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.Electronic supplementary materialThe online version of this article (10.1186/s41182-018-0125-6) contains supplementary material, which is available to authorized users.

Many generic products of latanoprost ophthalmic solution are commercially available. For pharmacists＇ guidance, patients often ask questions, such as the total number of drops to be used per bottle. However, materials, including package inserts, that can be obtained from pharmaceutical companies do not provide such information, such as the total number of drops, the volume of a drop, or sense of use regarding each preparation. In this study, we compared the total number of drops, the weight of a drop, squeezing force, and sense of use using brand-name and generic products of latanoprost ophthalmic solution to establish selection criteria. The weight of a drop exceeded 25 mg in all products, but there were significant differences among the products. In generic products, the total number of drops per bottle was lower than in the brand-name product (112.6 ± 0.9 drops), showing significant differences (10 to 20 drops). The squeezing force required for dripping differed among the products (1.5 to 5-fold). The sense-of-use score regarding the rigidity of an eye drop container reduced with the increase in the squeezing force, showing a negative correlation. The utilization of this information may improve glaucoma patients＇ adherence and/ or reduce costs, providing beneficial information for adopting pharmaceutical preparations in medical institutions.

Background Although hypertension is becoming more prevalent among the adult population of the Lao People’s Democratic Republic (PDR), with a prevalence of approximately 20% in 2013, treatment adherence of patients with hypertension, especially those in rural areas, remains poorly understood. The objective of the present study was to examine the rate of medication adherence to antihypertensive medicines among outpatients with hypertension in rural districts of the Savannakhet. Methods A prospective observational study was conducted in Xepon, Phin, and Nong districts. The study population was outpatients aged 18 years or older who were prescribed antihypertensive medicines at three district hospitals between February and August 2017. Data were collected on the first day of treatment (day 0) and the day of follow-up (around day 7) through interviews with the patients and outpatient registration books. The medication adherence rate was determined using the four-item Morisky Medication Adherence Scale. The level of adherence was evaluated by the sum of the scale, with scores ranging from 0 to 4 points. The adherent group, namely those with a score of 0, and the non-adherent group, namely those with scores of 1 to 4 points, were compared. Fisher’s exact test was used to identify factors associated with medication adherence. Results Of the 68 patients examined, 38.2% newly began treatment. Half of the patients (n = 34, 50.0%, 95% CI 0.38 to 0.62) adhered to medication instructions. The adherent group was more likely to have received written instructions when prescribed medication, compared to the non-adherent group (79.4% vs 55.9%, p = 0.068). Those who perceived that hypertension needs lifelong treatment were significantly more likely to adhere to the medication regimen (p = 0.028). Conclusions Medication adherence was present among 50% of outpatients with hypertension who visited a district hospital. Therefore, providing written instructions to patients would be effective for improving medication adherence.

Several studies have described factors such as augmented renal clearance that lead to low trough levels of vancomycin (VCM) in patients in the intensive care unit (ICU). In contrast, few studies have examined such factors in patients admitted to general wards. Therefore, the purpose of this study was to clarify factors associated with low VCM trough levels in general ward inpatients. We conducted this retrospective study on patients who had been monitored for changes in VCM blood levels at Gunma University Hospital for a 5-year period from January 1, 2014. Children under 18 years of age, pregnant women, and patients receiving renal replacement therapy were excluded; in total, 217 patients were examined. Subjects were divided into two groups: a low-level group comprising 88 patients with an initial trough concentration of less than 10 µg/mL and an optimal group comprising 129 patients with a trough concentration of 10 -20 µg/mL. Of the 177 general ward patients other than ICU, 74 were in the low-level group and 103 were in the optimal group. Multivariate logistic regression analysis revealed that low uid volume, febrile neutropenia (FN), and non-sepsis were mainly independent risk factors for reduced trough levels. We believe that FN is one of the important risk factors for low trough levels, especially in general ward patients rather than ICU.