title: The role of communication between clients and health care providers: implications for adherence to malaria treatment in rural Gambia.
abstract: OBJECTIVE
  One of the major barriers to the successful treatment of malaria is the non-adherence to drug regimens. Work till now has often been based on the assumption that most patients begin their treatment having received adequate or at least similar instructions and information about both the disease itself and the content and course of their treatment. This paper questions such an assumption. We ask whether people do not adhere to treatment in part because they have not understood the diagnosis and subsequent treatment from the outset.
  
  
  METHODS
  This study was conducted in the North Bank district of The Gambia, West Africa where a convenience sample of 1337 caretakers with children under 10 years of age were interviewed immediately after their consultation about their recommended treatment.
  
  
  RESULTS
  Findings show a mismatch between caretakers and healthcare providers' (HCP) interpretations of a child's clinic visit, both in terms of the diagnosis and drug regimen. Less than a third of the caretakers' responses matched the diagnosis that the HCP had written on the child's medical card. Results also showed a delay in the first important antimalarial dose. A common response was 'I'm not sure what is wrong with the child but I will start the medicine when I get home'.
  
  
  CONCLUSIONS
  The findings from these exit interviews lend weight to the argument that the value of pre-packaged blisters could potentially provide far greater benefits than their additional cost, especially when coupled with improved communication by HCP.
authors.affiliation: Health Policy Unit and Gates Malaria Partnership, London School of Hygiene and Tropical Medicine, London, UK. lesong.conteh@lshtm.ac.uk
authors.forename: Lesong
authors.initials: L
authors.lastname: Conteh
authors.forename: Warren
authors.initials: W
authors.lastname: Stevens
authors.forename: Virginia
authors.initials: V
authors.lastname: Wiseman
mesh_terms: D000962:Antimalarials / Q000008:administration & dosage; D001294:Attitude to Health; D002648:Child; D002675:Child, Preschool; D002738:Chloroquine / Q000008:administration & dosage; D003144:Communication Barriers; D004334:Drug Administration Schedule; D004338:Drug Combinations; D005260:Female; D005334:Fever / Q000175:diagnosis; D005714:Gambia / Q000453:epidemiology; D006801:Humans; D007223:Infant; D008288:Malaria / Q000188:drug therapy* / Q000453:epidemiology / Q000523:psychology; D008297:Male; D010349:Patient Compliance / Q000523:psychology*; D011369:Professional-Patient Relations; D011739:Pyrimethamine / Q000008:administration & dosage; D012423:Rural Health; D013413:Sulfadoxine / Q000008:administration & dosage
chemical_list: D000962:Antimalarials; D004338:Drug Combinations; C001205:fanasil, pyrimethamine drug combination; D013413:Sulfadoxine; D002738:Chloroquine; D011739:Pyrimethamine