title: Adherence to artemether/lumefantrine treatment in children under real-life situations in rural Tanzania.
abstract: A follow-up study was conducted to determine the magnitude of and factors related to adherence to artemether/lumefantrine (ALu) treatment in rural settings in Tanzania. Children in five villages of Kilosa District treated at health facilities were followed-up at their homes on Day 7 after the first dose of ALu. For those found to be positive using a rapid diagnostic test for malaria and treated with ALu, their caretakers were interviewed on drug administration habits. In addition, capillary blood samples were collected on Day 7 to determine lumefantrine concentrations. The majority of children (392/444; 88.3%) were reported to have received all doses, in time. Non-adherence was due to untimeliness rather than missing doses and was highest for the last two doses. No significant difference was found between blood lumefantrine concentrations among adherent (median 286 nmol/l) and non-adherent [median 261 nmol/l; range 25 nmol/l (limit of quantification) to 9318 nmol/l]. Children from less poor households were more likely to adhere to therapy than the poor [odds ratio (OR)=2.45, 95% CI 1.35-4.45; adjusted OR=2.23, 95% CI 1.20-4.13]. The high reported rate of adherence to ALu in rural areas is encouraging and needs to be preserved to reduce the risk of emergence of resistant strains. The age-based dosage schedule and lack of adherence to ALu treatment guidelines by health facility staff may explain both the huge variability in observed lumefantrine concentrations and the lack of difference in concentrations between the two groups.
authors.affiliation: Department of Community Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania. dsimba@muhas.ac.tz
authors.forename: Daudi O
authors.initials: DO
authors.lastname: Simba
authors.forename: Deodatus
authors.initials: D
authors.lastname: Kakoko
authors.forename: Goran
authors.initials: G
authors.lastname: Tomson
authors.forename: Zul
authors.initials: Z
authors.lastname: Premji
authors.forename: Max
authors.initials: M
authors.lastname: Petzold
authors.forename: Margarita
authors.initials: M
authors.lastname: Mahindi
authors.forename: Lars L
authors.initials: LL
authors.lastname: Gustafsson
mesh_terms: D000704:Analysis of Variance; D000962:Antimalarials / Q000627:therapeutic use*; D000077611:Artemether, Lumefantrine Drug Combination; D037621:Artemisinins / Q000627:therapeutic use*; D002675:Child, Preschool; D016000:Cluster Analysis; D004334:Drug Administration Schedule; D004338:Drug Combinations; D004983:Ethanolamines / Q000627:therapeutic use*; D005260:Female; D005449:Fluorenes / Q000627:therapeutic use*; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D016778:Malaria, Falciparum / Q000188:drug therapy* / Q000453:epidemiology / Q000523:psychology; D016017:Odds Ratio; D012307:Risk Factors; D012423:Rural Health; D012959:Socioeconomic Factors; D013636:Tanzania / Q000453:epidemiology; D016903:Drug Monitoring
chemical_list: D000962:Antimalarials; D000077611:Artemether, Lumefantrine Drug Combination; D037621:Artemisinins; D004338:Drug Combinations; D004983:Ethanolamines; D005449:Fluorenes