Jackline D Nkoma, Susan F Rumisha, Hamisi S Japhari, Emanuel L Peter
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Two authors independently assessed retrieved studies for eligibility and risk of bias, then the adherence rate was pooled using the random effect model implemented in STATA. Publication bias was assessed using a funnel plot symmetry and the Egger test. Subgroup analysis was performed to explore the effect of the national and types of regimens on the overall estimate. Qualitative analysis was applied to explain factors that influence adherence.</p><p><strong>Results: </strong>A total of 29 studies with 15 927 participants were included. The overall adherence rate was 70.30% (95% CI 61.93-78.67; 29 studies; I<sup>2</sup> = 99.76%), with the highest level reported in Rwanda (100%, 95% CI 97.28-100.00) and lowest in Tanzania (6.99%, 95% CI 0.2.81-11.17). Furthermore, adherence was high for chloroquine plus sulfadoxine-pyrimethamine (96.27%, 93.87-98.66; one study). 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引用次数: 0
摘要
背景：尽管东非对2030年消除疟疾的目标作出了承诺，但它在全球疟疾负担中仍占很大份额。此外，据报告，在坚持使用抗疟疾药物方面的差异阻碍了区域消除疟疾的努力。此外，该地区没有全面和可比较的依从性估计，供政策制定者确定重点、目标控制战略和评估干预措施的有效性。因此，本系统综述综合了东非地区依从性估计。方法：作者从PubMed、Science Direct、CINHAL、Scopus和谷歌Scholar中检索文章。两位作者独立评估检索到的研究的合格性和偏倚风险，然后使用STATA中实施的随机效应模型汇总依从率。采用漏斗图对称和Egger检验评估发表偏倚。进行亚组分析以探讨国家和方案类型对总体估计的影响。采用定性分析解释影响依从性的因素。结果：共纳入29项研究，15927名受试者。总依从率为70.30% (95% CI 61.93-78.67；29日的研究;I2 = 99.76%)，卢旺达报告的水平最高（100%,95% CI 97.28-100.00），坦桑尼亚最低（6.99%,95% CI 0.2.81-11.17）。此外，氯喹联合磺胺多辛-乙胺嘧啶的依从性较高(96.27%,93.87 ~ 98.66；一项研究)。回顾正确的指示并在卫生机构服用第一剂对患者的依从性有积极影响。结论：东非平均约有四分之三的疟疾患者坚持服药。鉴于这些发现，需要进行进一步的干预性研究，以解决该地区抗疟疾药物依从性低的问题。此外，在东非仍然需要采用适当的测量方法进行依从性研究，以获得可靠的可推广的估计。本综述在PROSPERO注册，注册ID为CRD42023410048。
Adherence to anti-malarials among patients diagnosed with malaria in East Africa: a systematic review and meta-analysis.
Background: East Africa continues to bear a significant share of the global malaria burden, despite its commitment to the malaria elimination goal of 2030. Furthermore, reported variations in adherence to anti-malarials hamper the regional effort in malaria elimination. Moreover, the region has no comprehensive and comparable adherence estimates for policymakers to set priorities, target control strategies, and evaluate the effectiveness of interventions. Hence, this systematic review synthesized the regional adherence estimate for East Africa.
Methods: Authors searched articles from PubMed, Science Direct, CINHAL, Scopus, and Google Scholar. Two authors independently assessed retrieved studies for eligibility and risk of bias, then the adherence rate was pooled using the random effect model implemented in STATA. Publication bias was assessed using a funnel plot symmetry and the Egger test. Subgroup analysis was performed to explore the effect of the national and types of regimens on the overall estimate. Qualitative analysis was applied to explain factors that influence adherence.
Results: A total of 29 studies with 15 927 participants were included. The overall adherence rate was 70.30% (95% CI 61.93-78.67; 29 studies; I2 = 99.76%), with the highest level reported in Rwanda (100%, 95% CI 97.28-100.00) and lowest in Tanzania (6.99%, 95% CI 0.2.81-11.17). Furthermore, adherence was high for chloroquine plus sulfadoxine-pyrimethamine (96.27%, 93.87-98.66; one study). Recalling correct instructions and taking the first dose at the health facility had a positive influence on patient adherence.
Conclusion: On average, about three-quarters of malaria patients in East Africa adhere to their medications. In light of these findings, further interventional studies are needed to address low adherence to anti-malarials in the region. Moreover, adherence studies with the appropriate method of measurement are still needed to obtain a robust generalizable estimate in East Africa. Trial registration This review was registered at PROSPERO with the registration ID CRD42023410048.
期刊介绍：
Malaria Journal is aimed at the scientific community interested in malaria in its broadest sense. It is the only journal that publishes exclusively articles on malaria and, as such, it aims to bring together knowledge from the different specialities involved in this very broad discipline, from the bench to the bedside and to the field.
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