Adherence to antimalarial treatment in the context of reactive case detection in Zanzibar

Abstract

Adherence to antimalarial treatment is a central building block of effective malaria control and elimination. While patient adherence to treatment regimens has been investigated in different settings, there is a dearth of evidence on adherence by asymptomatic individuals who are provided 103 astmh.org treatment in the context of reactive case detection strategies. This study aimed to assess adherence to the first-line treatment artesunateamodiaquine (AsAq) by symptomatic and asymptomatic individuals detected and provided treatment by the expanded surveillance system of the Zanzibar Malaria Elimination Programme (ZAMEP). A rolling crosssectional survey in six districts in Zanzibar followed passively and actively detected infected individuals of all ages on the 3rd day after receiving antimalarial treatment, when they were expected to have completed a full AsAq treatment course. Treatment adherence was assessed by inspection of the blister package and structured interviews with patients or caretakers. A total of 495 study participants were analyzed. The overall patients’ adherence to AsAq was 85% (95% CI: 81% - 88%). The adherence by symptomatic study participants was 88% (95% CI: 84% - 93%) and 75% (95% CI: 71% - 79%) by asymptomatic participants. Study participants’ health condition was found to be a determinant of adherence to AsAq (OR = 2.8, P = 0.001). Common self-reported reasons for non-adherence were not feeling sick, rapid recovery rate, a perception that the drug is too strong, and forgetting to take the pills. In conclusion, we found moderate and high levels of adherence to AsAq among treated asymptomatic and symptomatic study participants respectively. Presence of signs and symptoms prior treatment influenced intake on the treatment. Further efforts focusing on IEC/BCC activities are needed to improve correct and completion of dose uptake by both treated patients