Are Tanzanian patients attending public facilities or private retailers more likely to adhere to artemisinin-based combination therapy?

Abstract

BackgroundArtemisinin combination therapy (ACT) is first-line treatment for malaria in most endemic countries and is increasingly available in the private sector. Most studies on ACT adherence have been conducted in the public sector, with minimal data from private retailers.MethodsParallel studies were conducted in Tanzania, in which patients obtaining artemether-lumefantrine (AL) at 40 randomly selected public health facilities and 37 accredited drug dispensing outlets (ADDOs) were visited at home and questioned about doses taken. The effect of sector on adherence, controlling for potential confounders was assessed using logistic regression with a random effect for outlet.ResultsOf 572 health facility patients and 450 ADDO patients, 74.5% (95% CI: 69.8, 78.8) and 69.8% (95% CI: 64.6, 74.5), respectively, completed treatment and 46.0% (95% CI: 40.9, 51.2) and 34.8% (95% CI: 30.1, 39.8) took each dose at the correct time (‘timely completion’). ADDO patients were wealthier, more educated, older, sought care later in the day, and were less likely to test positive for malaria than health facility patients. Controlling for patient characteristics, the adjusted odds of completed treatment and of timely completion for ADDO patients were 0.65 (95% CI: 0.43, 1.00) and 0.69 (95% CI: 0.47, 1.01) times that of health facility patients. Higher socio-economic status was associated with both adherence measures. Higher education was associated with completed treatment (adjusted OR = 1.68, 95% CI: 1.20, 2.36); obtaining AL in the evening was associated with timely completion (adjusted OR = 0.35, 95% CI: 0.19, 0.64). Factors associated with adherence in each sector were examined separately. In both sectors, recalling correct instructions was positively associated with both adherence measures. In health facility patients, but not ADDO patients, taking the first dose of AL at the outlet was associated with timely completion (adjusted OR = 2.11, 95% CI: 1.46, 3.04).ConclusionWhen controlling for patient characteristics, there was some evidence that the adjusted odds of adherence for ADDO patients was lower than that for public health facility patients. Better understanding is needed of which patient care aspects are most important for adherence, including the role of effective provision of advice.Electronic supplementary materialThe online version of this article (doi:10.1186/s12936-015-0602-x) contains supplementary material, which is available to authorized users.

Socioeconomic Determinants of Antimalarial Drug Use Behaviours: A Systematic Review

“…(P <0.001) [26] No association between educational level and adherence/non-adherence [19] The adjusted odds of completed treatment for those who has finished primary school was 1.68 times that of patients who has not (95% CI: 1.20, 2.36; P=0.003) [28] No significant for mothers' attainment of tertiary (or higher) education and the use of ACTs (OR 0.905, CI0.195-4.198; P=0.898) [25] There was a statistically significant association between fathers' attainment of tertiary (higher education) and use of ACTs, when compared to fathers who had not attained this level of education (OR 0.054, CI 0.006-0.510; P=0.011) [25] Adherence and income P=0.003; OR 0.340; 95% CI, 0.167-0.694. higher income level (Ksh >9000 (i.e., >GBP 66 monthly) was associated with ACT adherence [20] [14,20,2 7,31] P=0.034 with participants of higher income salary showing correct dosage of drugs [31] Initiation of home treatment was higher in the poorer households. 25% of the poorest will use home treatment first as against 14% in wealthiest SE category [14] In addition, household monthly income significantly influenced dosage of the drugs used (P=0.034) primarily due to the fact that higher proportions of respondents with an income salary of KShs.…”

“…Six studies [18,20,21,25,26,28] reported a statistically significant relationship between higher educational level and adherence; four studies [19,24,27,29] reported no statistically significant relationship between the variables.…”

“…More than half of the studies (10 studies) reported on educational level in relation to adherence. Nine of these studies were conducted in the African region [18][19][20][21][24][25][26][27][28] while one study was conducted in Southeast Asia [29]. There was a high level of uniformity in the measurement tool used to assess educational level.…”

“…At the end of the assessment and appraisal exercise, seventeen (17) studies [14][15][16][17][18][19][20][21][23][24][25][26][27][28][29][30][31] that were of good quality based on the PCAqs assessment were included in this systematic review.…”

Can Rapid Diagnostic Testing for Malaria Increase Adherence to Artemether–Lumefantrine?: A Randomized Controlled Trial in Uganda

“…6,7 Patients who obtain drugs from the private sector have been shown to have lower adherence rates. 7,8 When patients with malaria do not finish their medications, they risk a recurrence of the infection. Clinical studies have found that the 28-day cure rates for artemetherlumefantrine (AL), a type of ACT, are 10-30% points lower when patients take only four doses instead of the recommended six doses.…”