Prescriber practices and patient adherence to artemisinin-based combination therapy for the treatment of uncomplicated malaria in Guinea, 2016.
BACKGROUND
The World Health Organization recommends the use of artemisinin-based combination therapy (ACT) to treat uncomplicated malaria for the control of malaria across the world. There are several types of ACT used across malaria-endemic countries, yet there is little information about preferences and adherence practices regarding different types of ACT. The objective of this study was to evaluate levels of adherence to two types of ACT, artemether-lumefantrine (AL) and artesunate + amodiaquine (ASAQ), for the treatment of uncomplicated malaria among prescribers and patients in Guinea in 2016.


METHODS
The study included a review of records of malaria patients and three health-facility, cross-sectional surveys. Patients diagnosed with uncomplicated malaria and prescribed ACT (n = 1830) were recruited and visited in their home after receiving the medication and administered a questionnaire regarding ACT adherence. Prescribers (n = 115) and drug dispensers (n = 43) were recruited at the same public health facilities and administered questionnaires regarding prescribing practices and opinions regarding the national treatment policies and protocols.


RESULTS
According to the registry review, 35.8% of all-cause consultations were recorded as malaria. Of these, 26.6% were diagnosed clinically without documentation of laboratory confirmation. The diagnosis of uncomplicated malaria represented 64.1% of malaria cases among children under 5 years and 74.9% of those 5 years of age and older. An ACT was prescribed for 83.5% of cases of uncomplicated malaria. Among participants in the study, ACT adherence was 95.4% (95% CI 94.4, 96.3). Overall, about one in four patients (23.4%; 95% CI 21.5, 25.3) reported experiencing adverse events. While patients prescribed ASAQ were significantly more likely to report experiencing adverse effects than patients on AL (p < 0.001), given the overall high adherence, there was no evidence of a statistically significant difference in adherence between AL and ASAQ. Patients 5 years or older who reported experiencing adverse events were more likely to be non-adherent.


CONCLUSION
Although there were more reported adverse events associated with ASAQ when compared with AL, both prescribers and patients were found to be mostly adherent to ACT for the treatment of malaria, regardless of ACT type.
['Camara|Alioune|A|', 'Moriarty|Leah F|LF|', 'Guilavogui|Timothée|T|', 'Diakité|Papa Sambou|PS|', 'Zoumanigui|Joseph Souba|JS|', 'Sidibé|Sidikiba|S|', 'Bah|Ibrahima|I|', 'Kaba|Ibrahima|I|', 'Kourouma|Djebory|D|', 'Zoumanigui|Koho|K|', 'Plucinski|Mateusz|M|']
D000293:Adolescent D000328:Adult D000368:Aged D000655:Amodiaquine D000962:Antimalarials D000077611:Artemether, Lumefantrine Drug Combination D037621:Artemisinins D002648:Child D002675:Child, Preschool D003430:Cross-Sectional Studies D004338:Drug Combinations D005260:Female D016701:Guinea D006801:Humans D007223:Infant D008288:Malaria D008297:Male D008875:Middle Aged D010349:Patient Compliance D011361:Professional Competence D055815:Young Adult
Adherence Malaria Guinea ACT Amodiaquine Drug intake Lumefantrine