The Open Public Health Journal

ISSN: 1874-9445 ― Volume 12, 2019

Drug Metabolite as a Novel Tool for Measuring Antimalarial Drug Adherence

Irfanul Chakim1, 2, *, Tepanata Pumpaibool1
1 College of Public Health Science, Chulalongkorn University, Bangkok, Thailand
2 Epidemiology and Tropical Medicine, Universitas Muhammadiyah Semarang, Semarang, Indonesia


Malaria has been a major public health problem worldwide. The burden of malaria has been reduced by the adoption of Artemisinin-Combination Therapy (ACT) followed by primaquine dosage in malaria-endemic countries. However, evidences of non-adherence behavior lead to the discovery of antimalarial drug adherence to ensure a successful and satisfactory treatment of ACT, since it is the only available antimalarial drugs against asexual form of the parasite. Unstandardized questionnaires and limited effective alternative approaches have been the major obstacles to measure adherence. With rapid development of pharmacokinetic research, public health researchers can adopt the approach to measure adherence. Notwithstanding, the current structured questionnaire has explained in detail that the measurement and classification of adherence have produced satisfactory results. However, it is subject to social desirability bias. Therefore, in this review, we offer a new strategy combining structured questionnaire and drug metabolite as a novel consensus which eliminates biases. A new classification of adherence and graphical representation of practical strategy and other important factors are provided in this review. Thus, it initiates further works to conduct an intervention program to increase adherence level. Additionally, adherence behavior prevents the development of drug resistance and its spread, increases satisfactory cure rate and inhibits transmission by eliminating gametocyte inside host’s body.

Keywords: Drug metabolite, Artemisinin Combination Therapy, Adherence, Novel approach, Measurement, Malaria.

Article Information

Identifiers and Pagination:

Year: 2018
Volume: 11
First Page: 288
Last Page: 297
Publisher Id: TOPHJ-11-288
DOI: 10.2174/1874944501811010288

Article History:

Received Date: 7/5/2018
Revision Received Date: 22/5/2018
Acceptance Date: 9/6/2018
Electronic publication date: 29/6/2018
Collection year: 2018

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© 2018 Irfanul Chakim.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

* Address correspondence to this author at the College of Public Health Science, Chulalongkorn University, Institute building 3 (10th – 11th floor), Chulalongkorn soi 62, Phyathai Rd., Bangkok, Thailand, Tel: +6285725598570; E-mail:


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