Patients’ adherence to artemisinin-based combination therapy and healthcare workers’ perception and practice in Savannakhet province, Lao PDR

Abstract

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.

Adherence to antihypertensive medications in rural Lao PDR: a prospective observational study

“…In the present study, the adherent group tended to be more likely to have received written instructions when they were prescribed medications. The finding is consistent with a study conducted in the same region but for a different medication (i.e., adherence to malaria medication) [ 16 ]. It is necessary to promote the provision of written instructions in these areas; however, the following two issues should be considered and additional strategies developed and implemented accordingly.…”

“…These districts were selected because malaria remains endemic, and most healthcare resources are directed toward treating acute diseases; therefore, it is thought that NCDs are not adequately addressed. Furthermore, we thought it would be possible to compare the results of this study on adherence to antihypertensives with those of the study on adherence to anti-malaria medication [ 16 ]. Therefore, data were collected in the three district hospitals.…”

Malaria prevalence, knowledge, perception, preventive and treatment behavior among military in Champasak and Attapeu provinces, Lao PDR: a mixed methods study

“…Additionally, non-compliance with antimalarial drug regimen or receiving sub-optimal dose led to increased risk of treatment failure [42]. Poor adherence to antimalarial medication for uncomplicated malaria was observed among rural communities in Lao PDR [43]. Failure to monitor this concern would affect prevalence of antimalarial drug resistance [44].…”

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

“…Eventually, it might lead to the emergence and spread of drug resistant PF malaria strains [3,7,8]. Patients with uncomplicated PF malaria have strongly discontinued the full or partial course of AL when they were symptom-free since its symptoms improve rapidly after the treatment was initiated [9][10][11][12]. Multiple factors might lead to poor AL adherence, normally classified into five categories: socioeconomic factors [12][13][14][15][16], patient-related factors [11][12][13][17][18][19][20] drug and condition-related factors [14,21], and health system-related factors [13].…”