Factors Associated with Non-compliance with Anti-malarial Treatment among Malaria Patients in Puerto Princesa, Palawan

Analigaya R. Agoncillo, Kristine Ayessa Elaine B. Coronacion, Julienne Theresa T. Dagdag, Ma. Stephanie C. Matira, Niña Kashka E. Pamintuan, Charles Sherwin M. Soriano, Maria Sonia S. Salamat, Ofelia P. Saniel and Pilarita T. Rivera

College of Public Health, University of the Philippines Manila

Objective. Malaria is a life-threatening, mosquito-borne disease that continues to cause numerous deaths worldwide. In the Philippines, malaria remains an important problem, with five provinces having > 1000 cases of malaria a year. The objective of this cross-sectional analytical study was to determine the association of selected factors with non-compliance to anti-malaria treatment among patients in Puerto Princesa, Palawan, specifically: perceived susceptibility to malaria, perceived seriousness and severity of malaria, perceived benefits of medication, perceived barriers to treatment compliance and cues to action.

Methods. Using an interviewer-administered structured questionnaire, 320 individuals diagnosed with and treated for malaria from January to October 2010 were interviewed regarding compliance to anti-malarial treatmetn and the factors related to compliance. Descriptive statistics and multiple logistic regression were used to analyze the data.

Results. The rate of non-compliance to anti-malaria treatment was 17% (95% CI 12.1%-21.2%). After multivariate analysis using logistic regression, symptom perception as a cue to action and forgetfulness as a perceived barrier to treatment compliance were found to be significantly associated with non-compliance to treatment. The odds of non-compliance were three times higher for individuals who perceived that an improvement in symptoms implied cure of malaria. An individual who forgot to take at least one dose of medication was 17 times more likely to be non-compliant with treatment compared to someone who did not forget to take a single dose.

Conclusion. Given the factors found to be associated with non-compliance to treatment, more effective ways of ensuring compliance with anti-malaria treatment may be explored e.g., doing directly observed treatment and utilizing treatment partners that may help address the problem of forgetfulness. The fact that symptom improvement is not equivalent to cure must be stressed when advising patients. Emphasizing compliance to treatment and the consequences of non-compliance when conducting patient education activities may help boost treatment compliance.

Key Words: Malaria, patient compliance, therapeutics