Adherence to Artemisinin-Based Combination Therapy for the Treatment of Uncomplicated Malaria: A Systematic Review and Meta-Analysis

Abstract

Adherence to artemisinin-based combination therapy (ACT) is not clearly defined. This meta-analysis determines the prevalence and predictors of adherence to ACT. Twenty-five studies and six substudies met the inclusion criteria. The prevalence of ACT adherence in the public sector was significantly higher compared to retail sector (76% and 45%, resp., P < 0.0001). However, ACT adherence was similar across different ACT dosing regimens and formulations. In metaregression analysis prevalence estimates of adherence significantly decrease with increasing year of study publication (P = 0.046). Factors found to be significant predictors of ACT adherence were years of education ≥ 7 {odds ratio (OR) (95% CI) = 1.63 (1.05–2.53)}, higher income {2.0 (1.35–2.98)}, fatty food {4.6 (2.49–8.50)}, exact number of pills dispensed {4.09 (1.60–10.7)}, and belief in traditional medication for malaria {0.09 (0.01–0.78)}. The accuracy of pooled estimates could be limited by publication bias, and differing methods and thresholds of assessing adherence. To improve ACT adherence, educational programs to increase awareness and understanding of ACT dosing regimen are interventions urgently needed. Patients and caregivers should be provided with an adequate explanation at the time of prescribing and/or dispensing ACT.

Longitudinal estimation of Plasmodium falciparum prevalence in relation to malaria prevention measures in six sub-Saharan African countries

“…Of note, to our knowledge, Seasonal Malaria Chemoprevention measures as recommended by the World Health Organization had not been implemented at the time the study ended in any of the study sites [ 35 ]. This finding may be explained by a number of highly interrelated extrinsic environmental, social, and economic factors such as diagnosis confirmation and local treatment practices, care seeking behaviour, access to health facilities and availability of local anti-malarials [ 36 ]. The discrepancy between infection prevalence and infrequent use of anti-malarials at some sites may be related to the immunity afforded by chronic infections resulting in asymptomatic parasite carriage, which have been widely described in P. falciparum endemic areas, including Africa [ 37 ].…”

Lay knowledge and management of malaria in Baringo county, Kenya

“…Secondly, the efficacy of many of the plants used as medicine is scientifically unproven due to insufficient pharmacological research and may interact with prescription medicines [ 33 ] Thirdly, the knowledge of the medicinal plants and their uses is passed from one generation to another orally and is not documented hence is at risk of distortion and loss [ 33 ]. Lastly, use of traditional medicines simultaneously with conventional malaria medicine may lead to non-compliance to biomedical treatment resulting in sub-optimal parasitological and clinical outcomes [ 36 ].…”

Adherence to Mass Drug Administration with Dihydroartemisinin–Piperaquine and Plasmodium falciparum Clearance in Southern Province, Zambia

“…Of note, the large sample size in our study likely led to finding statistically significant relationships with low effect estimates 36,37 ; however, our estimates of determinants of adherence were consistent with other MDA studies and help characterize adherent from nonadherent individuals in this trial. 38 In the context of a community-randomized controlled trial in Southern Province, Zambia, community-wide MDA and fMDA with DHAp both demonstrated high treatment adherence and high and durable clearance of malaria infections. Differences in adherence between MDA and fMDA trial arms suggest that the specific strategy for deploying an MDA intervention can influence the reception of treatment.…”