The role of communication between clients and health care providers: implications for adherence to malaria treatment in rural Gambia.

Objectives: One of the major barriers to the successful treatment of malaria is the non-adherence to drug regimens. Work till now has often been based on the assumption that most patients begin their treatment having received adequate or at least similar instructions and information about both the disease itself and the content and course of their treatment. This paper questions such an assumption. We ask whether people do not adhere to treatment in part because they have not understood the diagnosis and subsequent treatment from the outset.

Methods: This study was conducted in the North Bank district of The Gambia, West Africa where a convenience sample of 1337 caretakers with children under 10 years of age were interviewed immediately after their consultation about their recommended treatment.

Results: Findings show a mismatch between caretakers and healthcare providers' (HCP) interpretations of a child's clinic visit, both in terms of the diagnosis and drug regimen. Less than a third of the caretakers' responses matched the diagnosis that the HCP had written on the child's medical card. Results also showed a delay in the first important antimalarial dose. A common response was 'I'm not sure what is wrong with the child but I will start the medicine when I get home'.

Conclusions: The findings from these exit interviews lend weight to the argument that the value of pre-packaged blisters could potentially provide far greater benefits than their additional cost, especially when coupled with improved communication by HCP.