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Field-Testing of Anti-Malarial Packaging in Malaria-Endemic Countries


AED (now FHI 360) assisted the Medicines for Malaria Venture (MMV) in developing patient-friendly packaging to optimize the correct use of anti-malarial artemisinin combination therapy (ACT) in four countries.

The Importance of Medication Compliance

Malaria is a deadly mosquito-borne disease that takes almost one million lives per year and afflicts as many as half a billion people in more than 100 countries in Africa, Asia, and Latin America. Although effective therapies exist to treat malaria, partial or incorrect use of those therapies can lead to the emergence of drug-resistant malaria parasites. Correct prescription of and adherence to treatment is a critical objective in malaria case management. Patients often fail to take the appropriate therapeutic dose of ACT, and may not fully complete the course of treatment because they receive improper guidance, or have difficulty understanding written product instructions. AED worked with MMV to develop packaging and instructional inserts that optimized understanding of the correct use of the new anti-malarial drug, Pyramax®.

Project Vision

AED's field testing of Pyramax's packaging and information material aimed to ensure correct dosing and usage comprehension by health care workers, caregivers, and patients. Specifically, the testing aimed to assess:

  • Comprehension of instructions/pictograms
    a. Understanding that Pyramax is a medicine for malaria
    b. Number of tablets per dose/per day for different weight bands
    c. Number of days of treatment.
    d. The need to complete a full course of treatment to be cured
  • Ability to correctly demonstrate how to take the medicines
  • Perception of overall attractiveness, cultural acceptability, and appropriateness of the illustrations
  • Need for additional information


The study was conducted in four countries—two in Africa (Kenya and Senegal) and two in Asia (Cambodia and India). AED worked with local fieldworkers, forming four-person, highly skilled country teams made up of two senior investigators and a translator/fieldworker fluent in the language of the study community.

In each country, we worked in two different malarial areas of the country that represented different ecological and cultural zones. There were six communities per country: two urban or peri-urban, and four rural.

Chosen respondents were non-literate or low-literate, on the assumption that if they can understand the instructions, people who have more advanced literacy skills would also be able to do so. The four target groups for the study were:

  • Health care providers at formal facilities (including public, private, NGO)
  • Dispensers (including formal private, formal public, and licensed and unlicensed medicine sellers)
  • Mothers of young children
  • Other adults (men and women age 18 or over)

The results of these studies resulted in improved product packaging. The retooled packaging will ensure that dispensers, caregivers, and patients have the necessary information to understand the treatment schedule, the dosing, and the importance of completing a full course of treatment. Appropriate packaging will gain importance with the increased uptake of anti-malarials through the private sector with the phased introduction of the global subsidy, and with the scaling up of home management of fever/malaria.

News, Publications, and Results



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