1 / 12

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.

janna
Download Presentation

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

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  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

More Related