Abstract
BackgroundThe World Health Organization recommends the use of artemisinin-based combination therapy (ACT) to treat uncomplicated malaria for the control of malaria across the world. There are several types of ACT used across malaria-endemic countries, yet there is little information about preferences and adherence practices regarding different types of ACT. The objective of this study was to evaluate levels of adherence to two types of ACT, artemether–lumefantrine (AL) and artesunate + amodiaquine (ASAQ), for the treatment of uncomplicated malaria among prescribers and patients in Guinea in 2016.MethodsThe study included a review of records of malaria patients and three health-facility, cross-sectional surveys. Patients diagnosed with uncomplicated malaria and prescribed ACT (n = 1830) were recruited and visited in their home after receiving the medication and administered a questionnaire regarding ACT adherence. Prescribers (n = 115) and drug dispensers (n = 43) were recruited at the same public health facilities and administered questionnaires regarding prescribing practices and opinions regarding the national treatment policies and protocols.ResultsAccording to the registry review, 35.8% of all-cause consultations were recorded as malaria. Of these, 26.6% were diagnosed clinically without documentation of laboratory confirmation. The diagnosis of uncomplicated malaria represented 64.1% of malaria cases among children under 5 years and 74.9% of those 5 years of age and older. An ACT was prescribed for 83.5% of cases of uncomplicated malaria. Among participants in the study, ACT adherence was 95.4% (95% CI 94.4, 96.3). Overall, about one in four patients (23.4%; 95% CI 21.5, 25.3) reported experiencing adverse events. While patients prescribed ASAQ were significantly more likely to report experiencing adverse effects than patients on AL (p < 0.001), given the overall high adherence, there was no evidence of a statistically significant difference in adherence between AL and ASAQ. Patients 5 years or older who reported experiencing adverse events were more likely to be non-adherent.ConclusionAlthough there were more reported adverse events associated with ASAQ when compared with AL, both prescribers and patients were found to be mostly adherent to ACT for the treatment of malaria, regardless of ACT type.
Highlights
The World Health Organization recommends the use of artemisinin-based combination therapy (ACT) to treat uncomplicated malaria for the control of malaria across the world
Among the 7195 patients 5 years or older, 27.3% received a diagnosis of uncomplicated malaria without documentation of laboratory confirmation noted in the register
There were more reported adverse events associated with artesunate + amodiaquine (ASAQ) when compared with artemether– lumefantrine (AL), both prescribers and patients were found to be mostly adherent to ACT for the treatment of malaria, regardless of ACT type
Summary
The World Health Organization recommends the use of artemisinin-based combination therapy (ACT) to treat uncomplicated malaria for the control of malaria across the world. Following the discovery of elevated chloroquine and sulfadoxine–pyrimethamine (SP) resistance, in the early 2000s the World Health Organization (WHO) proposed a new strategy for malaria control for all malaria-affected countries across the world This strategy recommends the use of artemisinin-based combination therapy (ACT) for the treatment of uncomplicated malaria [1, 2]. To prevent empiric treatment of fever without laboratory confirmation for malaria, national malaria control programmes (NMCP) introduced the use of rapid diagnostic tests (RDT) at health facilities. This ensures that an ACT is only prescribed for confirmed cases of uncomplicated malaria [3]. Collected health facility data show that 31% of all-cause outpatient consultations are due to malaria [5]
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