Treatment Adherence to Uncomplicated and Complicated Malaria Therapy in Two Villages of the Rural Commune of Kobiri, Mali

Abstract

Background: The adoption of Artemisinin-based Combination Therapies (ACTs) for malaria treatment in Mali has been challenged by reports of side effects potentially affecting patient adherence. This study assessed the adherence rate and its determinants to anti-malarial treatments, particularly Artesunate-Amodiaquine (AS-AQ). in two rural health centers in Mali.

Methods: A prospective observational study was conducted from April to September 2009 in the health centers of Diagala and Kohiri. Patients diagnosed with uncomplicated or complicated malaria based on clinical suspicion or Rapid Diagnostic Test (RDT) were included. Adherence was assessed during intermediate (II) and day 7 (17) visits. A good adherence threshold was set at >90%.

Results: Among 448 enrolled patients, the median age was 3 years, with 65.2% being children under five. AS-AQ was the most prescribed treatment (97%). The overall adherence rate for AS-AQ was 92.5% (95% CI: 89.6-94.8). However, adherence was significantly higher in children under 15 (94.4%) compared to those aged 15 and above (80%, p<0.001). The main reasons for non-adherence were side effects (55.2%) and misunderstanding of prescription instructions (27.6%).

Conclusion: While overall adherence to AS-AQ was satisfactory and above the 90% threshold, a significant adherence gap exists among adults. Side effects and comprehension issues are primary drivers of non-adherence. Targeted communication strategies for adults, improved patient education, and sustained quality assurance of medicines are recommended to optimize malaria treatment outcomes.