Factors influencing patients’ adherence to malaria Artemisinin-based combination therapy treatment in Kamuli District, Uganda
Authors: Bawate Charles , Callender-Carter Sylvia T , Guyah Bernard , Ouma Collins 
Published: October 2023

Abstract
Background
Patients’ adherence to prescribed Artemisinin-based Combination Therapy (ACT) treatment is a key malaria control strategy. To accelerate and realize a malaria free country, malaria management measures remain a key public health priority, and patients play a key role in all strategies. Several studies have posited differing experiences regarding patients’ adherence to ACT. The objective of this study was to determine the factors influencing patients’ adherence to malaria ACT treatment in Kamuli District, Uganda.
Methods
In a prospective study, information on patients’ adherence level to ACT and the factors influencing their adherence to malaria ACT treatment, was collected in Kamuli District, Uganda. A total of 1266 patients were enrolled at 8 public health facilities, and with equal numbers (422) assigned to either no follow-up arm to remove uncertainty about the intent to follow-up arm, day 2 arm to assess whether patients’ complete treatment course too early, and day 4 arm to assess whether patients delay or discontinue treatment. The final analysis was based on 844 participants. To establish the mean difference between groups, a Student t-test was used while chi-square was used for proportionality. A multivariate logistic regression analysis was used to establish the influence of predictor variables on the dependent variable. Statistical significance was established at p < 0.05.
Results
A total of 844 patients were considered in the analysis. The median age was 20 years, with majority (64.3%) being females. Overall patients’ adherence to ACT treatment was 588/844 (69.7%). At bivariate analysis level, age (t-test = 2.258, p = 0.024, 95% CI = 0.391–5.594), household head (χ2 = 14.484, p = 0.002), employment status (χ2 = 35.886, p < 0.0001), patients’ preference of ACT to other antimalarials (χ2 = 15.981, p < 0.0001), giving a patient/ caregiver instructions on how to take the medication (χ2 = 7.134, p = 0.011), being satisfied with getting ACT at facility (χ2 = 48.261, p < 0.0001), patient/ caregiver knowing the drug prescribed (χ2 = 5.483, p = 0.019), patient history of saving ACT medicines (χ2 = 39.242, p < 0.0001), and patient ever shared ACT medicines (χ2 = 30.893, p < 0.0001) were all associated with patients’ adherence to ACT prescriptions. Additional multivariate logistic regression analysis, demonstrated that; the odds of one adhering to ACT prescription is 3.063 times higher for someone who reports being satisfied with getting ACT at the facility (OR = 3.063; p < 0.0001; 95% CI = 1.857–5.051), 4.088 times for someone with history of saving ACT medicines (OR = 4.088; p < 0.0001; 95% CI = 2.165–7.721), 2.134 times for someone who ever shared ACT (OR = 2.134; p = 0.03; 95% CI = 1.078–4.224), and 2.817 times for someone with a household head (OR = 2.817; p = 0.008; 95% CI = 1.306–6.077), and all these factors were statistically significant.
Conclusion
In the current studied populations, patients’ adherence to ACT treatment prescriptions is good. However, patients’ tendencies of saving for future use and sharing among family members is a great threat, amidst the great benefits associated with good adherence and dangers of non-compliance. There is an urgent need to educate the public about proper adherence to medicines prescribed by professionals and the government supply chain to be tightened to avoid frequent stock-outs of ACT at facilities.