Health Behaviors in the Context of Malaria Treatment in Uganda

Abstract

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.