Factors associated with non-adherence to Artemisinin-based Combination Therapy (ACT) to malaria in a rural population from holoendemic region of western Kenya
Over the years, reports implicate improper anti-malarial use as a major contributor ofmorbidity and mortality amongst millions of residents in malaria endemic areas, Kenyaincluded. However, there are limited reports on improper use of Artemisinin-basedCombination Therapy (ACT) which is a first-line drug in the treatment of malaria in Kenya.Knowing this is important for ensured sustainable cure rates and also protection against theemergence of resistant malarial parasites.
We therefore investigated ACT adherence level,factors associated with non-adherence and accessibility in households (n = 297) in rurallocation of Southeast Alego location in Siaya County in western Kenya.
Methods:
ACT Adherence level was assessed with reference to the duration of treatment and number oftablets taken. Using systematic random sampling technique, a questionnaire was administeredto a particular household member who had the most recent malaria episode (<2 weeks) andused ACT for cure.
Parents/caretakers provided information for children aged <13 years. KeyInformant Interviews (KIIs) were also conducted with healthcare providers and privatedispensing chemist operators.
Results:
Adherence to ACT prescription remained low at 42.1 % and 57.9 % among individuals above13 and less than 13 years, respectively.
Stratification by demographic and socio-economiccharacteristics in relation to ACT adherence revealed that age (P = 0.011), education level(P <0.01), ability to read (P <0.01) and household (HH) monthly income (P = 0.002)significantly affected the level of ACT adherence. Consistently, logistic regression modeldemonstrated that low age (OR, 0.571, 95 % CI, 0.360-0.905; P = 0.017), higher educationlevel (OR, 0.074; 95 % CI 0.017-0.322; P <0.01), ability to read (OR, 0.285, 95 % CI, 0.167-0.486; P <0.01) and higher income (Ksh.
>9000; OR, 0.340; 95 % CI, 0.167-0.694;P = 0.003) were associated with ACT adherence. In addition, about 52.9 % of the respondentsreported that ACT was not always available at the source and that drug availability(P = 0.020) and distance to drug source (P <0.01) significantly affected accessibility.
Conclusions:
This study demonstrates that more than half of those who get ACT prescription do not takerecommended dose and that accessibility is of concern.
The findings of this study suggest apotential need to improve accessibility and also initiate programmatic interventions toencourage patient-centred care.
Author: Elizabeth O OnyangoGeorge AyodoCarren A WatsierahTom WereWilson OkumuSamuel B AnyonaEvans RaballahJohn M OkothSussy GumoGeorge O OrindaCollins Ouma Credits/Source: BMC Infectious Diseases 2012, 12:143
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