Nkoma Jackline D, Rumisha Susan F, Japhari Hamisi S, Peter Emanuel L
Mabibo Traditional Medicine Research Centre, National Institute for Medical Research, Dar Es Salaam, Tanzania.
Malaria Atlas Project, East Africa Node, Ifakara Health Institute, Dar Es Salaam, Tanzania.
Malar J. 2025 May 3;24(1):140. doi: 10.1186/s12936-025-05303-y.
East Africa continues to bear a significant share of the global malaria burden, despite its commitment to the malaria elimination goal of 2030. Furthermore, reported variations in adherence to anti-malarials hamper the regional effort in malaria elimination. Moreover, the region has no comprehensive and comparable adherence estimates for policymakers to set priorities, target control strategies, and evaluate the effectiveness of interventions. Hence, this systematic review synthesized the regional adherence estimate for East Africa.
Authors searched articles from PubMed, Science Direct, CINHAL, Scopus, and Google Scholar. Two authors independently assessed retrieved studies for eligibility and risk of bias, then the adherence rate was pooled using the random effect model implemented in STATA. Publication bias was assessed using a funnel plot symmetry and the Egger test. Subgroup analysis was performed to explore the effect of the national and types of regimens on the overall estimate. Qualitative analysis was applied to explain factors that influence adherence.
A total of 29 studies with 15 927 participants were included. The overall adherence rate was 70.30% (95% CI 61.93-78.67; 29 studies; I = 99.76%), with the highest level reported in Rwanda (100%, 95% CI 97.28-100.00) and lowest in Tanzania (6.99%, 95% CI 0.2.81-11.17). Furthermore, adherence was high for chloroquine plus sulfadoxine-pyrimethamine (96.27%, 93.87-98.66; one study). Recalling correct instructions and taking the first dose at the health facility had a positive influence on patient adherence.
On average, about three-quarters of malaria patients in East Africa adhere to their medications. In light of these findings, further interventional studies are needed to address low adherence to anti-malarials in the region. Moreover, adherence studies with the appropriate method of measurement are still needed to obtain a robust generalizable estimate in East Africa. Trial registration This review was registered at PROSPERO with the registration ID CRD42023410048.
尽管东非致力于实现2030年消除疟疾的目标，但该地区仍承担着全球疟疾负担的很大一部分。此外，报告显示在抗疟药物依从性方面存在差异，这阻碍了该地区消除疟疾的努力。而且，该地区没有全面且可比的依从性估计数据，以供政策制定者确定优先事项、制定目标控制策略以及评估干预措施的有效性。因此，本系统评价综合了东非地区的依从性估计数据。
作者检索了来自PubMed、Science Direct、CINHAL、Scopus和谷歌学术的文章。两位作者独立评估检索到的研究的 eligibility 和偏倚风险，然后使用STATA中实施的随机效应模型汇总依从率。使用漏斗图对称性和Egger检验评估发表偏倚。进行亚组分析以探讨国家和治疗方案类型对总体估计的影响。应用定性分析来解释影响依从性的因素。
共纳入29项研究，涉及15927名参与者。总体依从率为70.30%（95%可信区间61.93 - 78.67；29项研究；I = 99.76%），其中卢旺达报告的依从率最高（100%，95%可信区间97.28 - 100.00），坦桑尼亚最低（6.99%，95%可信区间0.281 - 11.17）。此外，氯喹加磺胺多辛 - 乙胺嘧啶的依从性较高（96.27%，93.87 - 98.66；1项研究）。回忆正确的用药说明以及在医疗机构服用首剂药物对患者依从性有积极影响。
平均而言，东非约四分之三的疟疾患者坚持服药。鉴于这些发现，需要进一步开展干预性研究，以解决该地区抗疟药物依从性低的问题。此外，仍需要采用适当测量方法的依从性研究，以在东非获得可靠且可推广的估计数据。试验注册 本评价已在PROSPERO注册，注册号为CRD42023410048。
