High adherence level to artemisinin-based combination therapies in rural settlement 11 years after their introduction in the health system, Nanoro, Burkina Faso

Abstract

Purpose

In 2005, Burkina Faso changed its first-line treatment for uncomplicated malaria from chloroquine to artemisinin-based combination therapies (ACTs). Patient adherence to ACTs regimen is a keystone to achieve the expected therapeutic outcome and prevent the emergence and spread of parasite resistance. Eleven years after the introduction of ACTs in the health system, this study aimed to measure adherence level of patients in rural settlement and investigate the determinants of nonadherence.

Patients and methods

The study was carried out at public peripheral health facilities from May 2017 to August 2017 in Nanoro health district, Burkina Faso. An electronic semi-structured questionnaire was used for data collection from patients with an ACT prescription at their medical consultation exit visit and during home visit at day 5±2. Adherence level was measured through self-report and pill counts. Logistic regression was performed to identify factors for nonadherence.

Results

The analysis was conducted on 199 outpatients who received ACT as prescription. About 92.5% of ACT prescriptions included artemether-lumefantrine tablets. Adherence level was measured in 97.0% of included patients at day 5±2. Of these, 86.0% were classified as “complete adherent” and 14.0% as “nonadherent”. In univariate analysis, patients/caregivers who considered that affordability of ACTs was easy seemed to be less adherent to the treatment regimen (OR: 0.26; 95% CI: 0.07–0.70). In univariate and multivariable analyses, patients/caregivers who did not receive advices from health care workers (HCWs) were more likely to be nonadherent to the prescribed ACTs (adjusted OR: 3.21; 95% CI: 1.13–9.12).

Conclusion

This study demonstrates that majority of those who get an ACT prescription comply with the recommended regimen. This emphasizes that in rural settings where ACTs are provided free of charge or at a subsidized price, patient adherence to ACTs is high, thus minimizing the risk of subtherapeutic concentrations of the drug in blood which is known to increase resistance and susceptibility to new infections. Therefore, to address the problem of patient nonadherence, strategy to strengthen communication between HCWs and patients should be given greater consideration.

Keywords:

• malaria
• hyperendemic area
• drug prescription
• artemether-lumefantrine
• amodiaquine-artesunate

Supplementary materials

Table S1 Dosing schedule for artesunate-amodiaquine

Table S2 Dosing schedule for artemether-lumefantrine

Reference

• Ministry of Health/National Malaria Control Program[National Guidelines for the Diagnosis, Treatment, and Prevention of Malaria in Burkina Faso] Directives Nationales pour La prise en charge Du paludisme Au Burkina FasoBurkina Faso2017 French
   Google Scholar

Acknowledgments

We are very grateful to all participants who participated in the study. We would like to thank everyone who supported this study directly or indirectly through fieldwork, data collection, or analysis support. The research team would like to thank its partners: National Malaria Control Program in Burkina Faso, INDEPTH Network, and Shinpoong Group, South Korea. The field work of this study was sponsored by the INDEPTH Network, thanks to a grant offered by the Bill & Melinda Gates Foundation.

Disclosure

The authors report no conflicts of interest in this work.