Abstract
BackgroundArtemisinin resistance in Plasmodium falciparum has been spreading across Southeast Asia. Patients’ adherence to artemisinin-based combination therapy (ACT) is critical to avoid expanding this resistance. The objectives of this research were to examine patients’ adherence to ACT for the treatment of uncomplicated malaria and to examine the healthcare workers’ perception of medication adherence and their dispensing practices for malaria patients in Savannakhet province, Lao PDR.MethodsA prospective observational study of patients and a descriptive study of healthcare workers were conducted in Xepon, Phin, and Nong districts. In the patient study, patients aged 18 years old or older who were prescribed artemether-lumefantrine (AL) at six healthcare facilities between October 2016 and August 2017 were examined. Patient interviews and tablet counts were conducted on the first day of treatment (day 0) and the follow-up day (around day 3). In the healthcare workers study, a self-administered questionnaire survey was conducted.ResultsOf the 54 patients examined, 51 (94.4%) were adherent to the AL regimen. The other three patients stopped medication because they felt better, even though the importance of completing the regimen was explained to all patients when it was prescribed. Among 152 healthcare workers who had ever instructed a malaria patient, 74.3% reported that they occasionally saw a malaria patient who adhered poorly to medication instructions. The healthcare workers perceived the major reasons for poor adherence to be illiteracy and poor understanding of medication instructions by patients. In practice, 27.6% of the healthcare workers did not regularly explain the importance of completing the regimen to patients, and 32.2% did not often or always confirm the patients’ understanding of medication instructions.ConclusionsPatient adherence to AL was high. The healthcare workers perceived that poor adherence was attributable to the patients, i.e., their poor understanding and illiteracy, which appeared to be related to linguistic differences. However, poor adherence also appeared to be attributable to the healthcare workers, who should tell patients of the importance of completing the AL regimen regardless of their improvement in physical condition and also confirm the patients’ understanding of the instructions.
Highlights
Artemisinin resistance in Plasmodium falciparum has been spreading across Southeast Asia
The emergence of artemisinin resistance was first confirmed in western Cambodia [4], and it has spread across five countries of Southeast Asia: Cambodia, Lao People’s Democratic Republic (Lao PDR), Myanmar, Thailand, and Vietnam [5, 6]
In the healthcare workers study who gave medication instructions to malaria patients reported that they occasionally saw a malaria patient who poorly adhered to the instructions
Summary
Artemisinin resistance in Plasmodium falciparum has been spreading across Southeast Asia. Patients’ adherence to artemisinin-based combination therapy (ACT) is critical to avoid expanding this resistance. Artemisinin-based combination therapies (ACTs), which are the first-line treatment in many countries [2], are the most effective treatment for Plasmodium falciparum malaria [3]. The emergence of artemisinin resistance was first confirmed in western Cambodia [4], and it has spread across five countries of Southeast Asia: Cambodia, Lao People’s Democratic Republic (Lao PDR), Myanmar, Thailand, and Vietnam [5, 6]. The spread of artemisinin resistance from Southeast Asia to other regions could trigger a global public health emergency. Completion of the full regimen is recommended to avoid promoting and spreading this resistance [9, 10]. The level of patient adherence to ACT varies greatly depending on the study setting: one systematic review showed the levels of adherence to artemether-lumefantrine (AL) to range from 39 to 96% [14]
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