Banek Kristin, DiLiberto Deborah D, Webb Emily L, Smith Samuel Juana, Chandramohan Daniel, Staedke Sarah G
Institute of Global Health and Infectious Diseases, University of North Carolina, Chapel Hill, NC 27514, USA.
Department of Clinical Research, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK.
Healthcare (Basel). 2021 Sep 18;9(9):1233. doi: 10.3390/healthcare9091233.
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.
药物依从性是疟疾治疗流程中的关键一步。我们在一项随机对照试验中开展了一项定性研究，比较了在塞拉利昂弗里敦治疗非重症疟疾时，两种基于青蒿素的联合疗法（ACT）的推荐剂量的依从性。本研究探讨了影响试验中照顾者对其孩子所开ACT药物依从性的情况和因素。对49名照顾者进行了深入访谈；所有访谈均进行了录音、转录和翻译。采用主题内容分析法对转录文本进行编码并归纳为主题。我们确定了影响最佳治疗依从性的四个关键因素：（1）卫生系统影响，（2）卫生服务，（3）照顾者对疟疾疾病和治疗的经历，以及（4）药物特性。具体而言，照顾者表示，由于设施维护良好且医疗免费，他们对卫生系统有信心。他们还认为卫生工作者提供了高质量的护理，这使他们信任卫生工作者并相信检测结果。药物给药的便利性、感知到的副作用风险以及照顾者先前治疗疟疾的经验影响了药物的给药方式。为确保ACT药物达到最大疗效，需要考虑这些背景因素并进一步开发适合儿童的抗疟药物。
