Do patients adhere to over-the-counter artemisinin combination therapy for malaria? evidence from an intervention study in Uganda
Open accessAbstract
BACKGROUND: Increasing affordability of artemisinin combination therapy (ACT) in the African retail sector could be critical to expanding access to effective malaria treatment, but must be balanced by efforts to protect the efficacy of these drugs. Previous research estimates ACT adherence rates among public sector patients, but adherence among retail sector purchasers could differ substantially. This study aimed to estimate adherence rates to subsidized, over-the-counter ACT in rural Uganda. METHODS: An intervention study was conducted with four licensed drug shops in Eastern Uganda in December 2009. Artemether-lumefantrine (AL) was made available for sale at a 95% subsidy over-the counter. Customers completed a brief survey at the time of purchase and then were randomly assigned to one of three study arms: no follow-up, follow-up after two days or follow-up after three days. Surveyors recorded the number of pills remaining through blister pack observation or through self-report if the pack was unavailable. The purpose of the three-day follow-up arm was to capture non-adherence in the sense of an incomplete treatment course ("under-dosing"). The purpose of the two-day follow-up arm was to capture whether participants completed the full course too soon ("over-dosing"). RESULTS: Of the 106 patients in the two-day follow-up sample, 14 (13.2%) had finished the entire treatment course by the second day. Of the 152 patients in the three-day follow-up sample, 49 (32.2%) were definitely non-adherent, three (2%) were probably non-adherent and 100 (65.8%) were probably adherent. Among the 52 who were non-adherent, 31 (59.6%) had more than a full day of treatment remaining. CONCLUSIONS: Overall, adherence to subsidized ACT purchased over-the-counter was found to be moderate. Further, a non-trivial fraction of those who complete treatment are taking the full course too quickly. Strategies to increase adherence in the retail sector are needed in the context of increasing availability and affordability of ACT in this sector.
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Variations in the age of participating children, level of caregiver education, household religion and socioeconomic position may influence treatment adherence.
“Specifically, variations in the age of participating children, level of caregiver education, household religion and socioeconomic position were found, all of which may influence treatment adherence [3, 29, 67, 68].”
From Adherence to treatment with artemether–lumefantrine or amodiaquine–artesunate for uncomplicated malaria in children in Sierra Leone: a randomized trial (2018) · cites this paper as [67]
The Results section (‘Variables associated with adherence’; page unavailable) reports that patients or caregivers with some secondary education were more likely to complete treatment. It found no significant relationship for patient age or socioeconomic measures other than education, and the passages found do not address household religion. Thus, this source supports the education component, but not the suggestion that all four factors may influence adherence. (LLM, conf=0.88)
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- Authors
- Cohen, J. L., Yavuz, E., Morris, A., Arkedis, J., & Sabot, O.
- Affiliations
- Brookings Institution (US)
- Harvard University (US)
- Clinton Health Access Initiative (US)
- Results for Development Institute (US)
- Corresponding author
- Cohen, Jessica L
- ORCID
- Cohen, Jessica L
- Venue
- Malaria Journal
- Published
- 2012-03-23
- Volume
- 11
- Issue
- 1
- Pages
- 83-83
- ISSN
- 1475-2875 (ISSN-L)
- PMC
- PMC3342228
- OpenAlex
- W2097205415
- Cited by
- 45
- References
- 41
- Citations by year
- 2025: 2 · 2024: 3 · 2023: 2 · 2022: 1 · 2020: 3 · 2019: 3 · 2018: 4 · 2017: 4 · 2016: 4 · 2015: 6 · 2014: 4 · 2013: 5 · 2012: 4
- FWCI
- 5.87
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Malaria Journal (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Digital Access to Scholarship at Harvard (DASH) (Harvard University) (submittedVersion, cc-by)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
- Funders
- Bill and Melinda Gates Foundation
- Clinton Foundation
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Malaria Research and Control
- Health Sciences › Medicine › Family Practice › Medication Adherence and Compliance
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Pharmaceutical Quality and Counterfeiting
- Keywords
- artemisinin-based combination therapy, medication adherence, malaria treatment, artemether-lumefantrine, over-the-counter drug sales, drug shops, drug subsidies, underdosing, drug affordability, Uganda
- MeSH terms
- Artemether, Lumefantrine Drug Combination, Adolescent, Adult, Antimalarials, Child, Child, Preschool, Drug Administration Schedule, Drug Combinations, Ethanolamines, Female, Fluorenes, Follow-Up Studies, Humans, Male, Patient Compliance, Pharmacies, Plasmodium falciparum, Random Allocation, Uganda, Malaria, Falciparum, Artemisinins
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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