Factors related to compliance to anti-malarial drug combination: example of amodiaquine/sulphadoxine-pyrimethamine among children in rural Senegal.
BACKGROUND
The introduction of new anti-malarial treatment that is effective, but more expensive, raises questions about whether the high level of effectiveness observed in clinical trials can be found in a context of family use. The objective of this study was to determine the factors related to adherence, when using the amodiaquine/sulphadoxine-pyrimethamine (AQ/SP) association, a transitory strategy before ACT implementation in Senegal.


METHODS
The study was conducted in five rural dispensaries. Children, between two and 10 years of age, who presented mild malaria were recruited at the time of the consultation and were prescribed AQ/SP. The child's primary caretaker was questioned at home on D3 about treatment compliance and factors that could have influenced his or her adherence to treatment. A logistic regression model was used for the analyses.


RESULTS
The study sample included 289 children. The adherence rate was 64.7%. Two risks factors for non-adherence were identified: the children's age (8-10 years) (ORa = 3.07 [1.49-6.29]; p = 0.004); and the profession of the head of household (retailer/employee versus farmer) (ORa = 2.71 [1.34-5.48]; p = 0.006). Previously seeking care (ORa = 0.28 [0.105-0.736], p=0.001] satisfaction with received information (ORa = 0.45 [0.24-0.84]; p = 0.013), and the quality of history taking (ORa = 0.38 [0.21-0.69]; p = 0.001) were significantly associated with good compliance.


CONCLUSIONS
The results of the study show the importance of information and communication between caregivers and health center staff. The experience gained from this therapeutic transition emphasizes the importance of information given to the patients at the time of the consultation and drug delivery in order to improve drug use and thus prevent the emergence of rapid drug resistance.
Souares
Aurélia
A
Faculté de Pharmacie, Institut de Recherche pour le Développement, UR10, Paris, France. souares@uni-heidelberg.de
Lalou
Richard
R
Sene
Ibra
I
Sow
Diarietou
D
Le Hesran
Jean-Yves
JY
D000655:Amodiaquine / Q000008:administration & dosage*; D000818:Animals; D000962:Antimalarials / Q000008:administration & dosage*; D017028:Caregivers; D002648:Child; D002675:Child, Preschool; D004334:Drug Administration Schedule; D004338:Drug Combinations; D004351:Drug Resistance; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D016015:Logistic Models; D008288:Malaria / Q000097:blood / Q000188:drug therapy* / Q000453:epidemiology / Q000469:parasitology; D008297:Male; D010961:Plasmodium / Q000187:drug effects*; D011739:Pyrimethamine / Q000008:administration & dosage*; D012424:Rural Population; D012675:Senegal / Q000453:epidemiology; D013413:Sulfadoxine / Q000008:administration & dosage*; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D016903:Drug Monitoring
D000962:Antimalarials; D004338:Drug Combinations; D000655:Amodiaquine; C001205:fanasil, pyrimethamine drug combination; D013413:Sulfadoxine; D011739:Pyrimethamine