Medication adherence and treatment outcomes in intestinal parasitic infections in rural Egypt: a cross-sectional follow-up study

Intestinal parasitic infections (IPIs) remain a pressing global health issue, particularly in low-resource settings where inadequate sanitation, poor hygiene, and limited healthcare access contribute to persistent transmission. In rural Egypt, IPIs are endemic and impose substantial health and economic burdens. This study aimed to assess medication adherence patterns among patients diagnosed with IPIs, identify barriers to adherence, and evaluate associated treatment outcomes in some rural health units in northern Egypt. A cross-sectional and follow-up study was conducted among 450 patients with laboratory-confirmed IPIs across seven rural health units. Data were collected through medical record reviews, structured questionnaires, and the Morisky 8-Item Medication Adherence Scale. Adherence barriers and treatment outcomes were analyzed using descriptive and inferential statistics. Participants had a wide age range (mean age 20.7 ± 17.4 years), with 86% residing in rural areas. Adherence levels were varied: 41.6% high, 18.4% moderate, and 40% low. Key barriers included side effects, forgetfulness, and disrupted routines. Clinical improvement is observed in 82% of patients during the first follow-up and in all patients who completed the third follow-up visit. However, high attrition during follow-up limited confirmation of long-term outcomes, with only 19.8% completing all visits. Notably, patients with higher adherence scores paradoxically showed lower improvement rates (p = 0.048), suggesting complex adherence-outcome dynamics that might be confounded by reinfection or measurement limitations. While antiparasitic treatments were generally effective, adherence varied widely and was influenced by socioeconomic and behavioral factors. In conclusion, reinfection and follow-up attrition remain major challenges. Public health interventions must prioritize patient education, improved follow-up systems, and targeted strategies to enhance adherence and reduce reinfection in high-risk communities.