Adherence to a Six-Dose Regimen of Artemether-Lumefantrine for Treatment of Uncomplicated Plasmodium Falciparum Malaria in Uganda

Abstract

Measuring baseline levels of adherence and identifying risk factors for non-adherence are important steps before the introduction of new antimalarials. In Mbarara in southwestern Uganda, we assessed adherence to artemether-lumefantrine (Coartem) in its latest World Health Organization blister formulation. Patients with uncomplicated Plasmodium falciparum malaria were prescribed artemether-lumefantrine and received an explanation of how to take the following five doses at home. A tablet count was made and a questionnaire was completed during a home visit. Among 210 analyzable patients, 21 (10.0%) were definitely or probably non-adherent, whereas 189 (90.0%) were probably adherent. Age group was not associated with adherence. Lack of formal education was the only factor associated with non-adherence after controlling for confounders (odds ratio = 3.1, 95% confidence interval [CI] = 1.1-9.7). Mean lumefantrine blood levels were lower among non-adherent (n = 16) (2.76 microg/mL, 95% CI = 1.06-4.45) than among adherent (n = 171) (3.19 microg/mL, 95% CI = 2.84-3.54) patients, but this difference was not statistically significant. The high adherence to artemether-lumefantrine found in our study suggest that this drug is likely to be very effective in Mbarara provided that patients receive clear dosage explanations.

Adherence and effectiveness of drug combination in curative treatment among children suffering uncomplicated malaria in rural Senegal

“…If we considered only the intake quantity, adherence at the 80% level was weaker in our study (64.7%) than that described by Fogg et al (2004) in Uganda (91%), where a new drug combination was tested, or by Ansah et al (2001) in Ghana (90%), where new CQ packaging was introduced. Our results were more closely related to the Reilley study in Sri Lanka, where 74% of patients were adherent when only total medication intake was considered (Reilley et al, 2002).…”

“…Our results were more closely related to the Reilley study in Sri Lanka, where 74% of patients were adherent when only total medication intake was considered (Reilley et al, 2002). The large differences might be explained by particular study conditions; for example, new drugs or new packaging tests (Ansah et al, 2001;Fogg et al, 2004). In these studies, the use of written consent at D0 and caregiver training induced differences in the usual health practices and may have had an impact on patient behavior, as people were aware of the research before treatment had commenced (Osterberg and Blaschke, 2005).…”

Adherence to artemether/lumefantrine treatment in children under real-life situations in rural Tanzania

“…6 One of the reasons for the lack of any difference might be due to the lack of a clear cut-off point. 24 Although a previous study in Thailand reported a Day 7 blood lumefantrine concentration cut-off point of 331 nmol/l (175 ng/ml), 25 another study in Malawi reported patients were cured even below this level.…”

“…The questionnaire was based on a literature review of previous adherence studies. 6,11 A pilot study was carried out for 1 week in two villages to validate the questionnaire and to gain field experiences in blood sampling techniques.…”

“…4 Adherence levels as high as 90% have been reported in controlled clinical trials. 5,6 These figures are likely to be an overestimation because in real-life situations caretakers are neither given detailed instruction on to how to administer the treatment nor do they receive follow-up on the use of the drugs by the child.…”