Reducing Antimalarial Resistance Through AI-Powered Treatment Adherence Support Among Under-Five Children in Ibadan, Nigeria
1
Department of Public Health, McPherson University, Seriki Sotayo, Nigeria
2
Department of Health Promotion and Community Services, Blue Gate Public Health Promotion Initiative, Ibadan, Nigeria
3
Public Health and Biological Sciences, Blue Gate Research Institute, Ibadan, Nigeria
Popul. Med. 2026;8(Supplement Supplement 1):A226
ABSTRACT
ABSTRACT:
Incomplete adherence to artemisinin-based combination therapy (ACT) remains a major challenge in treating uncomplicated malaria among under-five children. Caregivers often miss doses, stop treatment once symptoms improve, or reuse leftover antimalarials, leading to treatment failure, recurrent illness, and the emergence of antimalarial drug-resistance (AMR). This pilot intervention aims to evaluate the effectiveness of AI-powered adherence support in reducing antimalarial-resistance. This study used a quasi-experimental pre–post pilot-design to assess an AI-powered SMS and WhatsApp adherence reminder system among 101 caregivers of under-five children. Children were recruited during medical outreaches and screened using RDTs. Baseline data on malaria treatment knowledge, adherence, AMR-related behaviours, and mobile phone access were collected through a questionnaire. Based on baseline findings, caregivers were enrolled in the AI reminder system, which sent automated messages throughout the 3-day ACT course via SMS or WhatsApp, with voice calls for non-response. Caregivers confirmed dose administration through simple responses, which the AI system analysed to identify missed doses and flag high-risk cases. Endline data collected after six months were compared with baseline data using descriptive statistics and chi-square tests. Mean caregiver age was 32.1 ± 5.2 years; 23.9% had primary education, and 45.9% of children had malaria in the previous three months. Reported use of leftover antimalarials decreased from 53.8% to 10.9% (p<0.05). Non-completion of the 3-day ACT course declined from 30.6% to 0.0% (p<0.05), and stopping ACT once symptoms improved fell from 40.6% to 0.0% (p<0.05). The proportion of children receiving more than one ACT course within three months decreased from 35.8% to 23.0% (p>0.05), while sharing antimalarials between children reduced from 38.9% to 9.0% (p<0.05). While leftover drug use and sharing decreased significantly, they were not eliminated (remaining at 10.9% and 9.0%, respectively). Further qualitative research could identify the socio-economic factors that prevent these specific behaviours from reaching 0.0%.
Incomplete adherence to artemisinin-based combination therapy (ACT) remains a major challenge in treating uncomplicated malaria among under-five children. Caregivers often miss doses, stop treatment once symptoms improve, or reuse leftover antimalarials, leading to treatment failure, recurrent illness, and the emergence of antimalarial drug-resistance (AMR). This pilot intervention aims to evaluate the effectiveness of AI-powered adherence support in reducing antimalarial-resistance. This study used a quasi-experimental pre–post pilot-design to assess an AI-powered SMS and WhatsApp adherence reminder system among 101 caregivers of under-five children. Children were recruited during medical outreaches and screened using RDTs. Baseline data on malaria treatment knowledge, adherence, AMR-related behaviours, and mobile phone access were collected through a questionnaire. Based on baseline findings, caregivers were enrolled in the AI reminder system, which sent automated messages throughout the 3-day ACT course via SMS or WhatsApp, with voice calls for non-response. Caregivers confirmed dose administration through simple responses, which the AI system analysed to identify missed doses and flag high-risk cases. Endline data collected after six months were compared with baseline data using descriptive statistics and chi-square tests. Mean caregiver age was 32.1 ± 5.2 years; 23.9% had primary education, and 45.9% of children had malaria in the previous three months. Reported use of leftover antimalarials decreased from 53.8% to 10.9% (p<0.05). Non-completion of the 3-day ACT course declined from 30.6% to 0.0% (p<0.05), and stopping ACT once symptoms improved fell from 40.6% to 0.0% (p<0.05). The proportion of children receiving more than one ACT course within three months decreased from 35.8% to 23.0% (p>0.05), while sharing antimalarials between children reduced from 38.9% to 9.0% (p<0.05). While leftover drug use and sharing decreased significantly, they were not eliminated (remaining at 10.9% and 9.0%, respectively). Further qualitative research could identify the socio-economic factors that prevent these specific behaviours from reaching 0.0%.
| eISSN: | 2654-1459 |
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