title: Adherence to antimalarial combination therapy with sulfadoxine-pyrimethamine and artesunate in rural Tanzania.
abstract: Artemisinin-containing antimalarial combination therapies are recommended to confront drug-resistant Plasmodium falciparum malaria. Among the questions surrounding whether these complex multidose treatments will be practical is to what extent patients complete the recommended doses. Combination therapy through coadministration of sulfadoxine-pyrimethamine plus artesunate was introduced as a first-line treatment for uncomplicated malaria in one district in Tanzania. Interventions to optimize correct use were also implemented. We observed 453 patient encounters at one health facility and recorded key practices as health workers dispensed the combination. A total of 253 patients were followed-up at 24 or 48 hours. Complete adherence measured at 48 hours reached 75.0%, based on self-report and tablet counts. This is substantially better than reported elsewhere and compares favorably with intervention studies to optimize adherence to chloroquine. Counseling about what to do if a patient vomits appears to have been an independent risk factor for nonadherence.
authors.affiliation: Malaria Case Management Unit, Malaria Branch, Division of Parasitic Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA. skachur@cdc.gov
authors.forename: S Patrick
authors.initials: SP
authors.lastname: Kachur
authors.forename: Rashid A
authors.initials: RA
authors.lastname: Khatib
authors.forename: Ellen
authors.initials: E
authors.lastname: Kaizer
authors.forename: Susan S
authors.initials: SS
authors.lastname: Fox
authors.forename: Salim M
authors.initials: SM
authors.lastname: Abdulla
authors.forename: Peter B
authors.initials: PB
authors.lastname: Bloland
mesh_terms: D000293:Adolescent; D000328:Adult; D000962:Antimalarials / Q000009:adverse effects / Q000627:therapeutic use*; D037621:Artemisinins / Q000009:adverse effects / Q000627:therapeutic use*; D000077332:Artesunate; D002648:Child; D002675:Child, Preschool; D004338:Drug Combinations; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D016015:Logistic Models; D016778:Malaria, Falciparum / Q000188:drug therapy*; D008297:Male; D010349:Patient Compliance; D011739:Pyrimethamine / Q000009:adverse effects / Q000627:therapeutic use*; D012307:Risk Factors; D012717:Sesquiterpenes / Q000009:adverse effects / Q000627:therapeutic use*; D012959:Socioeconomic Factors; D013413:Sulfadoxine / Q000009:adverse effects / Q000627:therapeutic use*; D013636:Tanzania
chemical_list: D000962:Antimalarials; D037621:Artemisinins; D004338:Drug Combinations; D012717:Sesquiterpenes; C001205:fanasil, pyrimethamine drug combination; D000077332:Artesunate; D013413:Sulfadoxine; D011739:Pyrimethamine