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How perceptions of malaria medication affect adherence

Start date: 1 Oct 2010

[Project summary in Français / Português]

Scientific title: Qualitative study on antimalarial drug use in the context of perceptions of ACTs and intra-household decision making in the Chikhwawa district of Malawi

Latest on this research

[Français / Português]

We recruited 218 participants and completed field work in April 2013. While overall adherence to the all doses of the treatment course was high around 80%, caregivers reported some difficulty in administering ACTs to children.

The sweet taste of dispersible LA (one of the drugs used in the main trial) may have made it easier to administer antimalarials to children, however there were still problems with this medication being spat, dribbled or spilt. Overall, adherence was greater among those receiving DHA-PPQ (the second drug), which requires fewer doses. 

Scroll down for related resources, or learn more about the main ACTia trial.

What did we know before this research?

There are very effective  antimalarial drugs available , but it is a challenge to ensure that they reach those that need them and that they are used appropriately.

If patients don’t take their medication as prescribed, symptoms may become worse. There is also an increased risk that the treatment will fail and they will become infected again. Ultimately this could lead to more cases of drug resistance.

The way patients perceive the purpose and efficacy of their medication often dictates the way they take it, and whether they follow the guidance given at the time of prescription. This is of particular concern in Malawi, where rumours have surrounded the use of Coartem (a type of ACT drug) when it was first introduced in 2007. It was seen as either too strong or ineffective against malaria, and some newspapers have described it as unsafe and ineffective.

What does this study add?

In places like Malawi, it takes some time for communities to accept the introduction of new drugs, such as antimalarials. Understanding people’s concerns about new drugs is crucial to ensure that they are used properly.

This qualitative study is linked to the the ACT Consortium trial “Safety of repeated drug use in children” and analyses how patients’ beliefs about these drugs affect the way they take their medication. It takes into consideration the perspectives of community members, including caregivers whose child was treated as part of the ACTia study, through the use of questionnaires, interviews and focus group discussions.

The research team

Principal Investigators:

  • Prof David Lalloo, Liverpool School of Tropical Medicine



Other Investigators:

  • Dr Victoria Ewing, Liverpool School of Tropical Medicine
  • Dr Anja Terlouw, Liverpool School of Tropical Medicine
  • Dr Rachel Tolhurst, Liverpool School of Tropical Medicine
  • Dr Miguel Sanjoaquin, Epidemiologist, Liverpool School of Tropical Medicine / Malawi Liverpool Wellcome Trust Clinical Research Programme (MLW)
  • Dr Sally Theobald, Liverpool School of Tropical Medicine
  • Dr Esther Richards, Liverpool School of Tropical Medicine

Related Publications

Seasonal and geographic differences in treatment-seeking and household cost of febrile illness among children in Malawi

Victoria L Ewing, David G Lalloo, Kamija S Phiri, Arantxa Roca-Feltrer, Lindsay J Mangham, Miguel A SanJoaquin  |  Published
The Malaria Journal

Perceptions and utilization of the anti-malarials artemether-lumefantrine and dihydroartemisininpiperaquine in young children in the Chikhwawa District of Malawi: A mixed methods study

Victoria L Ewing, Dianne J Terlouw, Andrew Kapinda, Cheryl Pace, Esther Richards, Rachel Tolhurst, David G Lalloo  |  Published
Malaria Journal

Understanding interpretations of and responses to childhood fever in the Chikhwawa district of Malawi

Victoria L. Ewing, Rachel Tolhurst, Andrew Kapinda, Miguel SanJoaquin, Dianne J. Terlouw, Esther Richards, David G. Lalloo  |  Published

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