Bawate Charles, Guyah Bernard, Callender-Carter Sylvia T, Ouma Collins
Kamuli General Hospital-Kamuli District Local Government, Kamuli, Uganda.
School of Public Health and Community Development, Maseno University, Maseno, Kenya.
Malar J. 2025 Jun 12;24(1):189. doi: 10.1186/s12936-025-05444-0.
Global malaria control programmes such as approaches to community engagements to deliver malaria control interventions have been successful in controlling malaria. Strategies aimed at accelerating patients' adherence to prescribed artemisinin-based combination therapy (ACT) are needed in the fight to control and eradicate malaria. Previous studies have shown the power of health education in improving patients' adherence to ACT. The objective of this study was to establish the impact of a community health education intervention on the patients' adherence to malaria ACT in Kamuli District, Uganda.
A pre-post-test intervention study without a control group was used to understand the impact of community health education training in improving patients' adherence to ACT. Quantitatively, equal number of 1266 patients were enrolled and assigned into any of the three arms equally (422)-no follow up, follow-up on day 2 and day 4 arm at pre-test and post-test phases. Qualitatively, 24 key informants were enrolled purposively. Mann-Whitney U test was used to establish the impact of the community health education on patients' adherence to ACT. Statistical significance was established at p < 0.05. Qualitative data was analysed using the thematic analysis technique.
A total of 1688 patients were analysed. At pre-test, the median age was 20 years with majority (64.3%) being females while patients' adherence was reported to be 588/844 (69.7%). At post-test, the median age was 21 years, majority (62.6%) females, and patients' adherence 700/844 (82.9%). A Mann-Whitney U test showed a statistically significant difference in the patients' adherence to ACT of pre-test and post-test after the intervention (U = 308,904, Z = - 6.409, p < 0.0001), with higher adherence at post-test (median = 900.5) than pre-test (median = 788.5) and small effect (0.156). Qualitatively, not all health workers explain clearly how to use the ACT medicines prescribed.
Community health education as an intervention was effective in improving patient's adherence to ACT. Therefore, there is need to avail medical supplies and patient education with adherence support to ensure adequate patients' adherence to ACT.
全球疟疾控制项目，如通过社区参与方式来实施疟疾控制干预措施，在控制疟疾方面已取得成功。在抗击疟疾、实现控制和消除疟疾的斗争中，需要采取旨在加速患者坚持使用青蒿素联合疗法（ACT）的策略。先前的研究已表明健康教育在提高患者对ACT依从性方面的作用。本研究的目的是确定在乌干达卡穆利区开展的社区健康教育干预对患者坚持使用疟疾ACT的影响。
采用无对照组的前后测干预研究，以了解社区健康教育培训对提高患者对ACT依从性的影响。在定量方面，纳入了同等数量的1266名患者，并将其平均分为三组（每组422人）——无随访组、测试前和测试后第2天及第4天随访组。在定性方面，有目的地纳入了24名关键信息提供者。采用曼-惠特尼U检验来确定社区健康教育对患者坚持使用ACT的影响。当p < 0.05时确定具有统计学意义。定性数据采用主题分析技术进行分析。
共分析了1688名患者。测试前，中位年龄为20岁，大多数（64.3%）为女性，据报告患者的依从性为588/844（69.7%）。测试后，中位年龄为21岁，大多数（62.6%）为女性，患者的依从性为700/844（82.9%）。曼-惠特尼U检验显示，干预后测试前和测试后患者对ACT的依从性存在统计学显著差异（U = 308,904，Z = - 6.409，p < 0.0001），测试后依从性更高（中位数 = 900.5），高于测试前（中位数 = 788.5），且效应量较小（0.156）。在定性方面，并非所有医护人员都能清楚解释如何使用所开的ACT药物。
作为一种干预措施，社区健康教育在提高患者对ACT的依从性方面是有效的。因此，需要提供医疗用品，并开展有依从性支持的患者教育，以确保患者充分坚持使用ACT。
