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.

Entomological survey of artificial container breeding sites of dengue vectors in Batasan Hills, Quezon City

OBJECTIVE: Dengue fever remains a public health problem in the Philippines. Eliminating key container artificial breeding sites of mosquito vectors is a vital part of dengue control. The objective of this descriptive cross-sectional study was to conduct an entomological survey of artificial container breeding sites of Aedes mosquitoes in households of two puroks in Batasan Hills, Quezon City. METHODS: All potential artificial container breeding sites of dengue in each household were inspected for mosquito larvae. Water was sampled from all containers that had mosquito larvae. Water was sampled from all containers that had mosquito larvae and the larval species determined through microscopic examination. Using the World Health Organization list of recognized containers, each container was classified as recognized or an unrecognized container. RESULTS: The larval indices computed were: container index = 6.4%, household index = 23.9% and Breteau index = 29%. The proportion of containers positive for A. aegypti larvae was significantly higher for the unrecognized containers (9.9%) than that of the recognized containers (3.9%) (p=0.002). CONCLUSION: The high household index and Breteau index indicate that the potential for dengue transmission is high in the study area. Unrecognized artificial containers contributed significantly to the number of Aedes breeding sites. "Search-and-destroy" campaigns in the community should be expanded to include these containers. Crafting specific vector control messages that address the problem of particular unrecognized containers as well as those of recognized containers with the highest proportion positive for Aedes larvae will also aid dengue control and prevention. Repeat surveys to monitor larval indices may be used to help ascertain the effectiveness of these messages in decreasing mosquito breeding sites.