High adherence to malaria treatment: promising results of an adherence study in South Kivu, Democratic Republic of the Congo

Gerstl, Sibylle; Namagana, Alexis; Palacios, Liliana; Mweshi, Franklin; Aprile, Stella; Lima, Angeles

doi:10.1186/s12936-015-0933-7

Cited by 10 publications

(9 citation statements)

References 39 publications

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“…Weaknesses in the collection, validation, and reporting of malaria data from ASHAs hampered surveillance efforts [8]. There was no system to verify treatment compliance and parasite clearance from the patients’ blood [12,13].…”

Section: Introductionmentioning

confidence: 99%

Improved access to early diagnosis and complete treatment of malaria in Odisha, India

Pradhan

Dutta

et al. 2019

PLoS ONE

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BackgroundIn 2013, the Comprehensive Case Management Programme (CCMP) was initiated to assess the impact of universal access to diagnosis and treatment and improved surveillance on malaria transmission in different settings in Odisha state, India.MethodsPairs of intervention and control sub-districts (blocks), matched on malaria incidence were selected in four districts with different transmission intensities. CCMP activities included training and supervision, ensuring no stock-outs of malaria tests and drugs, analysing verified surveillance data, stratifying areas based on risk factors, and appointing alternative providers to underserved areas. Composite risk scores were calculated for each sub-centre using principal component analysis. Post−pre changes (2013–2015 versus 2011–2012) for annual blood examination rates (ABER) and annual parasite incidence (API) across intervention and control groups were assessed using difference-in-difference (DID) estimates, adjusted for malaria transmission risk.ResultsIn the intervention sub-centres, the mean increase in ABER was 6.41 tests/sub-centre (95%CI 4.69, 8.14; p<0.01) and in API was 9.2 cases diagnosed/sub-centre (95%CI 5.18, 13.21; p<0.01). The control sub-centres reported lower increases in ABER (2.84 [95%CI 0.35, 5.34]; p<0.05) and API (3.68 [95%CI 0.45, 6.90]; p<0.05). The control-adjusted post–pre changes in API showed that 5.52 more cases (95%CI 0.34, 10.70; p<0.05) were diagnosed, and a 3.6 more cases (95%CI 0.58, 6.56; p<0.05) were tested per sub-centre in the intervention versus control areas. Larger differences in post–pre changes in API between intervention and control sub-centres were registered in the higher transmission-risk areas compared with the lower risk areas. All the changes were statistically significant.ConclusionsIntensive intervention activities targeted at improved access to malaria diagnosis and treatment produced a substantial increase in blood examination and case notification, especially in inaccessible, hard-to-reach pockets. CCMP provides insights into how to achieve universal coverage of malaria services through a routine, state-run programme.

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Section: Introductionmentioning

confidence: 99%

Improved access to early diagnosis and complete treatment of malaria in Odisha, India

Pradhan

Dutta

et al. 2019

PLoS ONE

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“…A number of studies have evaluated patient adherence to anti-malarial drugs and associated factors. The documented level of patient adherence to ASAQ varies from 48% in Sierra Leone [9] to 75% in the Democratic Republic of Congo [10], to 93% in Ghana [11]. One qualitative study comparing ACT adherence in northern Ghana found that patients preferred AL over ASAQ due to adverse events experienced with ASAQ [12].…”

Section: Introductionmentioning

confidence: 99%

Prescriber practices and patient adherence to artemisinin-based combination therapy for the treatment of uncomplicated malaria in Guinea, 2016

Camara

Moriarty

Guilavogui

et al. 2019

Malar J

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BackgroundThe World Health Organization recommends the use of artemisinin-based combination therapy (ACT) to treat uncomplicated malaria for the control of malaria across the world. There are several types of ACT used across malaria-endemic countries, yet there is little information about preferences and adherence practices regarding different types of ACT. The objective of this study was to evaluate levels of adherence to two types of ACT, artemether–lumefantrine (AL) and artesunate + amodiaquine (ASAQ), for the treatment of uncomplicated malaria among prescribers and patients in Guinea in 2016.MethodsThe study included a review of records of malaria patients and three health-facility, cross-sectional surveys. Patients diagnosed with uncomplicated malaria and prescribed ACT (n = 1830) were recruited and visited in their home after receiving the medication and administered a questionnaire regarding ACT adherence. Prescribers (n = 115) and drug dispensers (n = 43) were recruited at the same public health facilities and administered questionnaires regarding prescribing practices and opinions regarding the national treatment policies and protocols.ResultsAccording to the registry review, 35.8% of all-cause consultations were recorded as malaria. Of these, 26.6% were diagnosed clinically without documentation of laboratory confirmation. The diagnosis of uncomplicated malaria represented 64.1% of malaria cases among children under 5 years and 74.9% of those 5 years of age and older. An ACT was prescribed for 83.5% of cases of uncomplicated malaria. Among participants in the study, ACT adherence was 95.4% (95% CI 94.4, 96.3). Overall, about one in four patients (23.4%; 95% CI 21.5, 25.3) reported experiencing adverse events. While patients prescribed ASAQ were significantly more likely to report experiencing adverse effects than patients on AL (p < 0.001), given the overall high adherence, there was no evidence of a statistically significant difference in adherence between AL and ASAQ. Patients 5 years or older who reported experiencing adverse events were more likely to be non-adherent.ConclusionAlthough there were more reported adverse events associated with ASAQ when compared with AL, both prescribers and patients were found to be mostly adherent to ACT for the treatment of malaria, regardless of ACT type.Electronic supplementary materialThe online version of this article (10.1186/s12936-019-2664-7) contains supplementary material, which is available to authorized users.

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“…1 ): efficacy, access, diagnosis, health service provider practice, and patient adherence [ 1 , 13 ]. Several factors affect implementation at each step, falling into one of the following broader categories: health system, health service provider, and patient [ 14 , 15 ]. Low indicators at any step present a bottleneck to the overall performance of the system.…”

Section: Introductionmentioning

confidence: 99%

Challenges in implementing uncomplicated malaria treatment in children: a health facility survey in rural Malawi

Kabaghe

Phiri

et al. 2017

Malar J

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BackgroundPrompt and effective malaria treatment are key in reducing transmission, disease severity and mortality. With the current scale-up of artemisinin-based combination therapy (ACT) coverage, there is need to focus on challenges affecting implementation of the intervention. Routine indicators focus on utilization and coverage, neglecting implementation quality. A health system in rural Malawi was assessed for uncomplicated malaria treatment implementation in children.MethodsA cross-sectional health facility survey was conducted in six health centres around the Majete Wildlife Reserve in Chikwawa district using a health system effectiveness approach to assess uncomplicated malaria treatment implementation. Interviews with health facility personnel and exit interviews with guardians of 120 children under 5 years were conducted.ResultsHealth workers appropriately prescribed an ACT and did not prescribe an ACT to 73% (95% CI 63–84%) of malaria rapid diagnostic test (RDT) positive and 98% (95% CI 96–100%) RDT negative children, respectively. However, 24% (95% CI 13–37%) of children receiving artemisinin–lumefantrine had an inappropriate dose by weight. Health facility findings included inadequate number of personnel (average: 2.1 health workers per 10,000 population), anti-malarial drug stock-outs or not supplied, and inconsistent health information records. Guardians of 59% (95% CI 51–69%) of children presented within 24 h of onset of child’s symptoms.ConclusionThe survey presents an approach for assessing treatment effectiveness, highlighting bottlenecks which coverage indicators are incapable of detecting, and which may reduce quality and effectiveness of malaria treatment. Health service provider practices in prescribing and dosing anti-malarial drugs, due to drug stock-outs or high patient load, risk development of drug resistance, treatment failure and exposure to adverse effects.

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High adherence to malaria treatment: promising results of an adherence study in South Kivu, Democratic Republic of the Congo

Cited by 10 publications

References 39 publications

Improved access to early diagnosis and complete treatment of malaria in Odisha, India

Improved access to early diagnosis and complete treatment of malaria in Odisha, India

Prescriber practices and patient adherence to artemisinin-based combination therapy for the treatment of uncomplicated malaria in Guinea, 2016

Challenges in implementing uncomplicated malaria treatment in children: a health facility survey in rural Malawi

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