Introduction to malaria: Malaria is caused by unicellular protozoal parasites that belong to the genus Plasmodium. There are five  Plasmodium species that infect humans, namely, P. falciparum, P. vivax, P. malariae, P. ovale, and P. knowlesi. (Shigeharu Sato 2021). Malaria is transmitted to humans through the bites of female anopheline mosquitoes, also known as vectors.

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P. vivax is the dominant malaria parasite in Asia, Oceania and South America and is an important burden in the Horn of Africa and Madagascar. There is also a greater appreciation of P. vivax in other parts of Sub-Saharan Africa due to improved diagnostic tools (Oboh et al. 2020). Globally, the World Health Organization estimates that there were ~7 million cases of P. vivax malaria in 20221 (World Malaria report 2023).

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Strategies to tackle malaria include prevention, vector control, and treatment. The treatment for P. vivax and P. ovale is specific because of the need to eradicate the dormant stages in the liver, called hypnozoites; they reactive periodically to cause new bouts of infection and illness. The class of drugs that kills the hypnozoites, to achieve radical cure, is called the 8-amino derivative of quinoline and, currently, only two drugs are available, primaquine and tafenoquine. Primaquine is now recommended to be given for 7 days, down from the original 14 days, and tafenoquine is a single dose treatment.

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Research gap: There is strong evidence that patients with vivax malaria do not complete their courses of primaquine and approximately only 50% of patients who are prescribed 7 or 14-days of primaquine complete the treatment, resulting in poor effectiveness (Douglas et al. 2017; Rahmalia et al. 2023). This is a major obstacle to achieving e radical cure in patients and eliminating vivax malaria in populations. Previous studies showed marked improvement in adherence by drug packaging and labelling, but no one has developed this idea further (Qingjun et al. 1998a; Ansah et al. 2001).

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A project by Thoopmanee Kaendiao & Bob Taylor, and their team are running a project, titled “Exploring Optimal Packaging Designs with End-users to Promote Adherence to Radical Cure Primaquine (OPPAC)”, which seeks to explore the usefulness and user-friendliness of packaging designs to increase adherence to primaquine regimens. The researcher team would like to test which designs and messages on the primaquine packaging box or medication wallets help to promote the correct use of primaquine and increase adherence. The data for the study are being collected by a survey to score the packaging designs and focus group discussions. The project is currently in progress and is being conducted in, Cambodia and on the Thai-Myanmar border. The results are expected by around April 2025.