title: 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.
authors.affiliation: Epicentre, Paris, France.
authors.forename: Carole
authors.initials: C
authors.lastname: Fogg
authors.forename: Francis
authors.initials: F
authors.lastname: Bajunirwe
authors.forename: Patrice
authors.initials: P
authors.lastname: Piola
authors.forename: Samuel
authors.initials: S
authors.lastname: Biraro
authors.forename: Francesco
authors.initials: F
authors.lastname: Checchi
authors.forename: James
authors.initials: J
authors.lastname: Kiguli
authors.forename: Proscovia
authors.initials: P
authors.lastname: Namiiro
authors.forename: Joy
authors.initials: J
authors.lastname: Musabe
authors.forename: Agnes
authors.initials: A
authors.lastname: Kyomugisha
authors.forename: Jean-Paul
authors.initials: JP
authors.lastname: Guthmann
mesh_terms: D000293:Adolescent; D000818:Animals; D000962:Antimalarials / Q000008:administration & dosage* / Q000097:blood; D000077549:Artemether; D037621:Artemisinins / Q000008:administration & dosage* / Q000097:blood; D002648:Child; D002675:Child, Preschool; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D004983:Ethanolamines / Q000008:administration & dosage* / Q000097:blood; D005260:Female; D005449:Fluorenes / Q000008:administration & dosage* / Q000097:blood; D006801:Humans; D007223:Infant; D000078102:Lumefantrine; D016778:Malaria, Falciparum / Q000188:drug therapy* / Q000453:epidemiology / Q000473:pathology; D008297:Male; D010349:Patient Compliance / Q000706:statistics & numerical data*; D010963:Plasmodium falciparum; D012307:Risk Factors; D012646:Self Administration / Q000706:statistics & numerical data*; D012717:Sesquiterpenes / Q000008:administration & dosage* / Q000097:blood; D011795:Surveys and Questionnaires; D014454:Uganda / Q000453:epidemiology
chemical_list: D000962:Antimalarials; D037621:Artemisinins; D004983:Ethanolamines; D005449:Fluorenes; D012717:Sesquiterpenes; D000077549:Artemether; D000078102:Lumefantrine