Adherence to community prescribed antimalarial drugs among caregivers of U5 children and factors associated with their treatment seeking behaviour in Nadunget and Rupa sub-counties in Moroto District, Uganda

Abstract

Background: Malaria is the leading cause of child mortality in Moroto district. Through iCCM, VHTs treat children under five years of age for malaria at community level. Poor adherence to antimalarial drugs can result into development of ACT resistant plasmodium falciparum species. Adherence to community distributed ACTs in Moroto district is not known. Objectives: To determine caregivers’ adherence to ACTs prescribed by VHTs, and to understand health seeking behaviour for fever or suspected malaria among children under five in Moroto district. Methods: A cross sectional study was conducted in two subcounties in Moroto district. A structured questionnaire was used to interview 477 caregivers of children under five who had suffered with fever two weeks preceding the study. Dependent and independent variables were analysed at univariate, bivariate and multivariate levels. In the univariate analysis, categorical variables were summarized using proportions, percentages and presented using tables, bar charts and pie charts. Frequencies were calculated using proportions. In the bivariate analysis, the chi-square test was applied and prevalence ratios (PRs) were used as a measure of association. In the multivariate analysis, the chunk test was applied to generate adjusted prevalence ratios which were used as a measure of association. A 95% CI was used to assess statistical significance. Adherence to ACTs was assessed through caregiver self-reports. Results: Caregiver non-adherence to ACTs prescribed by VHTs was at 50%. Caregivers’ misunderstanding of the dosing instructions (79.7%; 130/163) was the main reason cited for non-adherence to ACTs. From the multivariate analysis, caregivers’ not understanding the dosing instructions given by the VHT (APR=10.752; 95% CI=5.44-21.26) and a child aged 36-47 months (APR=0.480; 95% CI=0.28-0.84) were associated with caregiver non-adherence to ACTs. VHTs (68.3%) and health facilities (26.4%) were the preferred sources of care for children with fever. From the multivariate analysis, availability of VHT at source of care (APR=1.791; 95% CI= 1.36-2.36).if VHT had attained formal education – at least primary level status (APR=0.560; 95% CI=0.463-0.678); and if caregiver had attained formal education – at least primary level status (APR=0.708; 95% CI=0.63- 0.79) were associated with seeking treatment for fever from a VHT. Conclusion: Caregiver adherence to ACTs prescribed by VHTs was 50% (and is lower than expected (>80% is ideal). Non-adherence to community prescribed ACTs in Moroto district can be minimised if caregivers’ understanding of the correct or recommended dosing instructions is enhanced through: improving the quality of pre-treatment counselling given by VHTs; refresher training of VHTs in iCCM; and community sensitisation on the dangers of non-adherence to medication. VHTs are the preferred source of care for treating fever in children in Moroto district. To reduce malaria related morbidity and mortality, the MoH should consider scaling up the iCCM program to additional districts.