Adherence to Treatment With Artemether-Lumefantrine for Uncomplicated Malaria in Rural Malawi
Adherence to Treatment With Artemether-Lumefantrine for Uncomplicated Malaria in Rural Malawi
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DOI：
10.1093/cid/cir498
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发表时间：
2011-10-15
影响因子：
11.8
通讯作者：
Skarbinski, Jacek
中科院分区：
文献类型：
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作者：
Mace, Kimberly E.;Mwandama, Dyson;Skarbinski, Jacek
背景。2007年，马拉维将治疗简单疟疾的一线药物磺胺多辛-乙胺嘧啶（单剂量方案）换成了蒿甲醚-氨苯曲明（AL）（6剂量，3天方案）。由于考虑到复杂的给药方案，我们评估了患者在常规实施后2年对AL的依从性。在3个保健中心招募了患有非复杂性疟疾的成人和儿童。我们对患者接受AL治疗72小时后的用药情况进行了药片计数和家庭访谈。通过药片计数和剂量召回来评估，完全依从性被定义为正确服用了所有6个AL剂量。我们使用逻辑回归来确定与完全依从性相关的因素。在386例患者中，65%完全依从。如果患者在健康中心接受第一剂AL作为直接观察治疗（比值比[OR]， 2.4; P < 0.01），接受使用药物包装作为视觉辅助的指导（比值比，2.5;P = 0.02），并且比其他抗疟药物更喜欢AL（比值比，2.7;P < 0.001），则患者更有可能完全坚持使用AL。相比之下，儿童
Background. In 2007, Malawi replaced the first-line medication for uncomplicated malaria, sulfadoxine-pyrimethamine-a single-dose regimen-with artemether-lumefantrine (AL)-a 6-dose, 3-day regimen. Because of concerns about the complex dosing schedule, we assessed patient adherence to AL 2 years after routine implementation.Methods. Adults and children with uncomplicated malaria were recruited at 3 health centers. We conducted both pill counts and in-home interviews on medication consumption 72 hours after patients received AL. Complete adherence was defined as correctly taking all 6 AL doses, as assessed by pill count and dose recall. We used logistic regression to identify factors associated with complete adherence.Results. Of 386 patients, 65% were completely adherent. Patients were significantly more likely to be completely adherent if they received their first dose of AL as directly observed therapy at the health center (odds ratio [OR], 2.4; P < .01), received instructions using the medication package as a visual aid (OR, 2.5; P = .02), and preferred AL over other antimalarials (OR, 2.7; P < .001). In contrast, children