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Simba, D. and Kakoko , D. Muhimbili University, United Republic of Tanzania

High adherence to artemether-lumefantrine treatment in children under real-life situation in rural Tanzania. Simba, D. and Kakoko , D. Muhimbili University, United Republic of Tanzania. BACKGROUND.

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Simba, D. and Kakoko , D. Muhimbili University, United Republic of Tanzania

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  1. High adherence to artemether-lumefantrine treatment in children under real-life situation in rural Tanzania Simba, D. and Kakoko, D. Muhimbili University, United Republic of Tanzania

  2. BACKGROUND • Artemether-lumefantrine (ALu) is highly efficacious (>95%) in treating uncomplicated Plasmodium falciparummalaria • However, it is questionable if the high levels of adherence observed under research conditions can be achieved in a real-life situation • Especially, in rural remote settings where the malaria burden is highest and access to the drug is limited

  3. OBJECTIVE • To determine the level of adherence to an ALu treatment schedule in a real-life situation in rural settings and its determinants

  4. METHODS • A follow-up design community-based study conducted in Kilosa district, Tanzania in 2008 • Stratified cluster sampling of 3/30 rural villages in wet-lowland areas • One from villages with and two from villages without a health facility • Two, additional, nearby semi-urban villages • Children <5 years followed up for 12 months • Inclusion criteria: fever diagnosed as malaria, using a rapid diagnostic test treated with Alu

  5. ctd • Children were identified from outpatient registers • Traced home on day 7 to determine adherence to treatment • Adherence determined using caretaker’s report , pill count and lumefantrine blood concentration • Multiple logistic regression analysis and mean of log-transformed lumefantrine concentration

  6. RESULTS • 88% (392/444) received all the doses on time • Rural (87.5%; 281/321) not different from semi-urban (90.2%; 111/123) areas, p-value >0.05. • Nonadherence due to mainly off-schedule dosing • Nonadherence higher in the last two doses

  7. Adherence for each dose and cumulative adherence

  8. ctd • Mean blood lumefantrine concentrations not different between adherent (286 nmol/L) and nonadherent (261 nmol/L) • Children from better-off households more likely to adhere (OR 2.45; 95% CI 1.35–4.45; adjusted OR 2.23; 95% CI 1.20–4.13)

  9. The distribution of lumefantrine blood concentration levels

  10. Lessons • Adherence to ALu treatment high even in rural villages without a nearby health facility and there was no tendency to keep drugs for later use • Large variability in lumefantrine concentrations cast doubt on the rationale of using aged-based dosage schedules and also on using capillary blood sample to measure adherence in the field • Since non-adherence was more pronounced in the last two doses

  11. Policy implications • Prescribe ALu on weight rather than age basis • More advocacy to improve adherence on the last doses

  12. Future research • Why adherence to Alu was high? Can the lesson be applied to improve adherence in other treatments? • Studies on methods for determining lumefantrineblood concentration in a field settings

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