Adherence to a six-dose regimen of artemether-lumefantrine among uncomplicated Plasmodium falciparum patients in the Tigray Region, EthiopiaReport as inadecuate

Adherence to a six-dose regimen of artemether-lumefantrine among uncomplicated Plasmodium falciparum patients in the Tigray Region, Ethiopia - Download this document for free, or read online. Document in PDF available to download.

Malaria Journal

, 10:349

First Online: 05 December 2011Received: 01 April 2011Accepted: 05 December 2011


BackgroundIn 2004, Ethiopia switched its first-line treatment of uncomplicated Plasmodium falciparum malaria from sulphadoxine-pyrimethamine to a fixed artemisinin-based combination therapy ACT, artemether-lumefantrine AL. Patient adherence to AL regimen is a major determining factor to achieve the desired therapeutic outcome. The aim of this study was to measure patient adherence levels to the six-dose AL regimen for the treatment of uncomplicated P. falciparum malaria and to identify its determinant factors in rural areas of the Tigray region, Ethiopia

MethodsThe study was conducted under routine health service delivery at health posts level. Patients-caregivers were not informed about their home visit and were traced on the day after they finished the AL regimen. By combining the response to a structured questionnaire and the tablet count from the blister, adherence level was classified into three categories: definitely non-adherent, probably non-adherent and probably adherent. Reasons for being definitely non-adherent were also assessed. For the purpose of examine risk factors, definitely non-adherent and probably non-adherent was merged into a non-adherent group. Variables found significantly associated p < 0.05 with the adherence level on the univariate analysis were fitted into a multivariate logistic regression model.

ResultsOut of the total initially enrolled 180 patients, 86.1% completed the follow-up. Out of these, 38.7% were classified as probably adherent, 34.8% as probably non-adherent, and 26.5% were definitely non-adherent. The most common reasons that definitely non-adherents gave for not taking the full dose were -too many tablets- 37.3% and to -felt better before finished the treatment course- 25.5%. The adherence of the patients was associated with the ownership of a radio adjusted odd ratio, AOR: 3.8; 95% CI: 1.66-8.75, the belief that malaria can be treated traditionally AOR: 0.09; 95% CI: 0.01-0.78 and a delay of more than one day in seeking treatment after the onset of fever AOR: 5.39; 95% CI: 1.83-15.88.

ConclusionThe very low adherence to AL found in this study raises serious concerns for the malaria control in the region. The implementation of a monitoring adherence system is essential to ensure long-term treatment efficacy.

Electronic supplementary materialThe online version of this article doi:10.1186-1475-2875-10-349 contains supplementary material, which is available to authorized users.

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Author: Hailemariam Lemma - Curt Löfgren - Miguel San Sebastian


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