Factors associated with non-compliance with anti-malarial treatment among malaria patients in Puerto Princesa, Palawan

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-malarial treatment among malaria 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 treatment 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% Cl 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 non­compliance 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 noncompliance when conducting patient education activities may also help boost treatment compliance.

Inhibitory effect of Quassia amara Linn. crude bark extract on Entamoeba histolytica in vitro

BACKGROUND: Entamoeba histolytica is an important etiologic agent of diarrhea. Globally, it is estimated to infect 40 to 50 million people and cause 40,000 to 100,000 deaths per year. Metronidazole is effective but can cause adverse reactions in certain individuals. In search of alternatives, traditional medicinal plants are being studied. Several plants in Family Simaroubaceae have shown anti-amoebic activity. Quassia amara, a member of this family has not been tested.OBJECTIVE: To determine the effect of Q. amara crude extract on Entamoeba histolytica in vitro.METHODS: Initial testing of 104 µg/ml ethanolic bark extract was performed. Counts were made after 72 hours. Three trials in triplicates were performed.Nine (9) dilutions of extract were then tested (18.8 to 5,00 µg/ml). Test tubes were checked for viable amoeba after 24-hour and 72-hour incubation. Minimum inhibitory concentrations (MIC) were determined for the two incubation periods. At least two trials in triplicates for each dilution were performed. metronidazole served as positive control.RESULTS: At 104 µg/ml incubated for 72 hours, no viable amoeba was obtained and counted. The MIC after 24 hours was 5,000 µg/ml, while the MIC at 72 hours was 37.5 µg/ml.CONCLUSION: Q. amara crude extract has inhibitory effects on E. histolycain vitro.

In vitro susceptibility of Plasmodium falciparum isolates to chloroquine and mefloquine in southeastern Mindanao Island, the Philippines.

Although the presence of multi-drug-resistant falciparum malaria has been reported in the Philippines, the distribution of drug-resistant malaria parasites has not yet been determined in Mindanao Island. In vitro susceptibility of P. falciparum to both chloroquine and mefloquine was assessed to forecast the spread of drug-resistant parasites in various foci in southeastern Mindanao Island. Of the 33 isolates of P. falciparum successfully tested, 10 (30%) were susceptible, 12 (36%) showed decreased susceptibility (80 nM < or = IC50 < 114 nM), and 11 (33%) were resistant (IC50 > or = 114 nM) to chloroquine. Ten (91%) of the resistant isolates and 9 (75%) of those with decreased susceptibility were from northern and northwestern Davao del Norte Province. Chloroquine-susceptible isolates were found among patients in the eastern parts of Davao del Norte and Davao Oriental provinces. Seven isolates from several foci in the study area were all mefloquine- susceptible (IC50 < 10 nM). This is the first report indicating the potential emergence of chloroquine-resistant P. falciparum on Mindanao Island, which is presently regarded as a drug-susceptible area.

PCR-amplification, sequencing, and comparison of the var/PfEMP-1 gene from the blood of patients with falciparum malaria in the Philippines.

The adhesion of Plasmodium falciparum-infected erythrocytes to vascular endothelium and to uninfected red blood cells (RBCs) plays a key role in the pathology of severe malaria. Adhesion is known to be mediated in part by the antigenically-variant erythrocyte membrane protein-1 (PfEMP-1), which is encoded by the var-gene family of P. falciparum. It has recently been reported that in vitro a single parasite simultaneously transcribes multiple var-genes but that, through a developmentally regulated process, the parasite selects only one PfEMP-1 that will to reach the surface of the host RBC. Were this to be true in vivo, one would expect a correlation between the type of var/PfEMP-1 that is expressed on the parasite-infected RBC and the severity of clinical disease. In order to test this assumption, we determined the sequence of the var-gene that was expressed by the parasites in patients' blood samples. Seven blood samples were collected from patients with or without severe clinical symptoms (cerebral malaria): two samples were from patients diagnosed as having imported falciparum malaria at the International Medical Center of Japan (IMCJ); the five others were from patients of the Davao Regional Hospital in Davao, the Philippines. The parasites (ring stage) in the blood samples were cultured for 24 hours; the matured trophozoites, in which the var-gene selection had taken place, served as material for mRNA isolation. The cDNA corresponding to the Duffy-binding-like (DBL)-1 domain of the var-gene was amplified by RT-PCR, using a region-specific primer set. The amplified cDNAs were cloned into the plasmid vector; the resultant clones (32) were sequenced on both strands. The results indicated that there was considerable diversity in the sequence of the DBL-1 domain among the clones, even among those from a single patient. In conclusion, it was difficult to demonstrate the correlation between the type of var-gene transcripts found in the RBCs of malaria patients and the severity of their symptoms.