Exploring barriers of adherence to Artemisinin-based Combination Therapy (ACT) with one day primaquine treatment for Plasmodium falciparum malaria and compliance to vector control among marginalized tribal communities in East Central India

Abstract

Abstract Background Artemisinin Based Combination Therapy (ACT) compounds, have been observed to produce rapid therapeutic response, introduced over the past few years against chloroquine resistant Plasmodium falciparum. In India, malaria treatment by Accredited Social Health Activists (ASHAs) in remote and tribal villages has expanded the use of ACTs for the management of uncomplicated malaria. To maximize its effectiveness, patients’ adherence to the treatment regimen is central. Measures should therefore be taken to ensure and monitor the use of ACT to avoid the emergence of resistance/treatment failure. The present study assessed the level of adherence to ACT treatment, including the respondents’ compliance to vector control interventions. Methods The research team visited the houses of pre-diagnosed P. falciparum infected malaria patients, treated by the Community Health Centres with ACT plus primaquine, on the 4th day post treatment. Adherence to the drug regimen was observed on the spot and the patients were interviewed using a semi-structured questionnaire on malaria and their compliance to the ongoing vector control intervention. Rapid diagnostic tests and peripheral blood smear collection were conducted to ascertain whether the patient was cleared of parasitaemia post treatment. Results 76.5% of the patients were found adhering to the drug regimen. Over 80% of the respondents informed mosquito that bite was one of the causes of malaria and felt it is a serious disease. Only 0.7% of the respondents preferred traditional to ACT medicines for malaria treatment. Lack of space, damaged nets, and use of mosquito repellents were the major reasons of the non-usage of Insecticide-Treated Nets(ITNs). Only 1.6% of the respondents had permitted for indoor residual spray(IRS) in all rooms of their houses. 27.3% of the respondents had permitted spraying their houses partially. Conclusion Too many tablets was the major reason for non-adherence to the ACT regimen. Strengthening information, education, and communication/behaviour change communication could enhance drug adherence, improving LLIN use rate, and acceptance to IRS. One of the important take away from the current study was the paradigm shift in preference to ACT from traditional medicines for malaria treatment.