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.

Keywords: Adherence; Artemether–lumefantrine; Plasmodium falciparum.

Fig. 1

Schematic presentation of sampling procedure among uncomplicated PF malaria patients in AsgedeTsimbla district, Tigray, Ethiopia, 2018

Fig. 2

Pill count and dose timing adherence to AL treatment among uncomplicated PF malaria patients in AsgedeTsimbla district, Tigray, Ethiopia, 2018