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DISPENSING AND DETERMINANTS OF NON‑ADHERENCE TO TREATMENT FOR NON COMPLICATED MALARIA CAUSED BY PLASMODIUM VIVAX AND PLASMODIUM FALCIPARUM IN HIGH‑RISK MUNICIPALITIES IN THE BRAZILIAN AMAZON
Afiliación
Fundação Oswaldo Cruz. Escola Nacional de Saúde Pública Sérgio Arouca. Núcleo de Assistência Farmacêutica. Rio de Janeiro, RJ, Brasil.
Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Laboratório de Doenças Parasitárias. Rio de Janeiro, RJ, Brasil.
Universidade Federal Fluminense. Faculdade de Farmácia. Departamento de Farmácia e Administração Farmacêutica. Niterói, RJ, Brasil.
Fundação Oswaldo Cruz. Centro de Pesquisa René Rachou. Laboratório de Educação em Saúde e Ambiente. Belo Horizonte, MG, Brasil
Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Laboratório de Doenças Parasitárias. Rio de Janeiro, RJ, Brasil.
Universidade Federal Fluminense. Faculdade de Farmácia. Departamento de Farmácia e Administração Farmacêutica. Niterói, RJ, Brasil.
Fundação Oswaldo Cruz. Centro de Pesquisa René Rachou. Laboratório de Educação em Saúde e Ambiente. Belo Horizonte, MG, Brasil
Resumen en ingles
Background: In Brazil, 99.7 % of malaria cases occur in the Amazon region. Although the number of cases is decreas‑
ing, the country accounted for almost 60 % of cases in the Americas Region, in 2013. Novel approaches for malaria
treatment open the possibility of eliminating the disease, but suboptimal dispensing and lack of adherence influence
treatment outcomes. The aim of this paper is to show the results on dispensing practices, non-adherence and deter‑
minants of non-adherence to treatment of non-complicated malaria.
Methods: The study was conducted in six high-risk municipalities with Plasmodium vivax and Plasmodium falciparum
transmission in the Brazilian Amazon and based on the theoretical framework of the Mafalda Project, which included
investigation of dispensing and adherence. The World Health Organization Rapid Evaluation Method has been used
to estimate sample size. Individuals over 15 years of age with malaria were approached at health facilities and invited
to participate through informed consent. Data was collected in chart review forms focusing on diagnosis, Plasmodium
type, prescribing, and dispensing (kind, quantity, labelling and procedures). Follow-up household interviews comple‑
mented data collection at health facility. Non-adherence was measured during the implementation phase, by selfreports
and pill-counts. Analysis was descriptive and statistical tests were carried out. Determinants of non-adherence
and quality of dispensing were assessed according to the literature.
Results: The study involved 165 patients. Dispensing was done according to the national guidelines. Labelling was
adequate for P. vivax but inadequate for P. falciparum medicines. Non-adherent patients were 12.1 % according to selfreports
and 21.8 % according to pill-counts. Results point to greater non-adherence among all P. falciparum patients
and among malaria non-naîve patients. More patients informed understanding adverse effects than ‘how to use’
anti-malarials.
Conclusions: Non-adherent patients were mostly those with a P. falciparum diagnosis and those in their second
or more malaria episode. New taxonomies and concepts on adherence stress the importance of focusing on the
individual patient. Interventions targeted to and tailored for malaria patients must be addressed by health policy and
implemented by managers and clinicians.
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