Adherence to Artemisinin-Based Combination Therapy for the Treatment of Uncomplicated Malaria: A Systematic Review and Meta-Analysis

Table 1

Characteristics of studies included in the systematic review and meta-analysis.

Author/year	Country	Sample size	Endemicity	ACT	Adherence measure	Comments/sources of bias
Ajayi et al. 2008 [22]	Nigeria	288	High	AL	Blister pack/caregivers recall	>97% of CMDs prescribing correct ACT doses
Ajayi et al. 2008 [22]	Ghana	382	High	AS/AQ	Blister pack/caregivers recall	>97% of CMDs prescribing correct ACT doses
Ajayi et al. 2008 [22]	Uganda	619	High	AL	Blister pack/caregivers recall	>97% of CMDs prescribing correct ACT doses
Asante et al. 2009 [23]	Ghana	401	High	AS/AQ	Blister pack	Home visit to supervise treatment which could influence adherence
Bell et al. 2009 [28]	Malawi	209	High	AL	Questionnaire and electronic device	Blood LU assayed on day 7
Chinbuah et al. 2006 [34]	Ghana	NA	High	AL	Blister pack	Majority of children receiving correct dose of AL
Fogg et al. 2004 [31]	Uganda	210	High	AL	Blister pack	Educated semiurban population, blood lumefantrine level assayed
Kabanywanyi et al. 2010 [25]	Tanzania	522	NR	AL	Blister pack	Pictorial instruction available, questionnaire not validated
Kachur et al. 2004 [32]	Tanzania	253	Moderate	AS/SP	Blister pack/self-report	Socioeconomic status assessed
Lawford et al. 2011 [24]	Kenya	918	Low/moderate	AL	Blister pack/self-report	Validity of translated questionnaire not mentioned
Mace et al. 2011 [30]	Malawi	868	High	AL	Pill count/dose recall	Pictorial instructions provided
Beer et al. 2009 [27]	Tanzania	195	Moderate	AS/AQ	Pill count/self-report	>50% of nonadherence was due to misunderstanding of instructions
Simba et al. 2012 [35]	Tanzania	444	High	AL	Self-report	Plasma LU concentration assayed, pictorial instruction provided, and questionnaire validated
Depoortere et al. 2004 [33]	Zambia	142	Moderate	AS/SP	Blister pack	No adequate dosage instructions
Gerstl et al. 2010 [26]	Sierra Leone	118	High	AS/AQ	Blister pack	37% given wrong dosage instructions
Lemma et al. 2011 [29]	Ethiopia	155	Low	AL	Blister pack/self-report	Study done at peak of malaria transmission
Onyango et al. 2012 [12]	Kenya	297	Low	AL	Pill count/self-report	Covered long distance to get ACT, questionnaire validated
Cohen et al. 2012 [36]	Uganda	152	Low	AL	Blister pack/self-report	Drug shops licensed, ACT heavily subsidized, and shop attendants trained and supervised
Achan et al. 2009 [37]	Uganda	175	Low	AL	Blister pack	Adequate instruction given
Amponsah et al. 2015 [38]	Ghana	219	High	AL	Pill count	Questionnaire validated
Amponsah et al. 2015 [38]	Ghana	55	High	AS/AQ	Pill count	Questionnaire validated
Amponsah et al. 2015 [38]	Ghana	26	High	AS/PP	Pill count	Questionnaire validated
Aung et al. 2015 [39]	Myanmar	161	High	AL	Pill count/self-report	Good dosage instructions given
Bruxvoort et al. 2015 [40]	Tanzania	572	Low	AL	Pill count/self-report	Taking first dose at health facility associated with good adherence
Bruxvoort et al. 2015 [40]	Tanzania	450	Low	AL	Pill count/self-report	Several drug shops not yet accredited and not receiving training
Congpuong et al. 2010 [41]	Thailand	240	High	AS/MQ	Day 3 whole blood MQ concentration and self-report	Self-report failing to identify 2.4% of subjects with poor adherence
Ewing et al. 2015 [42]	Malawi	101	High	AL	Pill count, blister pack, and self-report	Underdosing due to loss of medication, children followed up for 3 years to monitor long term effects of ACT
Ewing et al. 2015 [42]	Malawi	117	High	DA/PQ	Pill count, blister pack, and self-report	Underdosing due to loss of medication, children followed up for 3 years to monitor long term effects of ACT
Gore-Langton et al. 2015 [43]	Kenya	195	Low	AL	Self-report and blister pack	Study area affected by conflict leading to poor health delivery services
Siddiqui et al. 2015 [44]	DR Congo	108	High	AS/AQ	Self-report and blister pack	Poor understanding of the need to complete treatment schedule
Ogolla et al. 2013 [45]	Kenya	62	Low	AL	Pill count, blister pack, and self-report	Malaria was microscopically confirmed. The sixth ACT dose was the most commonly forgotten tablet

ACT: artemisinin-based combination therapy, AL: artemether-lumefantrine, AQ: amodiaquine, AS: artesunate, CMDs: community medicine distributors, DA: dihydroartemisinin, PQ: piperaquine, PP: piperazine, and SP: sulphadoxine-pyrimethamine.