Patients’ adherence to antimalarial medication; self-report of patients at the Volta regional hospital of Ho, Ghana

Agani Afaya, Solomon Mohammed Salia, Frederick Yaw Opare, Samira Ali, Richard Adongo Afaya


Background: Despite the advancement in malaria treatments and management; malaria morbidity and mortality is still on the increase. This phenomenon has been mostly attributed to the emergence and transmission resistance of the plasmodium parasite to drugs; which is as a result of non-adherence to anti-malaria medication. Therefore, the purpose of this study was to assess patients’ adherence to anti-malarial medications and the factors influencing their adherence in the Volta regional hospital.

Methods: A descriptive cross-sectional study was employed. Convenience sampling technique was used in recruiting respondents. Data were collected within a period of 8 weeks from April to May 2017. Data were analyzed using descriptive statistics in the form of frequencies, percentages, mean and standard deviations which was generated by the use of IBM statistical package for social sciences version 23.

Results: The average age of respondents surveyed for this study was 32.27±11.09 ranging from of 19 to 68 years. Majority (51.7%) of respondents were females and 76.7% of them being Christians. The study findings revealed that 36.6% of patient were completely adherent to anti-malarial medication. Over 90% of respondents agreed that the malarial medication had bad taste and it was an unpleasant feeling for them taking it.

Conclusions: Poor adherence to antimalaria medications could play a role in the future development of drug resistance. As such, identifying ways to improve anti-malarial compliance will help mitigate drug resistance. Therefore, further studies should be carried out on ways to improve patients’ adherence to antimalarial medication.


Anti-malarial medication, Adherence, Artemisinin-based combination therapy

Full Text:



Ministry of Health (MOH). Anti-Malaria Drug Policy for Ghana. 2009. Available at

Aung W, Dondorp AM, Min M, Kyaw TT, Lawpoolsri S, Krudsood S, et al. Assessment of adherence to three days course of Artemether-lumefantrine treatment in Rakhine state, Myanmar. JITMM Proceedings. 2015;4(3):16-23.

Rogier C. Natural history of Plasmodium falciparum malaria and determining factors of the acquisition of antimalaria immunity in two endemic areas, Dielmo and Ndiop (Senegal). Bull Mem Acad R Med Belg. 2000;155(5-6):218-26.

WHO. World malaria report 2011. Switzerland: World Health Organization. 2011. Available at

WHO. Guidelines for the treatment of malaria. (2nd ed.). 2010. Available at

White NJ, Olliaro PL. Strategies for the prevention of antimalarial drug resistance: rationale for combination chemotherapy for malaria. Parasitol Today. 1996;12(10):399-401.

Wongsrichanalai C, Sirichaisinthop J, Karwacki JJ, Congpuong K, Miller RS, Pang L. Drug resistant malaria on the Thai-Myanmar and Thai-Cambodian borders. Southeast Asian J Trop Med Public Health. 2001;32(1):41-9.

Noedl H, Se Y, Schaecher K, Smith BL, Socheat D, Fukuda MM. Evidence of artemisinin-resistant malaria in western Cambodia. N Engl J Med. 2008;359:2619-20.

Phyo AP, Nkhoma S, Stepniewska K, Ashley EA, Nair S, McGready R, et al. Emergence of artemisinin-resistant malaria on the Western border of Thailand: a longitudinal study. Lancet. 2012;379:1960-6.

Ashley EA, Dhorda M, Fairhurst RM, Amaratunga C, Lim P, Suon S, et al. Spread of artemisinin resistance in plasmodium falciparum malaria. New Eng J Med. 2014;371:411-23.

Lu F, Culleton R, Zhang M, Ramaprasad A, von Seidlein L, Zhou H, et al. Emergence of indigenous artemisinin-resistant Plasmodium falciparum in Africa. N Engl J Med. 2017;376:991-3.

Emergency response to artemisinin resistance in the Greater Mekong sub region: Regional framework for action 2013-2015. Geneva: World Health Organization. 2013. Available at

World Health Organization. Malaria rapid diagnostic test performance, Results of WHO product testing of malaria RDTs. Geneva: World Health Organization; 2010. Available at

World Health Organization. Global plan for artemisinin resistance. Available at

Meremikwu M, Okomo U, Nwachukwu C, Oyo-Ita A, Eke-Njoku J, Okebe J, et al. Anti-malarial drug prescribing practice in private and public facilities in south-east Nigeria: a descriptive study. Malar J. 2007;6:55.

WHO. The world medicines situation. Geneva: World Health Organization; 2004. Available at

Nshakira N, Kristenser M, Ssali F, Whytes R. Appropriate treatment of malaria? use of antimalarial drugs for children’s fevers in district medical units, drug shops and homes in eastern Uganda. Tropical Med Int Health. 2002;7:309-16.

Kachur SP, Khatib RA, Kaizer E, Fox SS, Abdulla SM, Bloland PB. Adherence to antimalarial combination therapy with sulfadoxine-pyrimethamine and artesunate in rural Tanzania. Am J Tropical Med Hygiene. 2004;71:715-22.

Depoortere E, Guthman JP, Sipilanyambe N, Nkandu E, Fermon F, Balkan S, Legros D. Adherence to the combination of Sulfadoxine-Pyrimethamine and artesunate in Maheba refugee settlement, Zambia. Tropical Health Int Health. 2004a;9:62-7.

Depoortere E, Salvador ET, Stivanello E, Bisoffi Z, Guthman JP, Sipilanyambe N, et al. Adherence to the combination of Artemether and Lumefantrine (Coartem) in Kajo Keji, Southern Sudan. Ann Tropical Med Parasitol. 2004b;98:635-7.

McDonnel PJ, Jacobs MR. Hospital admissions resulting from preventable adverse drug reactions. Ann Pharmacother. 2002;36:1331-6.

Okeke IN, Lamikanra A, Edelman R. Socioeconomic and behavioural factors leading to acquired bacterial resistance to antibiotics in developing countries. Emerging Infectious Dis. 1999;5(1):18-27.

World Health Organization. Effective drug regulations: What can countries do? World Health Organization, Geneva. 1999. Available at

Homedes N, Ugalde A. Improving the use of pharmaceuticals through patient and community level interventions. Social Sci Med. 2001;52:99-134.

Senst BL, Achusim LE, Genest RP, Cosentino LA, Ford CC, Little JA, et al. Practical approach to determining costs and frequency of adverse drug events in a health care network. AM J Health System Pharm. 2001;58:1126-32.

Snow RW, Craig M, Deichmann U, Marsh K. Estimating mortality, mortality and disability due to malaria among Africa’s non-pregnant population. Bulletin of World Health Organization. 1999;77:624-40.

Snow RW, Guerra CA, Noor AM, Myint HY, Hay SI. Episodes of Plasmodium falciparum malaria. Nature. 2005;434:214-7.

Oyetunde M, Kelechi O, Oyediran M. Perception of patients and other health care professionals about nurses at the university college hospital, Ibadan, Oyo State, Nigeria. Open J Nursing. 2014;4:947-55.

Amponsah AO, Vosper H, Marfo AFA. Patient related factors affecting adherence to antimalarial medication in an Urban Estate in Ghana. Hindawi Publishing Corporation Malaria Res Treatment. 2015:2015.

Gore-Langton GR, Alenwi N, Mungai J, Erupe NI, Eves K, Kimwana FN. Patient adherence to prescribed artemisinin-based combination therapy in Garissa County, Kenya, after three years of health care in a conflict setting. Malaria J. 2015;14(1):125.

Yeung S, White NJ. How do patients use antimalarial drugs? a review of the evidence. Tropical Med Int Health. 2005;10(2):121-38.

Fogg C, Bajunirwe F, Piola P, Biraro S, Checchi F, Kiguli J, et al. Adherence to a six-dose regimen of Artemether-lumefantrine for treatment of uncomplicated Plasmodium falciparum malaria in Uganda. Am J Tropical Med Hygiene. 2004;71:525:30.

Souares A, Lalou R, Sene I, Sow D, Le Hesran JY. Factors related to compliance to anti-malarial drug combination: example of amodiaquine/sulphadoxine-pyrimethamine among children in rural Senegal. Malaria Journal. 2009;8:118.

Banek K, Lalani M, Staedke SG, Chandramohan D. Adherence to artemisinin-based combination therapy for the treatment of malaria: a systematic review of the evidence. Malaria J. 2014;13(1):7.

Yukich JO, Bennett A, Albertini A, Incardona S, Moonga H, Chisha Z, et al. Reductions in artemisinin-based combination therapy consumption after the nationwide scale up of routine malaria rapid diagnostic testing in Zambia. Am J Tropical Med Hygiene. 2012;87(3):437-46.

Elmannan AAA, Elmardi KA, Idris YA, Spector JM, Ali NA, Malik EM. Anti-malarial prescribing practices in Sudan eight years after introduction of artemisinin-based combination therapies and implications for development of drug resistance. BMC Pharmacol Toxicol. 2015;16:3.

Sarpong N, Owusu-Dabo E, Kreuels B, Fobil JN, Segbaya S, Amoyaw F, et al. Prevalence of malaria parasitaemia in school children from two districts of Ghana earmarked for indoor residual spraying: a cross-sectional study. Malaria J. 2015;14(1):260.

Mbiti EN. Adherence to antimalarial combined therapy with Artemether Lumefantrine in children below five years in Embu District Kenya. A Research Thesis Submitted for The Degree of Master of Public Health Degree in The School of Health Sciences, Kenyatta University; 2009.