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Measuring baseline levels of adherence and identifying risk factors for non-adherence are important steps before the introduction of new antimalarials. In Mbarara in southwestern Uganda, we assessed adherence to artemether-lumefantrine (Coartem®) in its latest World Health Organization blister formulation. Patients with uncomplicated Plasmodium falciparum malaria were prescribed artemether-lumefantrine and received an explanation of how to take the following five doses at home. A tablet count was made and a questionnaire was completed during a home visit. Among 210 analyzable patients, 21 (10.0%) were definitely or probably non-adherent, whereas 189 (90.0%) were probably adherent. Age group was not associated with adherence. Lack of formal education was the only factor associated with non-adherence after controlling for confounders (odds ratio = 3.1, 95% confidence interval [CI] = 1.1–9.7). Mean lumefantrine blood levels were lower among non-adherent (n = 16) (2.76 µg/mL, 95% CI = 1.06–4.45) than among adherent (n = 171) (3.19 µg/mL, 95% CI = 2.84–3.54) patients, but this difference was not statistically significant. The high adherence to artemether-lumefantrine found in our study suggest that this drug is likely to be very effective in Mbarara provided that patients receive clear dosage explanations.
Received February 27, 2004. Accepted for publication April 29, 2004.
Acknowledgments: We thank all the staff who participated in the study. We also thank the staff and officials of Mbarara University Teaching Hospital, Mbarara University of Science and Technology, and the Kakoba Dispensary for their cooperation. We are very grateful to Loretxu Pinoges and Evelyn Depoortere (Epicentre) for their helpful advice on data analysis. Novartis Pharma AG performed free pharmacokinetic analyses, but did not take part in study design or analysis. We thank Marie-Noëlle Bizot (Novartis Pharma AG) for performing the lumefantrine measurements.
Financial support: This study was funded by Médecins sans Frontières.
Authors’ addresses: Carole Fogg, Patrice Piola, and Samuel Biraro, Epicentre, PO Box, Kampala, Uganda, Telephone/Fax: 256-41-269-998. Francis Bajunirwe and James Kiguli, Mbarara University of Science and Technology, PO Box 1410, Mbarara, Uganda, Telephone: 256-77-576-396, Fax: 256-48-520-782. Francesco Checchi and Jean-Paul Guthmann, Epicentre, 42, Boulevard Richard Lenoir, 75011 Paris, France, Telephone: 33-1-40-21-28-48, Fax: 33-1-40-21-28- 03. Proscovia Namiiro, Joy Musabe, and Agnes Kyomugisha, Mbarara University Teaching Hospital, PO Box 1410, Mbarara, Uganda, Telephone: 256-48-520-332, Fax: 256-48-520-782.
Reprint requests: Jean-Paul Guthmann, Epicentre, 8 Rue Saint-Sabin, 75011 Paris, France, Telephone: 33-1-40-21-28-48, Fax: 33-1-40-21-28-03, E-mail: jguthmann{at}epicentre.msf.org.
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