title: Adherence to Artemisinin-Based Combination Therapy for the Treatment of Uncomplicated Malaria: A Systematic Review and Meta-Analysis.
abstract: Adherence to artemisinin-based combination therapy (ACT) is not clearly defined. This meta-analysis determines the prevalence and predictors of adherence to ACT. Twenty-five studies and six substudies met the inclusion criteria. The prevalence of ACT adherence in the public sector was significantly higher compared to retail sector (76% and 45%, resp., P < 0.0001). However, ACT adherence was similar across different ACT dosing regimens and formulations. In metaregression analysis prevalence estimates of adherence significantly decrease with increasing year of study publication (P = 0.046). Factors found to be significant predictors of ACT adherence were years of education ≥ 7 {odds ratio (OR) (95% CI) = 1.63 (1.05-2.53)}, higher income {2.0 (1.35-2.98)}, fatty food {4.6 (2.49-8.50)}, exact number of pills dispensed {4.09 (1.60-10.7)}, and belief in traditional medication for malaria {0.09 (0.01-0.78)}. The accuracy of pooled estimates could be limited by publication bias, and differing methods and thresholds of assessing adherence. To improve ACT adherence, educational programs to increase awareness and understanding of ACT dosing regimen are interventions urgently needed. Patients and caregivers should be provided with an adequate explanation at the time of prescribing and/or dispensing ACT.
authors.affiliation: Infectious and Tropical Diseases Unit, Public Health and Diagnostic Institute, College of Medical Sciences, Northwest University, PMB 3220, Kano, Nigeria.
authors.forename: Ahmad M
authors.initials: AM
authors.lastname: Yakasai
authors.affiliation: Infectious and Tropical Diseases Unit, Department of Medicine, Aminu Kano Teaching Hospital, Bayero University, PMB 3452, Kano, Nigeria.
authors.forename: Muhammad
authors.initials: M
authors.lastname: Hamza
authors.affiliation: Infectious and Tropical Diseases Unit, Department of Medicine, Aminu Kano Teaching Hospital, Bayero University, PMB 3452, Kano, Nigeria.
authors.forename: Mahmood M
authors.initials: MM
authors.lastname: Dalhat
authors.affiliation: Department of Community Medicine, Aminu Kano Teaching Hospital, Bayero University, PMB 3452, Kano, Nigeria.
authors.forename: Musa
authors.initials: M
authors.lastname: Bello
authors.affiliation: Department of Community Medicine, Aminu Kano Teaching Hospital, Bayero University, PMB 3452, Kano, Nigeria.
authors.forename: Muktar A
authors.initials: MA
authors.lastname: Gadanya
authors.affiliation: Department of Pharmacy, Aminu Kano Teaching Hospital, PMB 3452, Kano, Nigeria.
authors.forename: Zuwaira M
authors.initials: ZM
authors.lastname: Yaqub
authors.affiliation: Department of Medicine, Aminu Kano Teaching Hospital, Bayero University, PMB 3452, Kano, Nigeria.
authors.forename: Daiyabu A
authors.initials: DA
authors.lastname: Ibrahim
authors.affiliation: Infectious and Tropical Diseases Unit, Department of Paediatrics, Aminu Kano Teaching Hospital, Bayero University, PMB 3452, Kano, Nigeria.
authors.forename: Fatimah
authors.initials: F
authors.lastname: Hassan-Hanga