Exploring Barriers and Facilitators of Adherence to Artemisinin-Based Combination Therapies for the Treatment of Uncomplicated Malaria in Children in Freetown, Sierra Leone
Medication adherence is an essential step in the malaria treatment cascade. We conducted a qualitative study embedded within a randomized controlled trial comparing the adherence to the recommended dosing of two artemisinin-based combination therapies (ACT) to treat uncomplicated malaria in Freetown...
| Main Authors: | , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
MDPI AG
2021-09-01
|
| Series: | Healthcare |
| Subjects: | |
| Online Access: | https://www.mdpi.com/2227-9032/9/9/1233 |
| _version_ | 1797519055332048896 |
|---|---|
| author | Kristin Banek Deborah D. DiLiberto Emily L. Webb Samuel Juana Smith Daniel Chandramohan Sarah G. Staedke |
| author_facet | Kristin Banek Deborah D. DiLiberto Emily L. Webb Samuel Juana Smith Daniel Chandramohan Sarah G. Staedke |
| author_sort | Kristin Banek |
| collection | DOAJ |
| description | Medication adherence is an essential step in the malaria treatment cascade. We conducted a qualitative study embedded within a randomized controlled trial comparing the adherence to the recommended dosing of two artemisinin-based combination therapies (ACT) to treat uncomplicated malaria in Freetown, Sierra Leone. This study explored the circumstances and factors that influenced caregiver adherence to the ACT prescribed for their child in the trial. In-depth interviews were conducted with 49 caregivers; all interviews were recorded, transcribed, and translated. Transcripts were coded and aggregated into themes, applying a thematic content approach. We identified four key factors that influenced optimal treatment adherence: (1) health system influences, (2) health services, (3) caregivers’ experiences with malaria illness and treatment, and (4) medication characteristics. Specifically, caregivers reported confidence in the health system as facilities were well maintained and care was free. They also felt that health workers provided quality care, leading them to trust the health workers and believe the test results. Ease of medication administration and perceived risk of side effects coupled with caregivers’ prior experience treating malaria influenced how medications were administered. To ensure ACTs achieve maximum effectiveness, consideration of these contextual factors and further development of child-friendly antimalarials are needed. |
| first_indexed | 2024-03-10T07:37:46Z |
| format | Article |
| id | doaj.art-70b41c6e727b4e9ab3b575ff71fd2854 |
| institution | Directory Open Access Journal |
| issn | 2227-9032 |
| language | English |
| last_indexed | 2024-03-10T07:37:46Z |
| publishDate | 2021-09-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Healthcare |
| spelling | doaj.art-70b41c6e727b4e9ab3b575ff71fd28542023-11-22T13:19:00ZengMDPI AGHealthcare2227-90322021-09-0199123310.3390/healthcare9091233Exploring Barriers and Facilitators of Adherence to Artemisinin-Based Combination Therapies for the Treatment of Uncomplicated Malaria in Children in Freetown, Sierra LeoneKristin Banek0Deborah D. DiLiberto1Emily L. Webb2Samuel Juana Smith3Daniel Chandramohan4Sarah G. Staedke5Institute of Global Health and Infectious Diseases, University of North Carolina, Chapel Hill, NC 27514, USAGlobal Health Office, Faculty of Health Sciences, McMaster University, Hamilton, ON L8S 4L8, CanadaMRC International Statistics and Epidemiology Group, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UKNational Malaria Control Programme, Ministry of Health and Sanitation, Freetown, Sierra LeoneDepartment of Disease Control, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UKDepartment of Clinical Research, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UKMedication adherence is an essential step in the malaria treatment cascade. We conducted a qualitative study embedded within a randomized controlled trial comparing the adherence to the recommended dosing of two artemisinin-based combination therapies (ACT) to treat uncomplicated malaria in Freetown, Sierra Leone. This study explored the circumstances and factors that influenced caregiver adherence to the ACT prescribed for their child in the trial. In-depth interviews were conducted with 49 caregivers; all interviews were recorded, transcribed, and translated. Transcripts were coded and aggregated into themes, applying a thematic content approach. We identified four key factors that influenced optimal treatment adherence: (1) health system influences, (2) health services, (3) caregivers’ experiences with malaria illness and treatment, and (4) medication characteristics. Specifically, caregivers reported confidence in the health system as facilities were well maintained and care was free. They also felt that health workers provided quality care, leading them to trust the health workers and believe the test results. Ease of medication administration and perceived risk of side effects coupled with caregivers’ prior experience treating malaria influenced how medications were administered. To ensure ACTs achieve maximum effectiveness, consideration of these contextual factors and further development of child-friendly antimalarials are needed.https://www.mdpi.com/2227-9032/9/9/1233malariaadherenceantimalarialACTartemisinin-based combination therapySierra Leone |
| spellingShingle | Kristin Banek Deborah D. DiLiberto Emily L. Webb Samuel Juana Smith Daniel Chandramohan Sarah G. Staedke Exploring Barriers and Facilitators of Adherence to Artemisinin-Based Combination Therapies for the Treatment of Uncomplicated Malaria in Children in Freetown, Sierra Leone Healthcare malaria adherence antimalarial ACT artemisinin-based combination therapy Sierra Leone |
| title | Exploring Barriers and Facilitators of Adherence to Artemisinin-Based Combination Therapies for the Treatment of Uncomplicated Malaria in Children in Freetown, Sierra Leone |
| title_full | Exploring Barriers and Facilitators of Adherence to Artemisinin-Based Combination Therapies for the Treatment of Uncomplicated Malaria in Children in Freetown, Sierra Leone |
| title_fullStr | Exploring Barriers and Facilitators of Adherence to Artemisinin-Based Combination Therapies for the Treatment of Uncomplicated Malaria in Children in Freetown, Sierra Leone |
| title_full_unstemmed | Exploring Barriers and Facilitators of Adherence to Artemisinin-Based Combination Therapies for the Treatment of Uncomplicated Malaria in Children in Freetown, Sierra Leone |
| title_short | Exploring Barriers and Facilitators of Adherence to Artemisinin-Based Combination Therapies for the Treatment of Uncomplicated Malaria in Children in Freetown, Sierra Leone |
| title_sort | exploring barriers and facilitators of adherence to artemisinin based combination therapies for the treatment of uncomplicated malaria in children in freetown sierra leone |
| topic | malaria adherence antimalarial ACT artemisinin-based combination therapy Sierra Leone |
| url | https://www.mdpi.com/2227-9032/9/9/1233 |
| work_keys_str_mv | AT kristinbanek exploringbarriersandfacilitatorsofadherencetoartemisininbasedcombinationtherapiesforthetreatmentofuncomplicatedmalariainchildreninfreetownsierraleone AT deborahddiliberto exploringbarriersandfacilitatorsofadherencetoartemisininbasedcombinationtherapiesforthetreatmentofuncomplicatedmalariainchildreninfreetownsierraleone AT emilylwebb exploringbarriersandfacilitatorsofadherencetoartemisininbasedcombinationtherapiesforthetreatmentofuncomplicatedmalariainchildreninfreetownsierraleone AT samueljuanasmith exploringbarriersandfacilitatorsofadherencetoartemisininbasedcombinationtherapiesforthetreatmentofuncomplicatedmalariainchildreninfreetownsierraleone AT danielchandramohan exploringbarriersandfacilitatorsofadherencetoartemisininbasedcombinationtherapiesforthetreatmentofuncomplicatedmalariainchildreninfreetownsierraleone AT sarahgstaedke exploringbarriersandfacilitatorsofadherencetoartemisininbasedcombinationtherapiesforthetreatmentofuncomplicatedmalariainchildreninfreetownsierraleone |