Adherence to artemether/lumefantrine treatment in children under real-life situations in rural Tanzania

Abstract

a b s t r a c tA 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 nonadherent [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.

Socioeconomic Determinants of Antimalarial Drug Use Behaviours: A Systematic Review

“…Participants' residence and reported adherence showed no statistically significant relationship (p=0.428) [27] Self-diagnosis was the most common diagnostic method in both rural and urban for adult and child diagnosis. There was higher proportion of self-diagnosis in rural than in urban areas for both adults and children.…”

“…Adherence and education P= 0.024 with 22% more adherence in participants with secondary education [21] Caretaker's educational level and reported adherence showed no statistically significance (p=0.354) [27] [18-21,2 P=0.005 with participants with ≤ 7ys of formal education more likely to adhere [18] Participants educational level was not associated with reasons for nonadherence (p=0.825) [24] P<0.01; OR 0.074; 95% CI 0.017-0.322. higher education level was associated with ACT adherence [20] There was no statistically significant association between the educational level of patients or caregivers and probably adherence (p=1.00) [29] Uptake of IPTp-SP increased with education, from as low as 38.9% among those who had no education to as high as 52.3% among those with secondary and higher education.Women with secondary and higher education were almost twice as likely as those who had never been to school for formal education to receive complete IPTp-SP doses (RRR=1.93, 95% CI 1.04 -3.56). (P <0.001) [26] No association between educational level and adherence/non-adherence [19] The adjusted odds of completed treatment for those who has finished primary school was 1.68 times that of patients who has not (95% CI: 1.20, 2.36; P=0.003) [28] No significant for mothers' attainment of tertiary (or higher) education and the use of ACTs (OR 0.905, CI0.195-4.198; P=0.898) [25] There was a statistically significant association between fathers' attainment of tertiary (higher education) and use of ACTs, when compared to fathers who had not attained this level of education (OR 0.054, CI 0.006-0.510; P=0.011) [25] Adherence and income P=0.003; OR 0.340; 95% CI, 0.167-0.694. higher income level (Ksh >9000 (i.e., >GBP 66 monthly) was associated with ACT adherence [20] [14,20,2 7,31] P=0.034 with participants of higher income salary showing correct dosage of drugs [31] Initiation of home treatment was higher in the poorer households.…”

“…25% of the poorest will use home treatment first as against 14% in wealthiest SE category [14] In addition, household monthly income significantly influenced dosage of the drugs used (P=0.034) primarily due to the fact that higher proportions of respondents with an income salary of KShs. 4500-9000 (48.5%) took the correct dosage of drugs as opposed to individuals with below KShs 4500 and above KShs 9000 [31] Caretakers from the third SES quintile were most likely to adhere to treatment compared to the first quintile [27] Adherence and ability to read P<0.01 OR 0.285; 95% CI 0.167-0.486. Ability to read was associated with ACT adherence [20] [ 20,21] However, ability to read was statistically significant to number of antimalarial tablets left (p=0.049) [21] Adherence in urban and rural 96% of rural dwellers would not administer appropriate dosages [17] 65% of urbanites would use incomplete dose.…”

“…At the end of the assessment and appraisal exercise, seventeen (17) studies [14][15][16][17][18][19][20][21][23][24][25][26][27][28][29][30][31] that were of good quality based on the PCAqs assessment were included in this systematic review.…”

“…More than half of the studies (10 studies) reported on educational level in relation to adherence. Nine of these studies were conducted in the African region [18][19][20][21][24][25][26][27][28] while one study was conducted in Southeast Asia [29]. There was a high level of uniformity in the measurement tool used to assess educational level.…”