Abstract
Between 2011 and 2013 the number of recorded malaria cases had more than doubled, and between 2009 and 2013 had increased almost 4-fold in MSF-OCA (Médecins sans Frontières – Operational Centre Amsterdam) programmes in the Democratic Republic of the Congo (DRC). The reasons for this rise are unclear. Incorrect intake of Artemisinin Combination Therapy (ACT) could result in failure to treat the infection and potential recurrence. An adherence study was carried out to assess whether patients were completing the full course of ACT.One hundred and eight malaria patients in Shamwana, Katanga province, DRC were visited in their households the day after ACT was supposed to be completed. They were asked a series of questions about ACT administration and the blister pack was observed (if available).Sixty seven (62.0%) patients were considered probably adherent. This did not take into account the patients that vomited or spat their pills or took them at the incorrect time of day, in which case adherence dropped to 46 (42.6%). The most common reason that patients gave for incomplete/incorrect intake was that they were vomiting or felt unwell (10 patients (24.4%), although the reasons were not recorded for 22 (53.7%) patients). This indicates that there may be poor understanding of the importance of completing the treatment or that the side effects of ACT were significant enough to over-ride the pharmacy instructions.Adherence to ACT was poor in this setting. Health education messages emphasising the need to complete ACT even if patients vomit doses, feel unwell or their health conditions improve should be promoted.
Highlights
Despite a wealth of natural resources, the Democratic Republic of the Congo (DRC) has one of the lowest per capita incomes in the world[1] and in 2014 ranked 186th in the United Nations Development Programme’s human development index[2].In Katanga the general trend is less clear for malaria cases
A total of 117 exit questionnaires were completed for patients who had received an Artemisinin Combination Therapy (ACT) prescription in one day (Table 2)
This study found that six (5.6%) patients were certainly nonadherent; approximately one out of 18 patients did not complete the course of ACT treatment within the timeframe of 3 days
Summary
Despite a wealth of natural resources, the Democratic Republic of the Congo (DRC) has one of the lowest per capita incomes in the world[1] and in 2014 ranked 186th (out of 187 countries) in the United Nations Development Programme’s human development index[2]. In Katanga the general trend is less clear for malaria cases. This is likely due to the variable numbers of projects supported between 2009 and 2013 (Figure 2a). Focussing on the fixed project in Shamwana, there has been a marked increase in malaria cases (Figure 2b). Médecins Sans Frontières-Operational Centre Amsterdam (MSFOCA) has been working in the provinces of North Kivu and South Kivu since the early 1990s and in Katanga since 2003. MSF-OCA operates health programmes in Mweso and Walikale in North Kivu; Baraka and Kimbi Lulimba in South Kivu; and Shamwana, Katanga (DRC)
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