Kühl Melf-Jakob, Nkosi-Gondwe Thandile, Ter Kuile Feiko O, Phiri Kamija S, Pannu Mehmajeet, Mukaka Mavuto, Robberstad Bjarne, Engebretsen Ingunn M S
Department of Global Public Health and Primary Care, Centre for International Health (CIH), University of Bergen, Bergen, Norway.
Department of Global Public Health and Primary Care, Health Economics Leadership and Translational Ethics Research Group, University of Bergen, Bergen, Norway.
PLOS Glob Public Health. 2023 Apr 17;3(4):e0001779. doi: 10.1371/journal.pgph.0001779. eCollection 2023.
Chemoprevention with antimalarials is a key strategy for malaria control in sub-Saharan Africa. Three months of postdischarge malaria chemoprevention (PDMC) reduces malaria-related mortality and morbidity in pre-school children recently discharged from hospital following recovery from severe anemia. Research on adherence to preventive antimalarials in children is scarce. We aimed to investigate the predictors for caregivers' adherence to three courses of monthly PDMC in Malawi. We used data from a cluster randomized implementation trial of PDMC in Malawi (n = 357). Modified Poisson regression for clustered data was used to obtain relative risks of predictors for full adherence to PDMC. We did not find a conclusive set of predictors for PDMC adherence. The distribution of households across a socio-economic index and caregivers' education showed mixed associations with poor adherence. Caregivers of children with four or more malaria infections in the past year were associated with reduced adherence. With these results, we cannot confirm the associations established in the literature for caregiver adherence to artemisinin-based combination therapies (ACTs). PDMC combines multiple factors that complicate adherence. Our results may indicate that prevention interventions introduce a distinct complexity to ACT adherence behavior. Until we better understand this relationship, PDMC programs should ensure high program fidelity to sustain adherence by caregivers during implementation.
使用抗疟药物进行化学预防是撒哈拉以南非洲疟疾控制的一项关键策略。出院后三个月的疟疾化学预防（PDMC）可降低近期因重度贫血康复而出院的学龄前儿童的疟疾相关死亡率和发病率。关于儿童对预防性抗疟药物依从性的研究很少。我们旨在调查马拉维照顾者对三个月每月一次PDMC依从性的预测因素。我们使用了马拉维一项PDMC整群随机实施试验的数据（n = 357）。对整群数据使用修正泊松回归来获得完全依从PDMC预测因素的相对风险。我们没有找到一组关于PDMC依从性的确凿预测因素。家庭在社会经济指数和照顾者教育方面的分布与依从性差呈现出复杂的关联。过去一年中感染疟疾四次或更多次的儿童的照顾者与依从性降低有关。基于这些结果，我们无法证实文献中所确立的照顾者对青蒿素联合疗法（ACTs）依从性的关联。PDMC包含多个使依从性变得复杂的因素。我们的结果可能表明预防干预措施给ACT依从行为带来了独特的复杂性。在我们更好地理解这种关系之前，PDMC项目应确保高度的项目保真度，以在实施过程中维持照顾者的依从性。
