Sticking with it: linking patient information and chloroquine adherence in rural Ghana

Delayed or inadequate malaria treatment increases the chance of severe disease and development of drug resistance. Chloroquine is a cheap and safe anti-malarial drug used widely throughout West Africa. Research by a District Health Management Team in Ghana shows that better communication and drug labelling increase patient adherence to chloroquine.

Inadequate treatment of malaria can result from:

• incorrect prescribing practices
• self-medication within the household
• non-adherence to the full dose.

Prescribers and dispensers do not always provide easy-to-understand information about the drugs, the duration of treatment or the ideal daily dose. This study evaluated the effect of improved drug labelling and verbal communication to patients with acute malaria on their adherence to oral chloroquine treatment.

The researchers created a two-day training programme for half of the prescribers, dispensers and their assistants in Dangme West - a rural district with a population of around 100 000. The other half did not receive the further training to provide a comparison for the study. They provided visual aids for educating clients about causes and prevention of malaria and pictorial stickers and rubber stamps for labelling drugs. They pre-tested these drawings in the community.

The researchers assessed the information provided to clients and the quality of drug labelling before and after the intervention. Adherence was assessed by a home-based interview with the client three days after their visit to the clinic. The researchers looked at 204 cases before the intervention and 197 cases afterwards. They found that:

• Before the intervention there was wide variation in measures of communication and adherence to therapy between the clinics.
• Ningo was the worst performing clinic in terms of information provision before the intervention and also in terms of adherence to therapy.
• Since the intervention, providers now tell clients the names of drugs, ask them if they have any questions and tell them about the purpose of medication and possible side effects. These improvements are greatest in Ningo.
• All intervention clinics showed improvements in adherence.
• Strict adherence is better for tablets than for syrups. Children are being overdosed with syrups in all areas.
• Clients interpret home visits as a sign of improved quality of care.

The researchers point out that a one-off training programme does not usually cause a sustained change in provider behaviour and emphasise the need to:

• develop a questionnaire for supervisors to use in primary care clinics to reinforce the impact of the initial training
• investigate other factors, such as client confidence in the provider, that might also affect adherence to treatment
• study the feasibility of prescribing chloroquine tablets rather than syrup for children to avoid overdosing
• explore the possibility of integrating follow-up of clinical malaria cases into the home visit routine of community health nurses.

Source(s):
‘Strategies to improve adherence to recommended chloroquine treatment regimes: a quasi-experiment in the context of integrated primary health care delivery in Ghana’, Social Science and Medicine 55: 2215-2226, by I. Agyepong et al., 2002
HINARI subscribers can access the full-text article here. Full document.

Funded by: WHO TDR; Liverpool School of Tropical Medicine

id21 Research Highlight: 17 March 2003

Further Information:
Irene Akua Agyepong
District Health Administration
PO Box 1
Dodowa
Ghana

Fax: +233 21 226739
Contact the contributor: iagyepong@ighmail.com

Liverpool School of Tropical Medicine (LSTM), UK

Other related links:
'Resisting change? Tackling drug-resistant malaria'

'All in the mix: combining malaria drugs to beat resistance in sub-Saharan Africa'

See id21's collection of links relevant to infectious diseases.