Adherence to 14-day primaquine treatment for radical cure of Plasmodium vivax and mixed malaria patients treated at health centers in Yilmana Densa district, Ethiopia: a community-based cross-sectional study.

BACKGROUND

Primaquine is the right drug for the radical cure of malaria. The Ethiopian National malaria guideline recommends a 14-day course of primaquine for vivax and mixed malaria patients. Adherence to the full course of primaquine is crucial to achieve a radical cure. However, the recurrence of malaria is still high. Therefore, this study aimed to assess adherence status and identify factors affecting adherence to primaquine treatment among malaria patients treated at health centers in Yilmana Densa district, Ethiopia.

METHODS

A community-based cross-sectional study was conducted in Yilmana Densa district from December 15, 2024 to January 30, 2025. A total of 594 malaria patients were selected using systematic random sampling. Data were collected through house-to-house visits by using an interviewer-administered questionnaire and observation. Self-report, followed by a pill count, was used to ascertain adherence status. The data were entered with EpiData 4.7 and analyzed using Stata version 17. Binary logistic regression was used. Variables with a P-value < 0.25 in bivariable analysis were entered into multivariable analysis. Variables with a P-value < 0.05 were considered statistically significant.

RESULTS

Among the 594 study participants, 545 (91.8%) were interviewed. The overall adherence to primaquine treatment was 282 (51.7%), with a 95% confidence interval (CI) of 47.4% to 56.0%. Female sex (AOR = 1.64, 95%CI = 1.11-2.43), having knowledge that malaria can relapse (AOR = 1.69, 95%CI = 1.11-2.58), and a prior history of malaria infection (AOR = 1.67, 95%CI = 1.14-2.44) were positively associated with probably adherent. Whereas experiencing side effects was negatively associated (AOR = 0.49, 95%CI = 0.33-0.72).

CONCLUSIONS

The primaquine treatment adherence status is low in the Yilmana Densa district. Being female, having knowledge that malaria can relapse, and having a prior malaria history were positively associated with adherence. Conversely, side effect has negatively associated. Hence, health education focusing on the risk of malaria relapse shall be promoted, giving due attention to males, and counselling about the expected side effects proactively.