) checklist. A random-effects meta-analysis was performed using STATA version 17.0 to estimate pooled odds ratios (PORs) with 95% confidence intervals (CIs).

Results

Inadequate self-care behaviors were significantly associated with uncontrolled hypertension. Medication non-adherence (POR: 2.29, 95% CI: 1.90–2.77), poor salt restriction (POR: 3.33, 95% CI: 1.83–6.07), insufficient physical activity (POR: 2.06, 95% CI: 1.53–2.77), inadequate weight management (POR: 2.31, 95% CI: 1.85–2.88), alcohol consumption (POR: 2.54, 95% CI: 1.37–4.73), and smoking (POR: 2.73, 95% CI: 1.51–4.94) were associated with higher odds of uncontrolled BP. Moderate to high heterogeneity was observed across studies. Sensitivity analyses confirmed the robustness of findings, and no significant publication bias was detected.

Conclusion

Poor self-care practices substantially contribute to uncontrolled hypertension in Ethiopia. Strengthening patient-centered interventions targeting adherence and lifestyle modification is essential to improve BP control and reduce hypertension-related complications.