Evaluation of medication adherence methods in the treatment of malaria in Rwandan infants.
OBJECTIVE
To compare three methods for evaluating treatment adherence in a 7-day controlled treatment period for malaria in children in Rwanda.


METHODS
Fifty-six children (< 5 years) with malaria were recruited at the University Hospital of Butare, Rwanda. Patients were treated with quinine sulfate, taste-masked, pellets during seven days: three days in hospital (in-patient) followed by a four-day out-patient period. Three methods to evaluate medication adherence among patients were compared: manual pill count of returned tablets, patient self-report and electronic pill-box monitoring. These pill-boxes were equipped with a microchip registering date and time of every opening. Medication adherence was defined as the proportion of prescribed doses taken. The inter-dose intervals were analysed as well.


RESULTS
Medication adherence data were available for 54 of the 56 patients. Manual pill count and patient self-report yielded a medication adherence of 100% for the in- and out-patient treatment periods. Based on electronic pill-box monitoring, medication adherence during the seven-day treatment period was 90.5 +/- 8.3%. Based on electronic pill-box monitoring inpatient medication adherence (99.3 +/- 2.7%) was markedly higher (p < 0.03) than out-patient adherence (82.7 +/- 14.7%), showing a clear difference between health workers' and consumers' medication adherence.


CONCLUSIONS
Health workers' medication adherence was good. However, a significant lower medication adherence was observed for consumers' adherence in the outpatient setting. This was only detected by electronic pill-box monitoring. Therefore, this latter method is more accurate than the two other methods used in this study.
Twagirumukiza
Marc
M
Heymans Institute of Pharmacology, Ghent University, Ghent, Belgium.
Kayumba
Pierre Claver
PC
Kips
Jan G
JG
Vrijens
Bernard
B
Stichele
Robert Vander
RV
Vervaet
Chris
C
Remon
Jean Paul
JP
Van Bortel
M Luc
ML
D000284:Administration, Oral; D000962:Antimalarials / Q000627:therapeutic use*; D002675:Child, Preschool; D004334:Drug Administration Schedule; D004349:Drug Packaging / Q000295:instrumentation*; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007902:Length of Stay; D008288:Malaria / Q000188:drug therapy*; D008297:Male; D011803:Quinine / Q000627:therapeutic use*; D012432:Rwanda; D016896:Treatment Outcome; D016903:Drug Monitoring
D000962:Antimalarials; D011803:Quinine