Social Determinants of Non-Communicable Disease Medication Adherence among Low-Income Urban Dwellers in Kano Metropolis, North West Nigeria

Background: The social determinants of health significantly shape medication adherence in patients with non-communicable diseases (NCDs) in low-income urban settings. In Nigeria, where out-of-pocket drug expenditure is high, socioeconomic factors intersect with behavioural and healthcare system variables to produce patterns of poor adherence. This study examined social determinants of NCD medication adherence among low-income urban dwellers in Kano metropolis. Methods: A cross-sectional analytical study was conducted among 360 NCD patients (hypertension, diabetes, asthma, and heart failure) from four urban primary healthcare centres in Kano. Medication adherence was assessed using the MMAS-8. Social determinants assessed included household income, food security, social support network, employment status, and neighbourhood healthcare access score. Structural equation modelling examined direct and indirect pathways to adherence. Results: Low adherence was found in 48 percent of participants. Structural equation modelling revealed that food insecurity had the strongest direct effect on poor adherence (beta -0.38), followed by low social support (beta -0.27) and limited healthcare access (beta -0.24). Income had a significant indirect effect mediated through food security. Conclusion: Social determinants, particularly food insecurity and social isolation, are powerful drivers of NCD medication non-adherence in Kano. Social protection programmes and community health networks must be integrated into NCD management frameworks. Keywords: social determinants, medication adherence, non-communicable diseases, Kano, food insecurity