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Title: 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
Authors: Castro, Claudia G. S. Osorio de
Suárez‑Mutis, Martha C.
Miranda, Elaine S.
Luz, Tatiana C. B.
Affilliation: 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
Abstract: 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.
Keywords: Malaria
DeCS: Malária
Dispensador de Medicamentos
Issue Date: 2015
Publisher: BioMed Central
Citation: CASTRO, Claudia G. S. et al. 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. Malaria Journal, v.14:471, 7p, 2015.
DOI: 10.1186/s12936-015-0998-3
ISSN: 1475-2875
Copyright: open access
Appears in Collections:IOC - Artigos de Periódicos
MG - IRR - Artigos de Periódicos
ENSP - Artigos de Periódicos

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