title: Adherence to artesunate-amodiaquine combination therapy for uncomplicated malaria in children in Zanzibar, Tanzania.
abstract: OBJECTIVE
  To estimate caretaker adherence to co-blistered, but not co-formulated, artesunate-amodiaquine (AsAq) for uncomplicated malaria and identify factors associated with caretaker adherence.
  
  
  METHODS
  Cross sectional household survey of caretakers of 210 children under 5 years of age who had been prescribed and dispensed AsAq at 21 public health facilities (HFs). The caretakers were interviewed in their homes on the 4th day of receiving the 3 day treatment. Adherence of caretakers was assessed by self report and pill count.
  
  
  RESULTS
  Caretaker adherence to AsAq was 77% (95% CI: 67%-87%). Non-adherence resulted in under-dosing (3/4) of the time and was most often in the form of wrong daily doses due to misunderstanding or forgetting the correct dose regimens. Predictors of adherence were education exceeding 7 years (OR = 5.08, P = 0.008) and receiving the exact number of pills to complete the treatment regimen (OR = 4.09, P = 0.006). All caretakers of children who were administered the first dose at the HF had adhered to the treatment.
  
  
  CONCLUSIONS
  We found moderate levels of caretaker adherence to AsAq. Further improvement could be achieved by producing dose-specific packaging for infants, providing clear instructions and giving the first dose under observation at the HF.
authors: Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden. netta.beer@gmail.com
authors: Netta
authors: N
authors: Beer
authors: Abdullah S
authors: AS
authors: Ali
authors: Guida
authors: G
authors: Rotllant
authors: Ali K
authors: AK
authors: Abass
authors: Rahila S
authors: RS
authors: Omari
authors: Abdul-wahiyd H
authors: AW
authors: Al-mafazy
authors: Anders
authors: A
authors: Björkman
authors: Karin
authors: K
authors: Källander
mesh_terms: D000655:Amodiaquine / Q000008:administration & dosage*; D000962:Antimalarials / Q000008:administration & dosage*; D037621:Artemisinins / Q000008:administration & dosage*; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D004338:Drug Combinations; D004348:Drug Labeling; D005260:Female; D006801:Humans; D007223:Infant; D016778:Malaria, Falciparum / Q000188:drug therapy* / Q000453:epidemiology; D008297:Male; D019727:Proxy; D013636:Tanzania / Q000453:epidemiology; D016903:Drug Monitoring
chemical_list: D000962:Antimalarials; D037621:Artemisinins; D004338:Drug Combinations; C515299:amodiaquine, artesunate drug combination; D000655:Amodiaquine