Abstract
BackgroundThe relation between therapeutic failure and non-adherence to treatment of malaria has been clearly established. Several measures have been used to estimate adherence to Plasmodium vivax therapy, but few protocols have been validated to ensure reliability of the estimates of adherence. The objective of this study was to validate a five-item-reported-questionnaire derived from original Morisky four-item scale to estimate adherence to P. vivax malaria therapy.MethodsA five-item-reported questionnaire was applied to patients after treatment of P. vivax malaria, considering behaviours regarding to forgetfulness, carelessness as to time of administration, cessation or discontinuation of use and replication of dose. Data were collected in dichotomous and Likert scales. Reliability was assessed by Cronbach’s alpha and by the contribution of each item to total. The concurrent validation was done with pill count and concordance between measures of adherence by coefficient of Kappa. Sensitivity, specificity and accuracy were also determined.ResultsA total of 135 patients were enrolled in the study. Adherence ranged from 63.8 to 72.7% in both psychometric measures and pill count. The responses on the Likert scale showed higher proportion of non-adherence behaviour, greater variance and concordance with pill count, as well as more sensitive to characterize the behaviour of self-medication. The internal consistency of questionnaire was moderate. Significant correlations were seen with items regarding the forgiveness or careless in taking pills in all scales. The agreement between psychometric measures and pill count was considered satisfactory. The non-adherence to malaria therapy in an endemic area of Amazon basin was 33.3%.ConclusionThe five-item-reported questionnaire with responses on Likert scale is a feasible option for reliable estimation of adherence to malaria therapy in endemic areas.
Highlights
The relation between therapeutic failure and non-adherence to treatment of malaria has been clearly established
Treatment failure has been reported throughout the world, including in Brazilian Amazon basin, where it has been estimated at 10-15% [3,4,5]
The objective of this study was to validate a five-item-self-reported questionnaire derived from the original Morisky questionnaire, with the addition of an item regarding self-medication behaviour, to be used to estimate adherence to malaria therapy in endemic areas
Summary
The relation between therapeutic failure and non-adherence to treatment of malaria has been clearly established. The objective of this study was to validate a five-item-reported-questionnaire derived from original Morisky four-item scale to estimate adherence to P. vivax malaria therapy. Malaria by Plasmodium vivax is a major health problem in Amazon basin, with approximately 200,000 cases reported annually [1]. Treatment failure has been reported throughout the world, including in Brazilian Amazon basin, where it has been estimated at 10-15% [3,4,5]. The treatment adherence ensures the complete recovery of patients and prevents the emergence of parasite resistance [7]. A study in Brazilian Amazon basin showed low adherence in 13.5% of patients [9]
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