Can individuals’ beliefs help us understand nonadherence to malaria test results? Evidence from rural Kenya

In malaria-endemic countries about a quarter of test-negative individuals take antimalarials (artemisinin-based combination therapies [ACTs]). ACT overuse depletes scarce resources for subsidies and contributes to parasite resistance. As part of an experiment in Kenya that provided subsidies for rapid diagnostic test and/or for ACTs conditionally on being positive, we studied the association between beliefs on malaria status (prior and posterior the intervention) and decisions to get tested and to purchase ACTs. We find that prior beliefs do not explain the decision of getting tested (conditional on the price) and nonadherence to a negative test. However, test-negative individuals who purchase ACTs report higher posterior beliefs than those who do not, consistent with a framework in which the formers revise beliefs upward, while the latters do not change or revise downward. We also do not find evidence that prior beliefs on ACT effectiveness and trust in test results play any major role in explaining testing or treatment behavior. Further research is needed to improve adherence to malaria-negative test results.

Duke Scholars

Author Wendy P O'Meara Medicine, Infectious Diseases

Author Elizabeth Louise Turner Biostatistics & Bioinformatics, Division of Biostatistics

Author Manoj Mohanan Sanford School of Public Policy