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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Adherence to treatment with artemether-lumefantrine for uncomplicated Malaria in Rural Malawi
Clinical Infectious Diseases, Volume 53, No. 8, Year 2011
Notification
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Description
Background. In 2007, Malawi replaced the first-line medication for uncomplicated malaria, sulfadoxine-pyrimethamine-a single-dose regimen-with artemether-lumefantrine (AL)-a 6-dose, 3-day regimen. Because of concerns about the complex dosing schedule, we assessed patient adherence to AL 2 years after routine implementation. Methods. Adults and children with uncomplicated malaria were recruited at 3 health centers. We conducted both pill counts and in-home interviews on medication consumption 72 hours after patients received AL. Complete adherence was defined as correctly taking all 6 AL doses, as assessed by pill count and dose recall. We used logistic regression to identify factors associated with complete adherence. Results. Of 386 patients, 65% were completely adherent. Patients were significantly more likely to be completely adherent if they received their first dose of AL as directly observed therapy at the health center (odds ratio [OR], 2.4; P <. 01), received instructions using the medication package as a visual aid (OR, 2.5; P =. 02), and preferred AL over other antimalarials (OR, 2.7; P <. 001). In contrast, children <5 years of age were significantly less likely to be adherent (OR, 0.5; P =. 05). Conclusions. Adherence to AL treatment for uncomplicated malaria was moderate, and children, who are the most likely to die of malaria, were less adherent than adults. Efforts to improve adherence should be focused on this vulnerable group. Interventions including the introduction of child-friendly antimalarial formulations, direct observation of the first dose, use of the AL package as a visual aid for instructions, and enhancing patient preference for AL could potentially increase AL adherence and overall effectiveness. © 2011 The Author.
Authors & Co-Authors
MacE, Kimberly E.
United States, Atlanta
Centers for Disease Control and Prevention
Mwandama, Dyson A.
Malawi, Zomba
University of Malawi
Jafali, James
Malawi, Zomba
University of Malawi
Luka-Banda, Madalitso
Malawi, Zomba
University of Malawi
Filler, Scott J.
United States, Atlanta
Centers for Disease Control and Prevention
Sande, John Hafu
Malawi, Lilongwe
Ministry of Health Malawai
Ali, Doreen
Malawi, Lilongwe
Ministry of Health Malawai
Kachur, Stephen Patrick
United States, Atlanta
Centers for Disease Control and Prevention
Mathanga, Don Pascal
Malawi, Zomba
University of Malawi
Skarbinski, Jacek
United States, Atlanta
Centers for Disease Control and Prevention
Statistics
Citations: 73
Authors: 10
Affiliations: 3
Identifiers
Doi:
10.1093/cid/cir498
ISSN:
10584838
e-ISSN:
15376591
Research Areas
Health System And Policy
Infectious Diseases
Maternal And Child Health
Study Design
Case-Control Study
Study Locations
Malawi