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Predicting adherence to postdischarge malaria chemoprevention in Malawian pre-school children: A prognostic multivariable analysis

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  • Melf-Jakob Kühl
  • Thandile Nkosi-Gondwe
  • Feiko O ter Kuile
  • Kamija S Phiri
  • Mehmajeet Pannu
  • Mavuto Mukaka
  • Bjarne Robberstad
  • Ingunn M S Engebretsen

Abstract

Chemoprevention with antimalarials is a key strategy for malaria control in sub-Saharan Africa. Three months of postdischarge malaria chemoprevention (PDMC) reduces malaria-related mortality and morbidity in pre-school children recently discharged from hospital following recovery from severe anemia. Research on adherence to preventive antimalarials in children is scarce. We aimed to investigate the predictors for caregivers’ adherence to three courses of monthly PDMC in Malawi. We used data from a cluster randomized implementation trial of PDMC in Malawi (n = 357). Modified Poisson regression for clustered data was used to obtain relative risks of predictors for full adherence to PDMC. We did not find a conclusive set of predictors for PDMC adherence. The distribution of households across a socio-economic index and caregivers’ education showed mixed associations with poor adherence. Caregivers of children with four or more malaria infections in the past year were associated with reduced adherence. With these results, we cannot confirm the associations established in the literature for caregiver adherence to artemisinin-based combination therapies (ACTs). PDMC combines multiple factors that complicate adherence. Our results may indicate that prevention interventions introduce a distinct complexity to ACT adherence behavior. Until we better understand this relationship, PDMC programs should ensure high program fidelity to sustain adherence by caregivers during implementation.

Suggested Citation

  • Melf-Jakob Kühl & Thandile Nkosi-Gondwe & Feiko O ter Kuile & Kamija S Phiri & Mehmajeet Pannu & Mavuto Mukaka & Bjarne Robberstad & Ingunn M S Engebretsen, 2023. "Predicting adherence to postdischarge malaria chemoprevention in Malawian pre-school children: A prognostic multivariable analysis," PLOS Global Public Health, Public Library of Science, vol. 3(4), pages 1-12, April.
    • Handle: RePEc:plo:pgph00:0001779
    DOI: 10.1371/journal.pgph.0001779
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    1. Miguel Angel Luque-Fernandez & Daniel Redondo-Sánchez & Camille Maringe, 2019. "cvauroc: Command to compute cross-validated area under the curve for ROC analysis after predictive modeling for binary outcomes," Stata Journal, StataCorp LLC, vol. 19(3), pages 615-625, September.
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