Adherence to artemether-lumefantrine treatment in patients with uncomplicated malaria in rural Bagamoyo

Abstract

Background: Since November 2006, Coartem® (Artemether-Lumefantrine-ALu) replaced Sulphadoxine-Pyrimethamine as first line drug of choice for treatment of uncomplicated malaria in Tanzania. Taking many pills of ALu, more than once daily for several days has proved to be problematic than single SP dose.

Objectives: We assessed adherence to Artemether-lumefantrine treatment in patients with uncomplicated Malaria in rural Bagamoyo

Materials and Methods: Confirmed malaria Patients were prescribed with ALu and then followed to their homes on day 3 where adherence was assessed by interviews and pill counts. In addition, blood slides for malaria parasites count were taken and axillary temperature was measured. The participants returned to the dispensary on day-7 where venous blood samples (2ml) for measurement of blood Lumefantrine concentrations and blood slides were collected. Lumefantrine plasma concentrations were described by age group and category of adherence as means with corresponding standard deviations.

Results: Among 143 patients with analyzable data, 10/143 (7%) were probably adherent. The rest were probably or definitely non adherent. Non adherence was attributed to taking fewer doses (20.8%) and untimely dosing (72.2%). Blister packs were available in 122 (85.3%) of the visited households and tablets were still remaining in 29 (23.8%) of the patients. 13/90(14.4.0%) of the patients had Lumefantrine level <175ng/ml. The difference in mean Lumefantrine concentration between the adherent and non adherent groups was not statistically significant (p=0.643). The median Lumefantrine concentration was higher in the adherent group (586.20 ng/ml, range 268.60-715.90) as compared to non adherent group (403.20 ng/ml range 0.00-2239.80). None of the patients failed to achieve parasite clearance on day-3 and day-7.

Conclusions: The overall adherence in the remote rural Bagamoyo population appears to be low. Non adherence is mainly due to untimely intake of ALu doses rather than missing doses. Day-3 and day-7 parasite clearance can be achieved despite the patients not completing drug intake and even those with sub-therapeutic day-7 blood Lumefantrine concentrations.