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.
Description
Keywords
Adolescent, Animals, Antimalarials/*administration & dosage/blood, Artemisinins/*administration & dosage/blood, Child, Child, Preschool, Drug Administration Schedule, Drug Therapy, Combination, Ethanolamines/*administration & dosage/blood, Female, Fluorenes/*administration & dosage/blood, Humans, Infant, Malaria, Falciparum/*drug therapy/epidemiology/pathology, Male, Patient Compliance/*statistics & numerical data, Plasmodium falciparum, Questionnaires, Risk Factors, Self Administration/*statistics & numerical data, Sesquiterpenes/*administration & dosage/blood, Uganda/epidemiology, Adolescent, Animals, Antimalarials, administration & dosage, blood, Artemisinins, administration & dosage, blood, Child, Child, Preschool, Drug Administration Schedule, Drug Therapy, Combination, Ethanolamines, administration & dosage, blood, Female, Fluorenes, administration & dosage, blood, Humans, Infant, Malaria, Falciparum, drug therapy, epidemiology, pathology, Male, Patient Compliance, statistics & numerical data, Plasmodium falciparum, Questionnaires, Risk Factors, Self Administration, statistics & numerical data, Sesquiterpenes, administration & dosage, blood, Uganda, epidemiology
Citation
Fogg, C., Bajunirwe, F., Piola, P., Biraro, S., Checchi, F., Kiguli, J., ... & Guthmann, J. P. (2004). Adherence to a six-dose regimen of artemether-lumefantrine for treatment of uncomplicated Plasmodium falciparum malaria in Uganda. The American journal of tropical medicine and hygiene, 71(5), 525-530.https://doi.org/10.4269/ajtmh.2004.71.525