Takahashi Emiri, Nonaka Daisuke, Iwagami Moritoshi, Phoutnalong Vilay, Chanthakoumane Ketmany, Kobayashi Jun, Pongvongsa Tiengkham, Kounnavong Sengchanh, Hongvanthong Bouasy, Brey Paul T, Kano Shigeyuki
1Department of Global Health, School of Health Sciences, Faculty of Medicine, University of the Ryukyus, Okinawa, 903-0215 Japan.
SATREPS Project for Parasitic Diseases, Vientiane, Lao People's Democratic Republic.
Trop Med Health. 2018 Dec 22;46:44. doi: 10.1186/s41182-018-0125-6. eCollection 2018.
Artemisinin resistance in has been spreading across Southeast Asia. Patients' adherence to artemisinin-based combination therapy (ACT) is critical to avoid expanding this resistance. The objectives of this research were to examine patients' adherence to ACT for the treatment of uncomplicated malaria and to examine the healthcare workers' perception of medication adherence and their dispensing practices for malaria patients in Savannakhet province, Lao PDR.
A prospective observational study of patients and a descriptive study of healthcare workers were conducted in Xepon, Phin, and Nong districts. In the patient study, patients aged 18 years old or older who were prescribed artemether-lumefantrine (AL) at six healthcare facilities between October 2016 and August 2017 were examined. Patient interviews and tablet counts were conducted on the first day of treatment (day 0) and the follow-up day (around day 3). In the healthcare workers study, a self-administered questionnaire survey was conducted.
Of the 54 patients examined, 51 (94.4%) were adherent to the AL regimen. The other three patients stopped medication because they felt better, even though the importance of completing the regimen was explained to all patients when it was prescribed. Among 152 healthcare workers who had ever instructed a malaria patient, 74.3% reported that they occasionally saw a malaria patient who adhered poorly to medication instructions. The healthcare workers perceived the major reasons for poor adherence to be illiteracy and poor understanding of medication instructions by patients. In practice, 27.6% of the healthcare workers did not regularly explain the importance of completing the regimen to patients, and 32.2% did not often or always confirm the patients' understanding of medication instructions.
Patient adherence to AL was high. The healthcare workers perceived that poor adherence was attributable to the patients, i.e., their poor understanding and illiteracy, which appeared to be related to linguistic differences. However, poor adherence also appeared to be attributable to the healthcare workers, who should tell patients of the importance of completing the AL regimen regardless of their improvement in physical condition and also confirm the patients' understanding of the instructions.
青蒿素耐药性已在东南亚蔓延。患者对以青蒿素为基础的联合疗法（ACT）的依从性对于避免这种耐药性的扩大至关重要。本研究的目的是调查患者对ACT治疗非复杂性疟疾的依从性，并调查老挝人民民主共和国沙湾拿吉省医护人员对药物依从性的看法及其对疟疾患者的配药做法。
在色邦、芬和农县对患者进行了前瞻性观察研究，并对医护人员进行了描述性研究。在患者研究中，对2016年10月至2017年8月期间在六个医疗机构中被开了蒿甲醚-本芴醇（AL）的18岁及以上患者进行了检查。在治疗的第一天（第0天）和随访日（约第3天）进行了患者访谈和药片计数。在医护人员研究中，进行了一项自填式问卷调查。
在检查的54名患者中，51名（94.4%）坚持服用AL方案。其他三名患者因为感觉好转而停止服药，尽管在开处方时已向所有患者解释了完成疗程的重要性。在曾指导过疟疾患者的152名医护人员中，74.3%报告说他们偶尔会见到一名对用药说明依从性差的疟疾患者。医护人员认为依从性差的主要原因是患者文盲以及对用药说明理解不佳。在实际操作中，27.6%的医护人员没有定期向患者解释完成疗程的重要性，32.2%的医护人员不经常或总是不确认患者对用药说明的理解。
患者对AL的依从性较高。医护人员认为依从性差归因于患者，即他们理解能力差和文盲，这似乎与语言差异有关。然而，依从性差似乎也归因于医护人员，他们应该告知患者无论身体状况是否改善都要完成AL疗程的重要性，并确认患者对说明的理解。
