Abstract
BackgroundCurrent day malaria cases and deaths are indicative of a lack of access to both methods of prevention, diagnosis, and treatment; an important determinant of treatment efficacy is adherence. This study is a follow up to the baseline study of adherence to artemether-lumefantrine (AL) carried out in Garissa District in 2010. The study presented evaluates any changes in adherence levels which may have occurred in the area during this period and after nearly three years of sustained use of ACT across the public health sector.MethodsThe study was carried out in Garissa County in the North Eastern Province of Kenya and included patients fitting the suspected malaria case definition and having been prescribed AL, regardless of confirmatory diagnosis. A questionnaire assessed the intake of AL via both self-reporting by the participant and observation of blister packs by the interviewer. On separate occasions exit interviews with patients and observations of prescribers were also carried out.ResultsOf the 218 participants enrolled, 195 were successfully followed up. 60% of participants were found to be adherent to the three-day AL regimen, this is 4.7% lower than the proportion of participants adherent in 2010; the result of a two-sided z-test was not significant (p = 0.23). The odds of the patient being adherent to AL increased by 65% with each additional correct statement regarding how to take AL that a patient could recall (between zero and four statements), this was the only variable significantly associated with patient adherence (p = 0.01).ConclusionSustaining the ACT adherence rates at the 2010 levels, through 2.5 years of insecurity in the study area is an achievement and suggests that if security can be improved barriers to improving health service quality and patient adherence to AL would be removed. This study, by looking specifically at anti-malarial adherence over a prolonged period and in a setting of severe conflict, provides a valuable and rare insight in to the challenges and barriers to ACT adherence in such settings.
Highlights
Current day malaria cases and deaths are indicative of a lack of access to both methods of prevention, diagnosis, and treatment; an important determinant of treatment efficacy is adherence
Patient adherence Of the 195 participants successfully followed up, 60.0% were found to be probably adherent to the three day artemisinin combination therapy (ACT)
This paper has laid out the findings of an ACT adherence study in Garissa County, Kenya, nearly three years after a base-line study and efforts to improve ACT prescription practices and adherence
Summary
Current day malaria cases and deaths are indicative of a lack of access to both methods of prevention, diagnosis, and treatment; an important determinant of treatment efficacy is adherence. There were 198 million (range 124–283) cases of malaria and 584,000 (range 367,000- 755,000) deaths from malaria in 2013 These large figures are a considerable decrease on the 2000 levels since when malaria cases have dropped by 26% worldwide, and the number of deaths due to malaria has fallen by 47% worldwide [1]. These reductions in morbidity and mortality are. ACT has a more complicated dosing regimen than monotherapies, in the case of artemether-lumefantrine (AL) this ranges from one to four tablets (determined by a patient’s weight) taken twice a day for three day. The consequences of poor patient adherence are serious; cure rates for patients are likely to be lower, and repeat exposure to sub-lethal drug dosages risks the development of parasite resistance to the active agents in the drug formulations [11,12]
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
