Health Behaviors in the Context of Malaria Treatment in Uganda

Type Thesis or Dissertation - Doctor of Science
Title Health Behaviors in the Context of Malaria Treatment in Uganda
Publication (Day/Month/Year) 2016
Malaria is a major cause of morbidity and mortality worldwide, particularly among young
children in Sub-Saharan Africa. There exists a very effective treatment for malaria, a class of drugs
known as artemisinin-based combination therapies (ACTs). However, it is estimated that only
12-22% of children with malaria were treated with an ACT in 2015 and, even when people take
ACTs, they do not always complete the full treatment course. This dissertation examines malaria
treatment behaviors in Central and Eastern Uganda.
The first two chapters of this dissertation use a randomized controlled trial to evaluate interventions
designed to increase patient adherence to the ACT treatment regimen. We find that 35%
of patients who purchase subsidized ACTs from local drug shops in central Uganda do not complete
the full 3-day treatment course. In the first chapter, we show that patients who felt better mid-way
through treatment were more likely to stop taking the medication than those who were still unwell.
However, short messages promoting adherence, delivered via stickers affixed to the standard ACT
package, increased adherence rates by approximately 9%.
The second chapter examines the impact of diagnostic testing for malaria on adherence to the
malaria treatment regimen. Since most people do not receive a confirmed diagnosis of malaria
before beginning treatment, uncertainty about the true cause of illness may be a factor in nonadherence.
We find that patients who tested positive for malaria on a rapid diagnostic test did
not have higher odds of adherence. However, we present some evidence that patients who tested
positive were more likely to consume a few additional pills of the drug.
The third chapter of this dissertation shows that the probability that a febrile patient has
malaria declines substantially with the age of the patient and increases with the local village prevalence
rate. We find, however, that ACT treatment rates are invariant to age and local prevalence,
and beliefs about whether an illness is malaria also do not vary with age or prevalence. This work
suggests that mis-perceptions of malaria risk may be contributing to the under-treatment of malaria
in young children.

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