Abstract
Medication adherence is an essential step in the malaria treatment cascade. We conducted a qualitative study embedded within a randomized controlled trial comparing the adherence to the recommended dosing of two artemisinin-based combination therapies (ACT) to treat uncomplicated malaria in Freetown, Sierra Leone. This study explored the circumstances and factors that influenced caregiver adherence to the ACT prescribed for their child in the trial. In-depth interviews were conducted with 49 caregivers; all interviews were recorded, transcribed, and translated. Transcripts were coded and aggregated into themes, applying a thematic content approach. We identified four key factors that influenced optimal treatment adherence: (1) health system influences, (2) health services, (3) caregivers’ experiences with malaria illness and treatment, and (4) medication characteristics. Specifically, caregivers reported confidence in the health system as facilities were well maintained and care was free. They also felt that health workers provided quality care, leading them to trust the health workers and believe the test results. Ease of medication administration and perceived risk of side effects coupled with caregivers’ prior experience treating malaria influenced how medications were administered. To ensure ACTs achieve maximum effectiveness, consideration of these contextual factors and further development of child-friendly antimalarials are needed.
Highlights
The malaria treatment cascade has five components contributing to antimalarial effectiveness, including: (1) drug efficacy—the ability to clear parasites from the body and cure patients of malaria; (2) access to treatment; (3) targeting treatment with confirmatory diagnosis; (4) health worker compliance to treatment guidelines, and (5) patient adherence to medication prescribed [1]
Medication-taking behaviours can be influenced by various contextual factors, including: socioeconomic status, health system characteristics, disease symptoms, treatment characteristics, and other patientrelated factors [3,4,5]
Our findings are consistent with prior research assessing longer-term therapies [3] as well as non-artemisinin-based combination therapies (ACT) antimalarials [8,32,33], suggesting that a range of individual and contextual factors influence treatment adherence
Summary
The malaria treatment cascade has five components contributing to antimalarial effectiveness, including: (1) drug efficacy—the ability to clear parasites from the body and cure patients of malaria; (2) access to treatment; (3) targeting treatment with confirmatory diagnosis; (4) health worker compliance to treatment guidelines, and (5) patient adherence to medication prescribed [1]. The final step, adherence, is considered an essential element for optimal treatment outcomes [2]. The World Health Organization defines adherence as “the extent to which a person’s behaviour—taking medications—corresponds with the agreed recommendations from a health care provider” [3]. Medication-taking behaviours can be influenced by various contextual factors, including: socioeconomic status, health system characteristics, disease symptoms, treatment characteristics, and other patientrelated factors [3,4,5]
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