Determinants and effect of health education intervention on patients’ adherence to artemisinin-based combination Therapy in Kamuli district, Uganda

Abstract

Malaria control strategies aimed at accelerating patients‘ adherence to artemisinin-based combination therapy are needed in the fight to control and eradicate malaria. Previous studies have shown the power of health education campaigns in improving patients‘ adherence to antimalarials. Patients in Kamuli district have low adherence and do not complete their prescribed ACT. The study assessed the determinants and effect of health education intervention on patients‘ adherence to ACT in Kamuli District, Uganda. Specifically, to determine the level of patients‘ adherence to ACT, to determine the factors influencing patients‘ adherence to malaria ACT, and to establish the effect of a health education intervention on the patients‘ adherence to malaria ACT. This was a quasi-experimental (pre-post-test intervention study design without a control group and unpaired) using quantitative and qualitative approaches. Trained health professionals conducted the health education training on patients‘ adherence to malaria ACT. The study was anchored on the diffusion of innovation theory. At pre- and post-test phases, participants were enrolled at eight randomly selected facilities. The study enrolled 2532 participants, equal numbers at pre and post phases. At each time, equal numbers (422) were assigned to any of the three arms (no follow-up, day 2 and 4). In addition, 24 key informants were purposively selected. At the health education intervention phase, 3496 participants were trained during the intervention. Data was collected by use of a questionnaire, interview guides, and observation and review checklist. Logistic regression used to establish the influence of predictor variables on the dependent variable. A Mann-Whitney U test used to establish the effect of health education intervention. At phase two, a paired sample t-test done to determine the effectiveness of the health education training. The study reported a 13.2% increment in patients‘ adherence to ACT, from 588/844 (69.7%) pre-test to 700/844 (82.9%) post-test, with a mid-term assessment of 677/844 (80.2%). Multivariate analysis showed at pre-test that adhering to ACT is 3.07 times higher for someone satisfied with getting ACT at the facility (OR = 3.07; p < 0.0001; 95% CI = 1.85-5.10), 4.23 times for someone with history of saving ACT (OR = 4.23; p < 0.0001), 2.19 times for someone who shared ACT (OR = 2.19; p = 0.025; 95% CI = 2.24-7.99), 2.61 times for someone with a household head as a mother (OR = 2.61; p = 0.014; 95% CI = 1.21-5.65). At post-test, the odds of one adhering to ACT prescription were 1.88 times for one who prefers ACT to other anti-malarials (OR =1.88; P = 0.009; 95% CI = 1.172-3.019), and 2.17 times for someone with history of saving ACT (OR = 2.17; p = 0.04; 95% CI = 1.28-3.69), and all factors were statistically significant. Qualitatively, key informants decried that, ―health workers do not explain clearly how to use the different medicines properly. They only put drugs in the book, call your name and tell you that where there is a star – those are not available. No clear instructions are given especially at busy facilities and on busy days‖. At intervention phase, the training had overall positive and significant effect on the community members and health care workers knowledge. 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 = 308904, 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). There was an improvement in the patients‘ adherence to ACT, and the health education intervention had a positive effect on patients‘ adherence to ACT in the studied population. However, patients‘ tendencies to save and share ACT is a threat, amidst the benefits and well-known dangers associated with adherence. There is a need to continuously educate all about adherence to medicines as prescribed and tighten government medicine supply. The study underscores the value of a tailored health education intervention in enhancing patients‘ adherence to ACT.