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Trop Med Health. 2018 Dec 22;46:44. doi: 10.1186/s41182-018-0125-6. eCollection 2018.

Patients' adherence to artemisinin-based combination therapy and healthcare workers' perception and practice in Savannakhet province, Lao PDR.

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1Department of Global Health, School of Health Sciences, Faculty of Medicine, University of the Ryukyus, Okinawa, 903-0215 Japan.
SATREPS Project for Parasitic Diseases, Vientiane, Lao People's Democratic Republic.
3Department of Tropical Medicine and Malaria, Research Institute, National Center for Global Health and Medicine, Tokyo, 162-8655 Japan.
4Institut Pasteur du Laos, Ministry of Health, Vientiane, Lao People's Democratic Republic.
5Center of Malariology, Parasitology and Entomology, Ministry of Health, Vientiane, Lao People's Democratic Republic.
6Lao Tropical and Public Health Institute, Ministry of Health, Vientiane, Lao People's Democratic Republic.
Savannakhet Provincial Health Department, Savannakhet, Lao People's Democratic Republic.
8Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.



Artemisinin resistance in Plasmodium falciparum has been spreading across Southeast Asia. Patients' adherence to artemisinin-based combination therapy (ACT) is critical to avoid expanding this resistance. The objectives of this research were to examine patients' adherence to ACT for the treatment of uncomplicated malaria and to examine the healthcare workers' perception of medication adherence and their dispensing practices for malaria patients in Savannakhet province, Lao PDR.


A prospective observational study of patients and a descriptive study of healthcare workers were conducted in Xepon, Phin, and Nong districts. In the patient study, patients aged 18 years old or older who were prescribed artemether-lumefantrine (AL) at six healthcare facilities between October 2016 and August 2017 were examined. Patient interviews and tablet counts were conducted on the first day of treatment (day 0) and the follow-up day (around day 3). In the healthcare workers study, a self-administered questionnaire survey was conducted.


Of the 54 patients examined, 51 (94.4%) were adherent to the AL regimen. The other three patients stopped medication because they felt better, even though the importance of completing the regimen was explained to all patients when it was prescribed. Among 152 healthcare workers who had ever instructed a malaria patient, 74.3% reported that they occasionally saw a malaria patient who adhered poorly to medication instructions. The healthcare workers perceived the major reasons for poor adherence to be illiteracy and poor understanding of medication instructions by patients. In practice, 27.6% of the healthcare workers did not regularly explain the importance of completing the regimen to patients, and 32.2% did not often or always confirm the patients' understanding of medication instructions.


Patient adherence to AL was high. The healthcare workers perceived that poor adherence was attributable to the patients, i.e., their poor understanding and illiteracy, which appeared to be related to linguistic differences. However, poor adherence also appeared to be attributable to the healthcare workers, who should tell patients of the importance of completing the AL regimen regardless of their improvement in physical condition and also confirm the patients' understanding of the instructions.

Conflict of interest statement

This study was approved by the National Ethics Committee for Health Research, Ministry of Health, Lao PDR (No. 034/NECHR, 2016) and the Ethics Review Committee for Epidemiological Study, University of Ryukyus, Japan (No. 346). Before starting the study, surveyors explained the details of the study to the participants, such as its purpose, voluntary participation, information that would be collected and how the data would be stored and managed. Written informed consent was obtained from each participant. For the healthcare workers study, self-administered anonymous questionnaires were used.Not applicable.The authors declare that they have no competing interests.Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

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