title: Adherence to Artemisinin Combination Therapy for the treatment of uncomplicated malaria in the Democratic Republic of the Congo.
abstract: Between 2011 and 2013 the number of recorded malaria cases had more than doubled, and between 2009 and 2013 had increased almost 4-fold in MSF-OCA (Médecins sans Frontières - Operational Centre Amsterdam) programmes in the Democratic Republic of the Congo (DRC). The reasons for this rise are unclear. Incorrect intake of Artemisinin Combination Therapy (ACT) could result in failure to treat the infection and potential recurrence. An adherence study was carried out to assess whether patients were completing the full course of ACT. One hundred and eight malaria patients in Shamwana, Katanga province, DRC were visited in their households the day after ACT was supposed to be completed. They were asked a series of questions about ACT administration and the blister pack was observed (if available). Sixty seven (62.0%) patients were considered probably adherent. This did not take into account the patients that vomited or spat their pills or took them at the incorrect time of day, in which case adherence dropped to 46 (42.6%). The most common reason that patients gave for incomplete/incorrect intake was that they were vomiting or felt unwell (10 patients (24.4%), although the reasons were not recorded for 22 (53.7%) patients). This indicates that there may be poor understanding of the importance of completing the treatment or that the side effects of ACT were significant enough to over-ride the pharmacy instructions. Adherence to ACT was poor in this setting. Health education messages emphasising the need to complete ACT even if patients vomit doses, feel unwell or their health conditions improve should be promoted.
authors.affiliation: MSF-UK, London, EC1N 8QX, UK.
authors.forename: M Ruby
authors.initials: MR
authors.lastname: Siddiqui
authors.affiliation: MSF-Canada, Toronto, ON, M5S 2T9, Canada.
authors.forename: Andrew
authors.initials: A
authors.lastname: Willis
authors.affiliation: MSF-OCA, Amsterdam, P.O Box 10014, Netherlands.
authors.forename: Karla
authors.initials: K
authors.lastname: Bil
authors.affiliation: MSF-OCA, Lubumbashi, Katanga, Congo, Democratic Republic.
authors.forename: Jatinder
authors.initials: J
authors.lastname: Singh
authors.affiliation: Katanga Ministry of Health, Lubumbashi, Katanga, Congo, Democratic Republic.
authors.forename: Eric
authors.initials: E
authors.lastname: Mukomena Sompwe
authors.affiliation: London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK.
authors.forename: Cono
authors.initials: C
authors.lastname: Ariti
keywords: Adherence; Plasmodium falciparum; artemisinin; artesunate-amodiaquine; compliance; malaria; side effects; treatment failure