Artemether–lumefantrin treatment adherence among uncomplicated plasmodium falciparum malaria patients, visiting public health facilities in AsgedeTsimbla district, Tigray, Ethiopia: a cross-sectional study

Abstract

Background Ethiopia has set a goal to eliminate malaria by 2030; Artemether–lumefantrine (AL) is put as one of the cornerstone strategies for uncomplicated plasmodium falciparum malaria treatment. However, only focusing on prescribing of the treatment without assessing patients’ adherence could lead to the resistance of the drug. In Ethiopia, there is limited evidence about patients’ adherence to AL and its influencing factors. Therefore, this study aimed at addressing this information gap. Methods A health facility based cross-sectional study was employed. Participants were selected using simple random sampling technique from registration books of the public health facilities in AsgedeTsimbla. Data were collected from March 24th to April 30th, 2018. We interviewed participants using a pre-tested structured questionnaire, and the blister pack was also inspected at their homes on day 4. Data were entered into Epi-Info and analyzed using SPSS 21. Odds ratios with 95% Confidence Intervals were estimated and the level of significance was declared at p-value ≤ 0.05. Results A total of 384 study participants were interviewed with a response rate of 95.5%. The overall AL adherence was 53.6% (95% CI 48.4–58.3%). Children aged < 5 years [AOR: 0.4, 95% CI (0.2–0.8)], and being treated in health post [AOR: 0.3, 95% CI (0.1–0.5)] were more likely to show AL adherence whereas illiteracy [AOR: 9.4, 95% CI (4.2–21.3)], didn’t know the consequence of discontinued AL [AOR: 4.0, 95% CI (2.1–7.6)], had concomitant drugs [AOR: 2.5, 95% CI (1.4–4.5)], and stopped/saved drug when improved before tablet got finished [AOR: 3.2, 95% CI (1.7–5.9)] were factors less likely to be associated with AL adherence. Conclusion AL adherence was low. Children aged < 5 years, and being treated in health post were determinants of AL adherence whereas illiteracy, didn’t know the consequence of discontinued the drug, had concomitant drugs, and stopped/saved drug when improved before tablet got finished were factors that hindered the AL adherence. Stakeholders should emphasize designing appropriate strategies including educational interventions to increase the AL adherence and prevent drug resistance. Further research should be conducted to evaluate AL resistance.

Factors influencing patients’ adherence to malaria Artemisinin-based combination therapy treatment in Kamuli District, Uganda

“…The current study nding contradicts other studies which found a statistical association between education and patient adherence to ACT [14,30,45]. Moreover, an Ethiopian study had shown earlier that illiteracy is a major hindering factor of patient adherence to ACT [29]. It is believed that proper education empowers and enables one to make informed decisions and discern between what is wrong and right about one's health.…”

Factors influencing patients’ adherence to malaria artemisinin-based combination therapy in Kamuli District, Uganda

“…The current study finding contradicts other studies which found a statistical association between education and patient adherence to ACT [ 14 , 30 , 45 ]. Moreover, an Ethiopian study had shown earlier that illiteracy is a major hindering factor of patient adherence to ACT [ 29 ]. It is believed that proper education empowers and enables one to make informed decisions and discern between what is wrong and right about one’s health.…”

Determinants of Patients’ Adherence to Malaria Treatment in the Democratic Republic of the Congo

“…This led to the concept of health literacy, first introduced in Canada by Rootman and Gordon-El-Bihbety, who defined it as the ability to access, understand, evaluate, and communicate information in ways that promote, maintain, and improve one’s health in a variety of settings over the course of life [ 42 ]. Health literacy is linked to the level of education [ 43 ] and is an important determinant of adherence to treatment [ 8 , 12 , 44 , 45 ]. Improving health literacy involves improving the level of education of the population and involves sectors other than health.…”