Adherence to a six-dose regimen of artemether-lumefantrine for treatment of uncomplicated Plasmodium falciparum malaria in Uganda

Fogg, Carole, Bajunirwe, Francis, Piola, Patrice, Biraro, Samuel, Checchi, Francesco, Kiguli, James, Namiiro, Proscovia, Musabe, Joy, Kyomugisha, Agnes and Guthmann, Jean-Paul (2004) Adherence to a six-dose regimen of artemether-lumefantrine for treatment of uncomplicated Plasmodium falciparum malaria in Uganda. American Journal of Tropical Medicine and Hygiene, 71 (5), 525-530. (doi:10.4269/ajtmh.2004.71.525).

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 artemetherlumefantrine (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 μg/mL, 95% CI = 1.06-4.45) than among adherent (n = 171) (3.19 μg/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.

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Contributors

Author: Carole Fogg

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