Barriers to prompt and effective treatment of malaria in northern Sri Lanka

Abstract

SummaryBACKGROUND For the past 18 years, northern Sri Lanka has been affected by armed ethnic conflict. This has had a heavy impact on displacement of civilians, health delivery services, number of health professionals in the area and infrastructure. The north of Sri Lanka has a severe malaria burden, with less than 5% of the national population suffering 34% of reported cases. Health care providers investigated treatment-seeking behaviour and levels of treatment failure believed to be the result of lack of adherence to treatment. METHODSMETHODS Pre-and post-treatment interviews with patients seeking treatment in the outpatient department (OPD) and focus groups.RESULTS RESULTS A total of 271 persons completed interviews: 54.4% sought treatment within 2 days of the onset of symptoms, and 91.9% self-treated with drugs with prior to seeking treatment, mainly with paracetamol. Self-treatment was associated with delaying treatment (RR 3.55, CI 1.23-10.24, P ¼ 0.002). In post-treatment interviews, self-reported default was 26.1%. The main reasons for not taking the entire regimen were side-effects (57.6%) and disappearance of symptoms (16.7%). Focus groups indicated some lack of confidence in chloroquine treatment and prophylaxis, and scant enthusiasm for prevention methods.CONCLUSIONS CONCLUSIONS A number of factors contribute to a lack of access and a lower quality of care for malaria: lack of medical staff and facilities because of the fighting; lack of confidence in treatment, and perception of malaria as a routine illness. Prevention efforts need to take into account certain beliefs and practices to be successful.keywords malaria, conflict, treatment-seeking behaviour, treatment access, prevention correspondence Brigg Reilley,

Successful introduction of artesunate combination therapy is not enough to fight malaria: results from an adherence study in Sierra Leone

“…These characteristics might have contributed to the relatively low adherence. Furthermore, the results were in line with studies carried out in rural Sri Lanka (26% non-adherent) 8 and rural Senegal (62%). 12 In Uganda, a study showed adherence to be as high as 93% 11 and in Tanzania adherence was still 75%.…”

“…[7][8][9][10] Focusing on studies that used a related study design, our results (23% certainly non-adherent) were comparable with two studies in South Sudan (18% certainly non-adherent) 20 and Zambia (21%). 13 Both settings were similar to this study: a remote rural area; low patient educational level; treatment intake over 3 days; and this specific treatment already implemented for some time.…”

“…4,5 There are few published studies on patient adherence to ACT, and the methods and definitions of adherence vary widely. [6][7][8][9][10] Adherence reports range from 38% to 93% 11,12 and the main reasons for nonadherence include education level, 11,13 non-supervision of intake of the first dose 14 and problems with drug packaging. 15,16 Consequently, it is very difficult to make comparisons and to draw valid conclusions regarding the role of adherence in the success of ACT treatment.…”

Adherence and effectiveness of drug combination in curative treatment among children suffering uncomplicated malaria in rural Senegal

“…If we considered only the intake quantity, adherence at the 80% level was weaker in our study (64.7%) than that described by Fogg et al (2004) in Uganda (91%), where a new drug combination was tested, or by Ansah et al (2001) in Ghana (90%), where new CQ packaging was introduced. Our results were more closely related to the Reilley study in Sri Lanka, where 74% of patients were adherent when only total medication intake was considered (Reilley et al, 2002). The large differences might be explained by particular study conditions; for example, new drugs or new packaging tests (Ansah et al, 2001;Fogg et al, 2004).…”

Malaria mortality in Colombia, 1979-2008

“…Otros factores que determinan la presencia de la enfermedad, como la colonización y la migración de la población, la ocupación, la pobreza, el analfabetismo, las creencias y prácticas de la comunidad sobre la enfermedad, la desnutrición, la falta de acceso al diagnóstico y al tratamiento, y el desarrollo de los servicios de atención, así como la disponibilidad y la oportunidad del tratamiento, pueden contribuir con la mortalidad por paludismo (19)(20)(44)(45)(46)(47)(48)(49)(50)(51).…”