Tropical Medicine and International Health
Volume 9, Issue 1, 2004, Pages 62-67

Adherence to the combination of sulphadoxine-pyrimethamine and artesunate in the Maheba refugee settlement, Zambia (Article)

Depoortere E.* , Guthmann J.-P. , Sipilanyambe N. , Nkandu E. , Fermon F. , Balkan S. , Legros D.
  • a Epicentre, Paris, France, Epicentre, 8 rue St. Sabin, 75011 Paris, France
  • b Epicentre, Paris, France, Epicentre, 8 rue St. Sabin, 75011 Paris, France
  • c National Malaria Control Centre, Lusaka, Zambia, National Malaria Control Centre, PO Box 32509, Lusaka, Zambia
  • d University of Zambia, School of Medicine, Lusaka, Zambia, University of Zambia, School of Medicine, PO Box 50110, Lusaka, Zambia
  • e Medecins Sans Frontieres, Paris, France, Medecins Sans Frontieres, 8, rue St. Sabin, 75011 Paris, France
  • f Medecins Sans Frontieres, Paris, France, Medecins Sans Frontieres, 8, rue St. Sabin, 75011 Paris, France
  • g Epicentre, Paris, France, Epicentre, 8 rue St. Sabin, 75011 Paris, France

Abstract

Artemisinin-based combination therapy (ACT) is one strategy recommended to increase cure rates in malaria and to contain resistance to Plasmodium falciparum. In the Maheba refugee settlement, children aged 5 years or younger with a confirmed diagnosis of uncomplicated falciparum malaria are treated with the combination of sulphadoxine-pyrimethamine (1 day) and artesunate (3 days). To measure treatment adherence, home visits were carried out the day after the last treatment dose. Patients who had any treatment dose left were considered certainly non-adherent. Other patients' classification was based on the answers to the questionnaire: patients whose caretakers stated the child had received the treatment regimen exactly as prescribed were considered probably adherent; all other patients were considered probably non-adherent. Reasons for non-adherence were assessed. We found 21.2% (95% CI [15.0-28.4]) of the patients to be certainly non-adherent, 39.4% (95% CI [31.6-47.6]) probably non-adherent, and 39.4% (95% CI [31.6-47.6]) probably adherent. Insufficient explanation by the dispenser was identified as an important reason for non-adherence. When considering the use of ACT, the issue of patient adherence remains challenging. However, it should not be used as an argument against the introduction of ACT. For these treatment regimens to remain efficacious on a long-term basis, specific and locally adapted strategies need to be implemented to ensure completion of the treatment.

Author Keywords

Zambia Malaria adherence Artesunate Artemisinin-based combination therapy Sulphadoxine-pyrimethamine

Index Keywords

pyrimethamine sulfadoxine refugee Sub-Saharan Africa disease treatment human Zambia Refugees Drug Combinations Southern Africa controlled study Malaria professional practice artesunate patient coding prescription Confidence interval Humans family Antimalarials male female preschool child Infant Child, Preschool newborn Africa questionnaire Protozoa Article Drug Therapy, Combination patient compliance Questionnaires major clinical study health education Sesquiterpenes Malaria, Falciparum malaria falciparum Plasmodium falciparum age distribution treatment refusal Artemisinins fansidar caregiver
Link
https://www.scopus.com/inward/record.uri?eid=2-s2.0-0842287132&doi=10.1046%2fj.1365-3156.2003.01157.x&partnerID=40&md5=2c0f8bcb8a0a53340e739a329c5b137e
DOI: 10.1046/j.1365-3156.2003.01157.x
ISSN: 13602276
Cited by: 55
Original Language: English