title: Patient adherence to prescribed artemisinin-based combination therapy in Garissa County, Kenya, after three years of health care in a conflict setting.
abstract: BACKGROUND
  Current day malaria cases and deaths are indicative of a lack of access to both methods of prevention, diagnosis, and treatment; an important determinant of treatment efficacy is adherence. This study is a follow up to the baseline study of adherence to artemether-lumefantrine (AL) carried out in Garissa District in 2010. The study presented evaluates any changes in adherence levels which may have occurred in the area during this period and after nearly three years of sustained use of ACT across the public health sector.
  
  
  METHODS
  The study was carried out in Garissa County in the North Eastern Province of Kenya and included patients fitting the suspected malaria case definition and having been prescribed AL, regardless of confirmatory diagnosis. A questionnaire assessed the intake of AL via both self-reporting by the participant and observation of blister packs by the interviewer. On separate occasions exit interviews with patients and observations of prescribers were also carried out.
  
  
  RESULTS
  Of the 218 participants enrolled, 195 were successfully followed up. 60% of participants were found to be adherent to the three-day AL regimen, this is 4.7% lower than the proportion of participants adherent in 2010; the result of a two-sided z-test was not significant (p = 0.23). The odds of the patient being adherent to AL increased by 65% with each additional correct statement regarding how to take AL that a patient could recall (between zero and four statements), this was the only variable significantly associated with patient adherence (p = 0.01).
  
  
  CONCLUSIONS
  Sustaining the ACT adherence rates at the 2010 levels, through 2.5 years of insecurity in the study area is an achievement and suggests that if security can be improved barriers to improving health service quality and patient adherence to AL would be removed. This study, by looking specifically at anti-malarial adherence over a prolonged period and in a setting of severe conflict, provides a valuable and rare insight in to the challenges and barriers to ACT adherence in such settings.
authors.affiliation: The MENTOR Initiative, Crawley, UK. georgia@mentor-initiative.net.
authors.forename: Georgia R
authors.initials: GR
authors.lastname: Gore-Langton
authors.affiliation: The MENTOR Initiative, Garissa, Kenya. nfornuh@mentor-initiative.net.
authors.forename: Nfornuh
authors.initials: N
authors.lastname: Alenwi
authors.affiliation: The MENTOR Initiative, Garissa, Kenya. jamesmungai2001@yahoo.com.
authors.forename: James
authors.initials: J
authors.lastname: Mungai
authors.affiliation: The MENTOR Initiative, Garissa, Kenya. nerupe@yahoo.com.
authors.forename: Nahashon I
authors.initials: NI
authors.lastname: Erupe
authors.affiliation: The MENTOR Initiative, Crawley, UK. katie@mentor-initiative.net.
authors.forename: Katie
authors.initials: K
authors.lastname: Eves
authors.affiliation: Ministry of Health, Garissa, Kenya. njoro33@yahoo.com.
authors.forename: Francis Njoroge
authors.initials: FN
authors.lastname: Kimwana
authors.affiliation: Ministry of Health, Nairobi, Kenya. dsoti2002@yahoo.com.
authors.forename: David
authors.initials: D
authors.lastname: Soti
authors.affiliation: Ministry of Health, Nairobi, Kenya. wilak4@yahoo.com.
authors.forename: Willis
authors.initials: W
authors.lastname: Akhwale
authors.affiliation: Ministry of Health, Garissa, Kenya. fahamin76@yahoo.com.
authors.forename: Farah A
authors.initials: FA
authors.lastname: Hassan
authors.affiliation: Ministry of Health, Nairobi, Kenya. jumaelizabeth@yahoo.com.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Juma
authors.affiliation: The MENTOR Initiative, Crawley, UK. richard@mentor-initiative.net.
authors.forename: Richard
authors.initials: R
authors.lastname: Allan
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000962:Antimalarials / Q000008:administration & dosage*; D000077611:Artemether, Lumefantrine Drug Combination; D037621:Artemisinins / Q000008:administration & dosage*; D004338:Drug Combinations; D004983:Ethanolamines / Q000008:administration & dosage*; D005260:Female; D005449:Fluorenes / Q000008:administration & dosage*; D005500:Follow-Up Studies; D006801:Humans; D007630:Kenya; D008288:Malaria / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D011795:Surveys and Questionnaires; D055815:Young Adult
chemical_list: D000962:Antimalarials; D000077611:Artemether, Lumefantrine Drug Combination; D037621:Artemisinins; D004338:Drug Combinations; D004983:Ethanolamines; D005449:Fluorenes