Assessment of adherence to a three day course of artemether-lumefantrine treatment in rakhine state, Myanmar

Abstract

Background: The development and spread of drug-resistant strains of malaria parasites has been identified as a key factor in malaria resurgence and is one of the greatest challenges to malaria control today. It is important to prevent or delay significantly the spread of artemisinin resistant parasites within the country and beyond its borders. Efforts to prevent deterioration of this problem are, therefore, at present directed towards finding novel ways of intervening to improve adherence and prevent the irrational use of currently available multi-dose anti-malarial drugs. The primary objective of this study was to access the level of patient adherence to artemether-lumefantrine under routine conditions of prescription. Method and Technique: Patients who consulted the fixed clinic or mobile clinic were routinely examined and screened for eligibility of inclusion in the study. The malaria positive P. falciparum malaria cases were treated with six doses of artemetherlumefantrine. Patient adherence was conducted by questionnaire and counting remaining pills on day 3 of anti-malaria treatment at their home. The adherence level was classified into three categories: definitely non-adherent, probably non-adherent and probably adherent. Reasons for being definitely non-adherent were also assessed. Results: Out of the total initially enrolled 175 patients, 161 (92%) patients completed the follow-up. Out of these, 138 (85.7%) were classified as probably adherent, 8 (5%) as probably non-adherent, and 15(9.3%) were definitely non-adherent. 40% of patients among definitely non-adherent group were age more than 15 years of age while 2-4 years of age compromised 70% of probably non-adherent group.