Adherence to malaria treatment, that is taking all the doses that are given, is very important for successful malaria treatment outcome. If patients do not adhere to the treatment they will not get cured completely and the disease will come back. Not adhering to the treatment can also lead to the parasites becoming resistant to the drug, so in future the drug will be less effective against the parasites.

Critical to patients' adherence is good communication between you and your patients. Adherence to malarial medication in patients has been linked to knowledge of malaria, access to information on medication for malaria, perceived benefit from the medication, and perceived barriers to treatment.

To ensure adherence, identify high risk patients that might not adhere to the treatment that is given to them. Do this identification during history-taking and clinical assessment. If the patient has one of the risk factors in the box below, then he or she may not adhere to the full course of the drug treatment they received.

Patients at high risk of low adherence to treatment

Patients with chronic medical illness.
Lack of transportation to come back or to send a sick family member.
History of psychiatric conditions.
Lack of economic support.
Pregnant mothers.
History of poor drug adherence for anti-malaria treatment.

Therefore, arrange a follow-up visit or link the patient to volunteer community health promoters or family members, if he or she is at risk of non-adherence.

During the first contact, if the patient is identified as a malaria case and has the high-risk features shown in the box above, the following are the actions and key messages that you should tell to the patient:

Ensure the first dose of the malaria treatment is taken under your observation and is well tolerated and not immediately vomited.
Advise the patient to complete the treatment and educate him or her on the risk of not completing. If the full course is not taken the malaria will occur again.
Advise patients not to share the drug with other sick members of the family. Advise them to send the sick ones to the health facility.
Visit the patient on the second day of the treatment and ensure that he or she takes the drugs properly (this can be aligned with your routine home visit).
Link the patient to volunteer community health promoters or family members, who will ensure the patient takes the drugs properly.