Adherence to Treatment With Artemether-Lumefantrine for Uncomplicated Malaria in Rural Malawi

Mace, Kimberly E.; Mwandama, Dyson; Jafali, James; Luka, Madalitso; Filler, Scott; Sande, John; Ali, Doreen; Kachur, S. Patrick; Mathanga, Don P.; Skarbinski, Jacek

doi:10.1093/cid/cir498

Cited by 66 publications

(106 citation statements)

References 13 publications

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“…Some of the respondents confirmed that during the course of therapy they either skipped a dose of their medication or did not continue therapy as soon as they got relief from the symptoms of the disease. This corresponds with recent reports that certain individuals frequently use medicines incompletely or halt the management once the signs lessen and preserve the rest to be used later (Mace et al, 2011). Forgetfulness and poor patient-health professional relationship have been shown to affect adherence to the usage of medicines including ACTs (Osterberg and Blaschke, 2005).…”

Section: Discussionsupporting

confidence: 80%

Artemisinin combination therapy use in Federal Capital Territory, Nigeria

Aboh¹,

Emeje²,

Oladosu³

et al. 2016

Afr. J. Pharm. Pharmacol.

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There is an alarming rise in treatment failures from artemisinin combination therapy (ACT). The aim of this study was to access the therapeutic effectiveness of ACT in the market and the rate of reoccurrence of malaria shortly after completion of therapy. The rate of adherence to therapy and relapse rate of four hundred volunteers, who recently treated malaria, were assessed using quantitative interview-semi structured questionnaire. Adherence levels were 56.0% while relapse rate was 47.0%. The rate of relapse among volunteers who adhered to therapy was 40.63%. While encouraging continuous quality assessment of artemisinin combination drugs, it is equally important for public health practitioners and institutions to design deliberate programs to enlighten the public on the importance of adherence to therapy as this rather than quality of medicines may be contributing largely to drug resistance.

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Section: Discussionsupporting

confidence: 80%

Artemisinin combination therapy use in Federal Capital Territory, Nigeria

Aboh¹,

Emeje²,

Oladosu³

et al. 2016

Afr. J. Pharm. Pharmacol.

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“…Other research with non-pregnant participants has highlighted mixed levels of adherence to AL: 90% probably adherent in southwest Uganda [34], compared to 65% in southern Malawi [35] and 38% in northern Ethiopia [36]; whereas only 1.7% of over 500 respondents missed a dose in rural Tanzania [37]. The range of adherence results from the varied contexts in which the research was conducted and the study designs (including the definition of adherence) [36].…”

Section: Discussionmentioning

confidence: 99%

The acceptability of intermittent screening and treatment versus intermittent preventive treatment during pregnancy: results from a qualitative study in Northern Ghana

Pell

Meñaca

Chatio

et al. 2014

Malar J

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BackgroundAffecting mother and child, malaria during pregnancy (MiP) provokes a double morbidity and mortality burden. Within a package of interventions to prevent MiP in endemic areas, the WHO currently recommends intermittent preventive treatment (IPTp). Concerns about anti-malarial resistance have however prompted interest in intermittent screening and treating (IST) as an alternative approach to IPTp. IST involves screening for malaria infection at scheduled antenatal care (ANC) clinic visits and treating malaria cases. In light of the need to comprehensively evaluate new interventions prior to roll out, this article explores the acceptability of IST with artemether-lumefantrine (AL) compared to IPTp with sulphadoxine-pyrimethamine (SP) and in Upper East Region, northern Ghana.MethodsData were collected alongside an open-label, randomized, controlled trial of IST-AL and IPTp-SP in Kassena-Nankana District. Thirty pregnant women enrolled in the clinical trial participated in six focus group discussions. Ten in-depth interviews were carried out with clinical trial staff. Observations were also made at the health facilities where the clinical trial took place.ResultsTrial participants were generally willing to endure the discomfort of the finger prick necessary for a rapid diagnostic test for malaria and this reflected a wider demand for diagnostic techniques. Reports of side effects were however linked to both trial anti-malarials. Direct complaints about SP were particularly severe with regard to women’s experience of vomiting. Although the follow-up treatment doses of AL for IST were not supervised, based on blister inspection and questioning trial, staff were confident about participants’ adherence to the treatment course. One case of partial adherence to the AL treatment course was reported.ConclusionDespite the discomfort of the finger prick required to perform the intermittent malaria screening, trial participants generally expressed more positive sentiments towards IST-AL than IPTp-SP. Nonetheless, questions remain about adherence to a multiple dose anti-malarial regimen during pregnancy, particularly in endemic areas where MiP is often non-symptomatic. Any implementation of IST must be accompanied by appropriate health messages on adherence and the necessary training for health staff regarding case management.

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“…For example, patients may not understand how to correctly take the medication, 45,56-60 they may forget to take their pills, 18,56,58,59 they may be saving some pills for a future malaria episode, 45,56 or they may stop taking the medication once they feel better. 61,62 In our study, we found no relationship between literacy or education and adherence, and we also found that 91% of patients took the first two doses of AL with the correct number of pills at approximately the correct time (data not shown).…”

Section: Discussionmentioning

confidence: 99%

Can Rapid Diagnostic Testing for Malaria Increase Adherence to Artemether–Lumefantrine?: A Randomized Controlled Trial in Uganda

Saran¹,

Yavuz²,

Kasozi³

et al. 2016

The American Society of Tropical Medicine and Hygiene

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Abstract. Most patients with suspected malaria do not receive diagnostic confirmation before beginning antimalarial treatment. We investigated the extent to which uncertainty about malaria diagnosis contributes to patient nonadherence to artemether-lumefantrine (AL) treatment through a randomized controlled trial in central Uganda. Among 1,525 patients purchasing a course of AL at private drug shops, we randomly offered 37.6% a free malaria rapid diagnostic test (RDT) and then assessed adherence through home visits 3 days later. Of these subjects, 68.4% tested positive for malaria and 65.8% adhered overall. Patients who tested positive did not have significantly higher odds of adherence than those who were not offered the test (adjusted odds ratio [OR]: 1.07, 95% confidence interval [CI]: 0.734-1.57, P = 0.719). Patients who received a positive malaria test had 0.488 fewer pills remaining than those not offered the test (95% CI: −1.02 to 0.043, P = 0.072). We found that patients who felt relatively healthy by the second day of treatment had lower odds of completing treatment (adjusted OR: 0.532, 95% CI: 0.394-0.719, P < 0.001). Our results suggest that diagnostic testing may not improve artemisinin-based combination therapy adherence unless efforts are made to persuade patients to continue taking the full course of drugs even if symptoms have resolved.

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Adherence to Treatment With Artemether-Lumefantrine for Uncomplicated Malaria in Rural Malawi

Cited by 66 publications

References 13 publications

Artemisinin combination therapy use in Federal Capital Territory, Nigeria

Artemisinin combination therapy use in Federal Capital Territory, Nigeria

The acceptability of intermittent screening and treatment versus intermittent preventive treatment during pregnancy: results from a qualitative study in Northern Ghana

Can Rapid Diagnostic Testing for Malaria Increase Adherence to Artemether–Lumefantrine?: A Randomized Controlled Trial in Uganda

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