Abstract:
Background: Prompt access to artemesinin-combination therapy (ACT) is not adequate unless the drug is taken
according to treatment guidelines. Adherence to the treatment schedule is important to preserve efficacy of the
drug. Although some community based studies have reported fairly high levels of adherence, data on factors
influencing adherence to artemether-lumefantrine (AL) treatment schedule remain inadequate. This study was
carried-out to explore the provider’s instructions to caretakers, caretakers’ understanding of the instructions and
how that understanding was likely to influence their practice with regard to adhering to AL treatment schedule.
Methods: A qualitative study was conducted in five villages in Kilosa district, Tanzania. In-depth interviews were
held with providers that included prescribers and dispensers; and caretakers whose children had just received AL
treatment. Information was collected on providers’ instructions to caretakers regarding dose timing and how to
administer AL; and caretakers’ understanding of providers’ instructions.
Results: Mismatch was found on providers’ instructions as regards to dose timing. Some providers’ (dogmatists)
instructions were based on strict hourly schedule (conventional) which was likely to lead to administering some
doses in awkward hours and completing treatment several hours before the scheduled time. Other providers
(pragmatists) based their instruction on the existing circumstances (contextual) which was likely to lead to delays in
administering the initial dose with serious treatment outcomes. Findings suggest that, the national treatment
guidelines do not provide explicit information on how to address the various scenarios found in the field. A
communication gap was also noted in which some important instructions on how to administer the doses were
sometimes not provided or were given with false reasons.
Conclusions: There is need for a review of the national malaria treatment guidelines to address local context. In
the review, emphasis should be put on on-the-job training to address practical problems faced by providers in the
course of their work. Further research is needed to determine the implication of completing AL treatment prior to
scheduled time.
