Factors associated with access and adherence to artemisinin‐based combination therapy (ACT) for children under five: a secondary analysis of a national survey in Sierra Leone

Abstract

Background Access and adherence to artemisinin-based combination therapy (ACT) are key challenges to effective malaria treatment. A secondary analysis of the Sierra Leone malaria Knowledge, Attitudes, and Practices (mKAP) survey was conducted to investigate access and adherence to ACT for the treatment of fever in children under-five. Methods The mKAP was a nationally representative, two-stage cluster-sample survey, conducted in 2012. Thirty primary sampling units per district were randomly selected using probability proportionate to size, based on national census estimates; 14 households were subsequently randomly selected and enrolled per sampling unit. The analysis was restricted to children under-five with fever in the past two weeks. Factors associated with access and adherence were assessed using multivariate logistic regression. Results Of 5169 enrolled households, 1456 reported at least one child under-five with fever in the past two weeks. Of the 1641 children from these households, 982 (59.8%) received any treatment for fever and were analysed for access to ACT; 469 (47.6%) received ACT and 466 were analysed for treatment adherence. Only 222 (47.4%) febrile children received ACT and completed 3-day treatment. In an adjusted analysis, factors associated with ACT access included knowledge of ACT (odds ratio [OR] 2.78, 95% CI 2.02–3.80; p < 0.001), knowledge of insecticide-treated nets (ITNs) (OR 1.84, 95% CI 1.29–2.63; p = 0.001), source of care (public health facility vs. other; OR 1.86, 95% CI 1.27–2.72, p = 0.001), geographic region (East vs. West; OR 2.30, 95% CI 1.20–4.44; p = 0.025), and age (24–59 vs. 0–23 months; OR 1.45, 95% CI 1.07–1.96; p = 0.016). The only factor associated with ACT adherence was time to treatment; children treated within 24 h were less likely to adhere (OR 0.55, 95% CI 0.34–0.89; p = 0.015). Conclusions In 2012, access and adherence to ACT remained low in Sierra Leone. Knowledge of ACT and ITNs, and seeking care in the public sector, were most strongly associated with ACT access. National surveys provide important information on anti-malarial access and could be expanded to measure treatment adherence.

Evaluating recurrent episodes of malaria incidence in Timika, Indonesia, through a Markovian multiple-state model

“…This shows that low medication adherence can prevent Plasmodium in the blood from being eliminated properly, leading to the condition of Undetected Parasitaemia. According to ( Banek et al., 2021 ), people who receive treatment immediately after experiencing symptoms of malaria are at a greater risk of non-adherence than people who have symptoms of malaria but do not seek immediate treatment. This behavior can also keep Plasmodium from being completely eliminated, leading to a recurrence.…”

Starting at the community: Treatment-seeking pathways of children with suspected severe malaria in Uganda

“…Fourth, investments into the supply side should be complemented by the removal of barriers to appropriate treatment on the demand side. Effective strategies may be educating caregivers on the importance of ACT administration after injectable antimalarials [ 44 ], and making antimalarials more affordable in the private sector. In Uganda, ACTs are subsidized through the private sector co-payment mechanism (CPM) [ 29 ].…”

Starting at the community: Treatment seeking pathways of children with suspected severe malaria in Uganda

“…Fourth, investments into the supply side should be complemented by the removal of barriers to appropriate treatment on the demand side. Effective strategies may be educating caregivers on the importance of ACT administration after injectable antimalarials, 40 and making antimalarials more affordable in the private sector. In Uganda, ACTs are subsidized through the private sector co-payment mechanism (CPM).…”