Background
Methods
Study setting
Study design
Sample size calculations
Selection of outlets
Study procedures
Data entry and analysis
Comparison of adherence between sectors
Factors associated with adherence within sectors
Ethics
Results
Patient characteristics, care received, and status at interview
Public health facilities (N = 572 patients from 40 outlets)
|
Private ADDOs (N = 450 patients from 37 outlets)
|
p-value
| |
---|---|---|---|
Male | 43.2 (39.9, 46.5) | 53.1 (46.8, 59.4) | 0.007 |
Age
1
| |||
Under 3 years | 42.5 (37.4, 47.8) | 18.2 (14.5, 22.6) | |
3 years to under 8 years | 28.2 (23.5, 33.3) | 23.1 (18.8, 28.0) | |
8 years to under 12 years | 6.6 (4.3, 10.0) | 9.1 (6.9, 12.0) | |
12 years and above | 22.7 (18.7, 27.3) | 49.6 (43.0, 56.2) | <0.0001 |
Patient (or caregiver if patient below age 12) completed primary school2
| 58.2 (50.7, 65.4) | 71.8 (65.2, 77.6) | 0.007 |
Socio-economic status
3
| |||
1st quintile (most poor) | 27.9 (23.1, 33.2) | 10.2 (7.6, 13.5) | |
2nd quintile | 24.5 (20.5, 29.1) | 14.2 (10.1, 19.8) | |
3rd quintile | 20.0 (16.5, 23.9) | 20.2 (15.4, 26.1) | |
4th quintile | 17.3 (13.1, 22.6) | 23.3 (19.5, 27.6) | |
5th quintile (least poor) | 10.3 (7.4, 14.4) | 32.1 (23.3, 42.2) | <0.0001 |
Slept under net the night before the interview | 73.6 (68.9, 77.8) | 71.4 (65.3, 76.9) | 0.6 |
Sought care for this episode prior to attending outlet | 36.4 (31.9, 41.2) | 37.8 (31.6, 44.4) | 0.7 |
Sought care at outlet within two days of fever onset4
| 77.5 (73.5, 81.1) | 72.0 (67.8, 75.9) | 0.051 |
Symptoms
| |||
Fever or headache | 94.1 (91.3, 96.0) | 91.1 (87.6, 93.7) | 0.1 |
Respiratory | 14.0 (10.5, 18.4) | 7.5 (5.3, 10.7) | 0.007 |
Stomach upset | 53.5 (47.7, 59.2) | 48.9 (42.3 55.6) | 0.3 |
Body/joint pain | 15.4 (12.2, 19.1) | 30.4 (25.2, 36.2) | <0.0001 |
Fatigue | 10.1 (7.5, 13.6) | 18.0 (14.2, 22.5) | 0.003 |
Convulsions | 2.5 (1.6, 3.9) | 0.4 (0.1, 1.7) | 0.007 |
Other5
| 12.4 (9.6, 15.9) | 10.0 (7.5, 13.1) | 0.2 |
Attended an outlet in an urban ward | 13.1 (5.1, 29.6) | 68.4 (48.3, 83.4) | <0.0001 |
Distance of 2.5 km or less from home to outlet (by GPS coordinates)6
| 69.4 (62.6, 75.4) | 71.4 (58.5, 81.5) | 0.8 |
Time of day drug was obtained
| |||
Morning | 77.1 (71.9, 81.6) | 44.7 (38.2, 51.3) | |
Afternoon | 18.7 (14.6, 23.6) | 26.9 (22.2, 32.2) | |
Evening | 4.2 (2.5, 7.0) | 28.4 (21.6, 36.4) | <0.0001 |
Time between obtaining AL and interview (hours)
7
| |||
60-67 | 5.8 (3.8, 8.6) | 24.8 (20.7, 29.3) | |
68-72 | 47.0 (41.7, 52.4) | 37.4 (33.1, 41.9) | |
73-84 | 32.5 (28.5, 36.7) | 21.6 (16.9, 27.2) | |
85 or more | 14.7 (11.4, 18.8) | 16.2 (12.1, 21.4) | <0.0001 |
Public health facilities (N = 572 patients from 40 outlets)
|
Private ADDOs (N = 450 patients from 37 outlets)
|
p-value
| |
---|---|---|---|
Treatment received at outlet
| |||
Tested for malaria | 54.4 (40.3, 67.9) | 11.1 (8.0, 15.4) | <0.0001 |
Told diagnosis | 64.1 (56.3, 71.1) | 53.5 (46.1, 60.8) | 0.051 |
Obtained correct blister pack for age1
| 78.9 (74.7, 82.5) | 83.1 (78.7, 86.8) | 0.1 |
Paid for AL | 28.7 (24.0, 34.0) | 97.8 (96.1, 98.7) | <0.0001 |
Took first dose of AL at outlet | 40.7 (29.8, 52.7) | 9.6 (6.3, 14.2) | <0.0001 |
Recall of instructions received from dispenser
| |||
Recalled correct instructions given by dispenser on the number of pills per dose, number of doses, and number of days to take AL | 60.8 (56.4, 65.2) | 59.3 (53.7, 64.7) | 0.7 |
Recalled that dispenser used packaging as a visual aid to explain how to take AL | 85.6 (81.9, 88.6) | 82.9 (77.9, 86.9) | 0.3 |
Reported being told to take the second dose of AL eight hours after the first dose | 58.0 (51.3, 64.5) | 63.3 (57.9, 68.4) | 0.2 |
Reported being told to take AL with food or milk | 63.8 (57.9, 69.3) | 61.8 (54.6, 68.5) | 0.7 |
Reported being told to complete all doses of AL even if feeling better | 77.9 (73.5, 81.7) | 63.3 (55.7, 70.4) | 0.0006 |
Reported being told to take a replacement dose in case of vomiting within half hour of taking a dose | 1.9 (1.1, 3.5) | 2.4 (1.3, 4.6) | 0.6 |
Reported being told about possible side effects | 2.3 (1.3, 4.0) | 3.0 (1.6, 5.6) | 0.6 |
Health status at interview
| |||
Reported current fever at time of interview | 13.7 (10.5, 17.7) | 14.7 (11.1, 19.1) | 0.7 |
Could play or work at time of interview | 92.6 (89.2, 95.1) | 92.4 (89.7, 94.5) | 0.9 |
Tested positive by mRDT at interview2
| 49.6 (39.7, 59.5) | 27.9 (20.7, 36.6) | 0.001 |
Tested positive by blood smear collected at interview3
| 2.9 (1.7, 4.7) | 1.4 (0.6, 3.0) | 0.1 |
Adherence to AL
| |||
Adherent by ‘verified completed treatment’4
| 74.6 (69.8, 78.8) | 69.8 (64.6, 74.5) | 0.2 |
Adherent by ‘verified timely completion’5
| 46.0 (40.9, 51.2) | 34.8 (30.1, 39.8) | 0.003 |
Comparison of adherence between sectors
Verified completed treatment
2
|
Verified timely completion
3
| |||
---|---|---|---|---|
Adjusted odds ratio
|
p-value
|
Adjusted odds ratio
|
p-value
| |
Attended ADDO vs. public health facility | 0.65 (0.43, 1.00) | 0.048 | 0.69 (0.47, 1.01) | 0.056 |
Age
4
| ||||
Under 3 years (ref) | --- | --- | --- | --- |
3 years to under 8 years | 1.01 (0.67, 1.52) | 0.9 | 0.88 (0.61, 1.28) | 0.5 |
8 years to under 12 years | 1.07 (0.57, 2.09) | 0.8 | 1.12 (0.62, 2.01) | 0.7 |
12 years and above | 1.02 (0.56, 2.05) | 0.8 | 0.87 (0.60, 1.27) | 0.5 |
Patient (or caregiver if patient below age 12) completed primary school | 1.68 (1.20, 2.36) | 0.003 | 1.06 (0.77, 1.45) | 0.9 |
Socio-economic status
5
| ||||
1st quintile (most poor, ref) | --- | --- | ||
2nd quintile | 0.98 (0.62, 1.57) | 0.9 | 1.04 (0.66, 1.64) | 0.9 |
3rd quintile | 1.17 (0.73, 1.88) | 0.5 | 1.10 (0.70, 1.75) | 0.7 |
4th quintile | 2.25 (1.33, 3.81) | 0.003 | 1.64 (1.03, 2.65) | 0.039 |
5th quintile (least poor) | 2.24 (1.28, 3.81) | 0.005 | 2.34 (1.40, 3.93) | 0.001 |
Distance from home to outlet within 2.5 km by GPS | 1.30 (0.92, 1.85) | 0.2 | 1.20 (0.87, 1.66) | 0.3 |
Time of day drug was obtained
| ||||
Morning (ref) | --- | --- | --- | --- |
Afternoon | 0.96 (0.62, 1.47) | 0.8 | 0.70 (0.48, 1.03) | 0.070 |
Evening | 0.93 (0.50, 1.70) | 0.8 | 0.35 (0.19, 0.64) | 0.001 |
Time between obtaining AL and interview (hours)
| ||||
60-67 (ref) | --- | --- | --- | --- |
68-72 | 2.43 (1.39, 4.23) | 0.002 | 1.46 (0.81, 2.63) | 0.2 |
73-84 | 2.83 (1.49, 5.37) | 0.001 | 1.92 (1.00, 3.66) | 0.049 |
85 or more | 6.44 (3.19, 13.01) | <0.001 | 2.61(1.37, 4.95) | 0.003 |
Factors associated with adherence within sectors
Verified completed treatment
1
|
Verified timely completion
2
| |||||||
---|---|---|---|---|---|---|---|---|
Public health facilities (N = 572)
3
|
ADDOs (N = 450)
4
|
Public health facilities (N = 572)
3
|
ADDOs (N = 450)
4
| |||||
Adjusted odds ratio (95% CI)
|
p-value
|
Adjusted odds ratio (95% CI)
|
p value
|
Adjusted odds ratio (95% CI)
|
p-value
|
Adjusted odds ratio (95% CI)
|
p-value
| |
Age
5
| ||||||||
Under 3 years (ref) | --- | --- | --- | --- | --- | --- | --- | --- |
3 years to under 8 years | 1.32 (0.76, 2.28) | 0.3 | 0.69 (0.35, 1.36) | 0.3 | 1.03 (0.60, 1.78) | 0.9 | 0.51 (0.28, 0.93) | 0.029 |
8 years to under 12 years | 1.33 (0.49, 3.57) | 0.6 | 0.97 (0.43, 2.16) | 0.9 | 2.25 (0.74, 6.86) | 0.2 | 0.75 (0.31, 1.82) | 0.5 |
12 years and above | 1.19 (0.62, 2.31) | 0.6 | 0.94 (0.48, 1.84) | 0.9 | 1.06 (0.59, 1.93) | 0.8 | 0.69 (0.35, 1.38) | 0.3 |
Patient (or caregiver if patient below age 12) completed primary school | 1.16 (0.70, 1.91) | 0.6 | 1.56 (1.00, 2.43) | 0.050 | 0.88 (0.55, 1.40) | 0.6 | 0.94 (0.54, 1.63) | 0.8 |
Socio-economic status
6
| ||||||||
1st quintile (most poor, ref) | --- | --- | --- | --- | --- | --- | --- | --- |
2nd quintile | 0.97 (0.60, 1.57) | 0.9 | 0.82 (0.38, 1.81) | 0.6 | 0.93 (0.52, 1.64) | 0.8 | 1.19 (0.62, 2.26) | 0.6 |
3rd quintile | 1.04 (0.54, 1.98) | 0.9 | 1.48 (0.72, 3.03) | 0.3 | 0.70 (0.37, 1.34) | 0.3 | 2.84 (1.15, 7.05) | 0.024 |
4th quintile | 2.20 (1.09, 4.47) | 0.038 | 1.75 (0.87, 3.51) | 0.1 | 1.25 (0.64, 2.44) | 0.5 | 1.82 (0.61, 5.45) | 0.3 |
5th quintile (least poor) | 2.19 (0.81, 5.93) | 0.2 | 1.99 (0.71, 5.54) | 0.2 | 2.21 (1.01, 4.82) | 0.046 | 2.47 (0.93, 6.55) | 0.070 |
Slept under a bed net the night before the interview | 1.60 (1.10, 2.34) | 0.015 | 0.98 (0.59, 1.62) | 0.9 | 1.23 (0.77, 1.96) | 0.4 | 0.79 (0.50, 1.27) | 0.3 |
Sought care within two days of fever onset | 1.01 (0.60, 1.72) | 0.9 | 1.16 (0.63, 2.13) | 0.6 | 1.61 (0.99, 2.61) | 0.056 | 1.11 (0.59, 2.09) | 0.8 |
Fever symptoms | 3.38 (1.21, 9.47) | 0.020 | 1.18 (0.56, 2.47) | 0.7 | 1.65 (0.64, 4.25) | 0.3 | 0.86 (0.47, 1.58) | 0.6 |
Distance from home to outlet within 2.5 km7
| 1.67 (1.05, 2.65) | 0.031 | 0.76 (0.48, 1.20) | 0.2 | 1.14 (0.68, 1.91) | 0.6 | 1.09 (0.65, 1.82) | 0.8 |
Time of day drug was obtained
| ||||||||
Morning (ref) | --- | --- | --- | --- | --- | --- | --- | --- |
Afternoon | 1.11 (0.62, 2.01) | 0.7 | 1.12 (0.52, 2.38) | 0.8 | 0.55 (0.31, 0.97) | 0.038 | 1.04 (0.57, 1.88) | 0.9 |
Evening | 0.81 (0.22, 3.04) | 0.7 | 0.95 (0.44, 2.05) | 0.9 | 0.10 (0.02, 47.6) | 0.004 | 0.69 (0.31, 1.53) | 0.4 |
Time between obtaining AL and interview (hours)
| ||||||||
60-67 (ref) | --- | --- | --- | --- | --- | --- | --- | --- |
68-72 | 2.37 (0.87, 6.51) | 0.093 | 2.80 (1.35, 5.82) | 0.006 | 1.47 (0.44, 4.95) | 0.5 | 1.55 (0.71, 3.36) | 0.3 |
73-84 | 3.64 (1.31, 10.08) | 0.013 | 2.73 (1.12, 6.63) | 0.027 | 2.03 (0.56, 7.29) | 0.3 | 2.94 (1.20, 7.20) | 0.018 |
85 or more | 5.59 (1.66, 18.79) | 0.005 | 5.94 (2.70, 13.06) | <0.001 | 2.72 (0.75, 9.84) | 0.1 | 2.09 (0.85, 5.13) | 0.1 |
Tested for malaria at outlet | 1.30 (0.82, 2.04) | 0.3 | 0.39 (0.17, 0.85) | 0.018 | 1.47 (0.96, 2.26) | 0.078 | 0.48 (0.24, 0.97) | 0.041 |
Took first dose of AL at outlet | 1.05 (0.71, 1.55) | 0.8 | 1.34 (0.60, 3.01) | 0.5 | 2.11 (1.46, 3.04) | <0.001 | 1.33 (0.57, 3.13) | 0.5 |
Recalled correct instructions given by dispenser on the number of pills per dose, number of doses, and number of days to take AL | 4.04 (2.59, 6.31) | <0.001 | 2.98 (2.03, 4.37) | <0.001 | 6.09 (3.71, 10.02) | <0.001 | 2.51 (1.41, 4.45) | 0.002 |
Recalled that dispenser used packaging as a visual aid to explain how to take AL | 1.33 (0.75, 2.36) | 0.3 | 1.28 (0.62, 2.66) | 0.5 | 1.85 (1.09, 3.11) | 0.022 | 1.40 (0.73, 2.67) | 0.3 |
Reported being told to take the second dose of AL eight hours after the first dose | 1.15 (0.74, 1.79) | 0.5 | 1.28 (0.87, 1.89) | 0.2 | 0.85 (0.52, 1.38) | 0.5 | 1.77 (1.12, 2.80) | 0.015 |
Reported being told to complete all doses of AL even if feeling better | 0.96 (0.54, 1.71) | 0.9 | 1.02 (0.61, 1.70) | 0.9 | 0.44 (0.28, 0.70) | 0.001 | 1.05 (0.73, 1.50) | 0.8 |