Factors Influencing Malaria Treatment and Patient Adherence to Antimalarial Drugs in Southern Ethiopia

Abstract

In Ethiopia the health system is underdeveloped and much of the rural population has limited access to modern health services. The Ethiopian government introduced the Health Extension Program which is a community-based health care delivery system aimed at accessing essential health services such as malaria treatment through its health extension workers (HEWs). The objective of this study was to evaluate factors influencing malaria treatment practice of health extension workers (HEWs) and patient adherence to antimalarial drugs. A qualitative research design that is explorative and descriptive was used. Data was collected by means of (1) in-depth individual interviews among 20 HEWs, and seven focus group discussions with malaria treated patients. Data was analyzed thematically. Four themes emerged from the data, namely: (1) health facility related factors, (2) HEWs related factors, (3) patient related factors, and (4) community related factors. Improving the availability of essential resources such as rapid diagnostic test kits (RDT) and antimalarial drugs, improving the community’s perception towards antimalarial drug effectiveness and adequately educating patients on how to take antimalarial drugs can improve malaria treatment practice of the HEWs and patient adherence to antimalarial drugs.

Management of uncomplicated malaria in private health facilities in North-West Ethiopia: a clinical audit of current practices

“…This finding is in line with Argaw’s [33] finding that the national survey revealed that health workers adhered to standard recommendations with respect to less than half of malaria patients they encountered. This could partly be due to insistence and pressure from patients to get anti-malaria drugs for febrile illnesses, providers’ clinical beliefs and capacity constraints of health providers to look for other causes of fever, limited patient diagnosis services and practices to identify other aetiologies such as viruses at medium clinics [28, 40, 41].…”

Adherence to national malaria clinical management and testing guidelines in selected private clinics of Gambela Town, Gambela Region, Ethiopia: a mixed method study

“…However, studies on the efficacy of training as a method to improve guideline adherence have yielded conflicting results. Some studies show improvement [ 22 ], while others show minimum or no improvement of healthcare worker practice [ 23 , 24 ]. In this context, wider dissemination of guidelines and extensive training of healthcare workers would be beneficial.…”

Determinants of Patients’ Adherence to Malaria Treatment in the Democratic Republic of the Congo

“…Mathematical modelling has shown that the infectivity of an untreated patient is 29–51 times higher than that of a correctly treated patient [ 7 ]. However, adherence to the treatment of illness in general and to antimalarial treatment in particular is not always perfect [ 4 , 8 , 9 , 10 , 11 , 12 , 13 ]. Therapeutic adherence depends on several factors, which are not always easy to identify [ 14 ].…”

“…This will help to assess the real impact of antimalarial interventions related to case management and to propose more appropriate improvement measures. Studies conducted in Ethiopia [ 10 ] identified patient-related factors (fear of adverse effects and forgetfulness) and community-related factors such as the perception of drug efficacy. A study conducted in Ghana [ 8 ] identified other factors, including knowledge of the drug and its beneficial effects.…”