Abstract

The development of parasite resistance to Chloroquine was a major factor in the resurgence of malaria in Africa over the past two decades. Successive generations of antimalarials have become more expensive to produce and less able to withstand parasite resistance. Artemisinin Combination Therapies (ACTs) are currently the only remaining effective antimalarial and preserving the efficacy of these drugs is essential to controlling malaria mortality and morbidity. A major driver of parasite resistance is non-compliance with treatment (“non-adherence”). Pilot evidence from Uganda generated for this project suggests that only 55% of people purchasing ACTs over-the-counter complete the full treatment course. This is a distressingly low level of treatment compliance. This study explores methods to improve treatment compliance through improved packaging and targeted messaging on over-the-counter ACTs. We explore both the content of messaging and the design and quality of the packaging, including pictorial instructions for illiterate consumers. We also test whether a confirmed diagnosis for malaria increases the rate at which people finish their medicine. This study will make recommendations to pharmaceutical manufacturers and African governments on cost-effective ways to increase compliance.