Adherence to 14-day radical cure for Plasmodium vivax malaria in Papua, Indonesia: a mixed-methods study
Abstract Background Reducing the risk of recurrent Plasmodium vivax malaria is critical for malaria control and elimination. Primaquine (PQ) is the only widely available drug against P. vivax dormant liver stages, but is recommended as a 14-day regimen, which can undermine adherence to a complete co...
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| Format: | Article |
| Language: | English |
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BMC
2023-05-01
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| Series: | Malaria Journal |
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| Online Access: | https://doi.org/10.1186/s12936-023-04578-3 |
| _version_ | 1797823017327263744 |
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| author | Annisa Rahmalia Jeanne Rini Poespoprodjo Chandra U. R. Landuwulang Maya Ronse Enny Kenangalem Faustina H. Burdam Kamala Thriemer Angela Devine Ric N. Price Koen Peeters Grietens Benedikt Ley Charlotte Gryseels |
| author_facet | Annisa Rahmalia Jeanne Rini Poespoprodjo Chandra U. R. Landuwulang Maya Ronse Enny Kenangalem Faustina H. Burdam Kamala Thriemer Angela Devine Ric N. Price Koen Peeters Grietens Benedikt Ley Charlotte Gryseels |
| author_sort | Annisa Rahmalia |
| collection | DOAJ |
| description | Abstract Background Reducing the risk of recurrent Plasmodium vivax malaria is critical for malaria control and elimination. Primaquine (PQ) is the only widely available drug against P. vivax dormant liver stages, but is recommended as a 14-day regimen, which can undermine adherence to a complete course of treatment. Methods This is a mixed-methods study to assess socio-cultural factors influencing adherence to a 14-day PQ regimen in a 3-arm, treatment effectiveness trial in Papua, Indonesia. The qualitative strand, consisting of interviews and participant observation was triangulated with a quantitative strand in which trial participants were surveyed using a questionnaire. Results Trial participants differentiated between two types of malaria: tersiana and tropika, equivalent to P. vivax and Plasmodium falciparum infection, respectively. The perceived severity of both types was similar with 44.0% (267/607) perceiving tersiana vs. 45.1% (274/607) perceiving tropika as more severe. There was no perceived differentiation whether malaria episodes were due to a new infection or relapse; and 71.3% (433/607) acknowledged the possibility of recurrence. Participants were familiar with malaria symptoms and delaying health facility visit by 1–2 days was perceived to increase the likelihood of a positive test. Prior to health facility visits, symptoms were treated with leftover drugs kept at home (40.4%; 245/607) or bought over the counter (17.0%; 103/607). Malaria was considered to be cured with ‘blue drugs’ (referring to dihydroartemisinin-piperaquine). Conversely, ‘brown drugs,’ referring to PQ, were not considered malaria medication and instead were perceived as supplements. Adherence to malaria treatment was 71.2% (131/184), in the supervised arm, 56.9% (91/160) in the unsupervised arm and 62.4% (164/263) in the control arm; p = 0.019. Adherence was 47.5% (47/99) among highland Papuans, 51.7% (76/147) among lowland Papuans, and 72.9% (263/361) among non-Papuans; p < 0.001. Conclusion Adherence to malaria treatment was a socio-culturally embedded process during which patients (re-)evaluated the characteristics of the medicines in relation to the course of the illness, their past experiences with illness, and the perceived benefits of the treatment. Structural barriers that hinder the process of patient adherence are crucial to consider in the development and rollout of effective malaria treatment policies. |
| first_indexed | 2024-03-13T10:17:29Z |
| format | Article |
| id | doaj.art-6da2e98274d749c993482c5971e4eea8 |
| institution | Directory Open Access Journal |
| issn | 1475-2875 |
| language | English |
| last_indexed | 2024-03-13T10:17:29Z |
| publishDate | 2023-05-01 |
| publisher | BMC |
| record_format | Article |
| series | Malaria Journal |
| spelling | doaj.art-6da2e98274d749c993482c5971e4eea82023-05-21T11:09:26ZengBMCMalaria Journal1475-28752023-05-0122111610.1186/s12936-023-04578-3Adherence to 14-day radical cure for Plasmodium vivax malaria in Papua, Indonesia: a mixed-methods studyAnnisa Rahmalia0Jeanne Rini Poespoprodjo1Chandra U. R. Landuwulang2Maya Ronse3Enny Kenangalem4Faustina H. Burdam5Kamala Thriemer6Angela Devine7Ric N. Price8Koen Peeters Grietens9Benedikt Ley10Charlotte Gryseels11Timika Malaria Research Programme, Papuan Health and Community Development FoundationTimika Malaria Research Programme, Papuan Health and Community Development FoundationTimika Malaria Research Programme, Papuan Health and Community Development FoundationInstitute of Tropical MedicineTimika Malaria Research Programme, Papuan Health and Community Development FoundationTimika Malaria Research Programme, Papuan Health and Community Development FoundationGlobal and Tropical Health Division, Menzies School of Health Research and Charles Darwin UniversityGlobal and Tropical Health Division, Menzies School of Health Research and Charles Darwin UniversityGlobal and Tropical Health Division, Menzies School of Health Research and Charles Darwin UniversityInstitute of Tropical MedicineGlobal and Tropical Health Division, Menzies School of Health Research and Charles Darwin UniversityInstitute of Tropical MedicineAbstract Background Reducing the risk of recurrent Plasmodium vivax malaria is critical for malaria control and elimination. Primaquine (PQ) is the only widely available drug against P. vivax dormant liver stages, but is recommended as a 14-day regimen, which can undermine adherence to a complete course of treatment. Methods This is a mixed-methods study to assess socio-cultural factors influencing adherence to a 14-day PQ regimen in a 3-arm, treatment effectiveness trial in Papua, Indonesia. The qualitative strand, consisting of interviews and participant observation was triangulated with a quantitative strand in which trial participants were surveyed using a questionnaire. Results Trial participants differentiated between two types of malaria: tersiana and tropika, equivalent to P. vivax and Plasmodium falciparum infection, respectively. The perceived severity of both types was similar with 44.0% (267/607) perceiving tersiana vs. 45.1% (274/607) perceiving tropika as more severe. There was no perceived differentiation whether malaria episodes were due to a new infection or relapse; and 71.3% (433/607) acknowledged the possibility of recurrence. Participants were familiar with malaria symptoms and delaying health facility visit by 1–2 days was perceived to increase the likelihood of a positive test. Prior to health facility visits, symptoms were treated with leftover drugs kept at home (40.4%; 245/607) or bought over the counter (17.0%; 103/607). Malaria was considered to be cured with ‘blue drugs’ (referring to dihydroartemisinin-piperaquine). Conversely, ‘brown drugs,’ referring to PQ, were not considered malaria medication and instead were perceived as supplements. Adherence to malaria treatment was 71.2% (131/184), in the supervised arm, 56.9% (91/160) in the unsupervised arm and 62.4% (164/263) in the control arm; p = 0.019. Adherence was 47.5% (47/99) among highland Papuans, 51.7% (76/147) among lowland Papuans, and 72.9% (263/361) among non-Papuans; p < 0.001. Conclusion Adherence to malaria treatment was a socio-culturally embedded process during which patients (re-)evaluated the characteristics of the medicines in relation to the course of the illness, their past experiences with illness, and the perceived benefits of the treatment. Structural barriers that hinder the process of patient adherence are crucial to consider in the development and rollout of effective malaria treatment policies.https://doi.org/10.1186/s12936-023-04578-3Primaquine adherenceMalaria radical cureVivax treatmentMalaria in PapuaMalaria Indonesia |
| spellingShingle | Annisa Rahmalia Jeanne Rini Poespoprodjo Chandra U. R. Landuwulang Maya Ronse Enny Kenangalem Faustina H. Burdam Kamala Thriemer Angela Devine Ric N. Price Koen Peeters Grietens Benedikt Ley Charlotte Gryseels Adherence to 14-day radical cure for Plasmodium vivax malaria in Papua, Indonesia: a mixed-methods study Malaria Journal Primaquine adherence Malaria radical cure Vivax treatment Malaria in Papua Malaria Indonesia |
| title | Adherence to 14-day radical cure for Plasmodium vivax malaria in Papua, Indonesia: a mixed-methods study |
| title_full | Adherence to 14-day radical cure for Plasmodium vivax malaria in Papua, Indonesia: a mixed-methods study |
| title_fullStr | Adherence to 14-day radical cure for Plasmodium vivax malaria in Papua, Indonesia: a mixed-methods study |
| title_full_unstemmed | Adherence to 14-day radical cure for Plasmodium vivax malaria in Papua, Indonesia: a mixed-methods study |
| title_short | Adherence to 14-day radical cure for Plasmodium vivax malaria in Papua, Indonesia: a mixed-methods study |
| title_sort | adherence to 14 day radical cure for plasmodium vivax malaria in papua indonesia a mixed methods study |
| topic | Primaquine adherence Malaria radical cure Vivax treatment Malaria in Papua Malaria Indonesia |
| url | https://doi.org/10.1186/s12936-023-04578-3 |
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