Volume 71, Issue 6
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645


Artemisinin-containing antimalarial combination therapies are recommended to confront drug-resistant malaria. Among the questions surrounding whether these complex multidose treatments will be practical is to what extent patients complete the recommended doses. Combination therapy through coadministration of sulfadoxine-pyrimethamine plus artesunate was introduced as a first-line treatment for uncomplicated malaria in one district in Tanzania. Interventions to optimize correct use were also implemented. We observed 453 patient encounters at one health facility and recorded key practices as health workers dispensed the combination. A total of 253 patients were followed-up at 24 or 48 hours. Complete adherence measured at 48 hours reached 75.0%, based on self-report and tablet counts. This is substantially better than reported elsewhere and compares favorably with intervention studies to optimize adherence to chloroquine. Counseling about what to do if a patient vomits appears to have been an independent risk factor for nonadherence.


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  1. Bloland PB, Kazembe PN, Oloo AJ, Himonga B, Barat LM, Ruebush TK, 1998. Chloroquine in Africa: critical assessment and recommendations for monitoring and evaluating chloroquine therapy efficacy in sub-Saharan Africa. Trop Med Int Health 3 : 543–552. [Google Scholar]
  2. Price RN, Nosten F, Luxemburger C, van Vugt M, Phaipun L, Chongsuphajaisiddhi T, White NJ, 1997. Artesunate/mefloquine treatment of multi-drug resistant falciparum malaria. Trans R Soc Trop Med Hyg 91 : 574–577. [Google Scholar]
  3. Nosten F, van Vugt M, Price R, Luxemburger C, Thway KL, Brockman A, McGready R, ter Kuile F, Looareesuwan S, White NJ, 2000. Effects of artesunate-mefloquine combination on incidence of Plasmodium falciparum malaria and mefloquine resistance in western Thailand: a prospective study. Lancet 356 : 297–302. [Google Scholar]
  4. White NJ, Nosten F, Looareesuwan S, Watkins WM, Marsh K, Snow RW, Kokwaro G, Ouma J, Hien TT, Molyneux ME, Taylor TE, Newbold CI, Ruebush TK 2nd, Danis M, Greenwood BM, Anderson RM, Olliaro P, 1999. Averting a malaria disaster. Lancet 353 : 1965–1967. [Google Scholar]
  5. World Health Organization, 2001. Antimalarial Drug Combination Therapy. Report of a WHO Technical Consultation. Geneva: World Health Organization. Publication no. WHO/CDS/RBM/2001.35.
  6. Kachur SP, Abdulla S, Barnes K, Mshinda H, Durrheim D, Kitua A, Bloland PB, 2001. Complex and large trials of malaria interventions (letter). Trop Med Int Health 6 : 324–325. [Google Scholar]
  7. von Seidlein L, Milligan P, Pinder M, Bojang K, Anyalebechi C, Gosling R, Coleman R, Ude JI, Sadiq A, Duraisingh M, Warhurst D, Alloueche A, Targett G, McAdam K, Greenwood B, Walraven G, Olliaro P, Doherty T, 2000. Efficacy of artesunate plus pyrimethamine-sulphadoxine for uncomplicated malaria in Gambian children: a double-blind, randomised, controlled trial. Lancet 355 : 352–357. [Google Scholar]
  8. Adjuik M, Agnamey P, Babiker A, Borrmann S, Brasseur P, Cisse M, Cobelens F, Diallo S, Faucher JF, Garner P, Gikunda S, Kremsner PG, Krishna S, Lell B, Loolpapit M, Matsiegui PB, Missinou MA, Mwanza J, Ntoumi F, Olliaro P, Osimbo P, Rezbach P, Some E, Taylor WR, 2002. Amodiaquine-artesunate versus amodiaquine for uncomplicated Plasmodium falciparum malaria in African children: a randomised, multicentre trial. Lancet 359 : 1365–1372. [Google Scholar]
  9. International Artemisinin Study Group, 2004. Artesunate combinations for treatment of malaria: meta-analysis. Lancet 363 : 9–17. [Google Scholar]
  10. Snow RW, Eckert E, Teklehaimanot A, 2003. Estimating the needs for artesunate-based combination therapy for malaria case-management in Africa. Trends Parasitol 19 : 363–369. [Google Scholar]
  11. Duffy PE, Mutabingwa TK, 2004. Drug combinations for malaria: time to ACT. Lancet 363 : 3–4. [Google Scholar]
  12. Bloland PB, Kachur SP, Williams HA, 2003. Trends in antimalarial drug deployment in sub-Saharan Africa. J Exp Biol 206 : 3761–3769. [Google Scholar]
  13. World Health Organization and UNICEF, 2003. The Africa Malaria Report. Geneva: World Health Organization. Report no. WHO/CDS/MAL/2003.1093.
  14. World Health Organization, 1986. Expert Committee on Malaria, Eighteenth Report. Geneva: World Health Organzation. Technical Series #735.
  15. McCombie SC, 1996. Treatment seeking for malaria: a review of recent research. Soc Sci Med 43 : 933–945. [Google Scholar]
  16. Basco LK, 2004. Molecular epidemiology of malaria in Cameroon. XIX. Quality of antimalarial drugs used for self-medication. Am J Trop Med Hyg 70 : 245–250. [Google Scholar]
  17. Pagnoni F, Convelbo N, Tiendrebeogo J, Cousens S, Esposito F, 1997. A community-based programme to provide prompt and adequate treatment of presumptive malaria in children. Trans R Soc Trop Med Hyg 91 : 512–517. [Google Scholar]
  18. Kidane G, Morrow RH, 2000. Teaching mothers to provide home treatment of malaria in Tigray, Ethiopia: a randomised trial. Lancet 356 : 550–555. [Google Scholar]
  19. Marsh VM, Mutemi WM, Muturi J, Haaland A, Watkins WM, Otieno G, Marsh K, 1999. Changing home treatment of childhood fevers by training shop keepers in rural Kenya. Trop Med Int Health 4 : 383–389. [Google Scholar]
  20. Tavrow P, Shabahang J, Makama S, 2003. Vendor-to-vendor education to improve malaria treatment by private drug outlets in Bungoma District, Kenya. Malar J 2 : 1–10. [Google Scholar]
  21. Yeboah-Antwi K, Gyapong JO, Asare IK, Barnish G, Evans DB, Adjei S, 2001. Impact of prepackaging antimalarial drugs on cost to patients and compliance with treatment. Bull World Health Organ 79 : 394–399. [Google Scholar]
  22. Agyepong IA, Ansah E, Gyapong M, Adjei S, Barnish G, Evans D, 2002. Strategies to improve adherence to recommended chloroquine treatment regimes: a quasi-experiment in the context of integrated primary health care delivery in Ghana. Soc Sci Med 55 : 2215–2226. [Google Scholar]
  23. Mwageni E, Momburi D, Juma Z, Irema M, Masanja H, and the Tanzania Essential Health Interventions Project and Adult Morbidity and Mortality Project, 2002. Rufiji Demographic Surveillance System. INDEPTH Network, ed. Population and Health in Developing Countries. Volume I. Population, Health and Survival at INDEPTH Sites. Ottawa, Ontario, Canada: International Development Research Centre, 173–181.
  24. National Bureau of Statistics United Republic of Tanzania, 2002. 2002 Population and Housing Census Database. Dar es Salaam: National Bureau of Statistics.
  25. Armstrong-Schellenberg J, Victora C, Mushi A, deSavigny D, Schellenberg D, Mshinda H, Bryce J, for the Tanzania IMCI MCE Baseline Household Survey Study Group, 2003. Inequities among the very poor: health care for children in rural southern Tanzania. Lancet 361 : 561–566. [Google Scholar]
  26. Depoortere E, Guthmann JP, Sipilanyambe N, Nkandu E, Fermon F, Balkan S, Legros D, 2004. Adherence to the combination of sulphadoxine-pyrimethamine and artesunate in the Maheba refugee settlement, Zambia. Trop Med Int Health 9 : 62–67. [Google Scholar]
  27. Deming MS, Gayibor A, Murphy K, Jones TS, Karsa T, 1989. Home treatment of febrile children with antimalarial drugs in Togo. Bull World Health Organ 67 : 695–700. [Google Scholar]
  28. Ruebush TK, Kern MK, Campbell CC, Oloo AJ, 1995. Self-treatment of malaria in a rural area of western Kenya. Bull World Health Organ 73 : 229–236. [Google Scholar]
  29. Slutsker L, Chitsulo L, Macheso A, Steketee RW, 1994. Treatment of malaria fever episodes among children in Malawi: results of a KAP survey. Trop Med Parasitol 45 : 61–64. [Google Scholar]
  30. Nshakira N, Kristensen M, Ssali F, Whyte SR, 2002. Appropriate treatment of malaria? Use of antimalarial drugs for children’s fevers in district medical units, drug shops and homes in eastern Uganda. Trop Med Int Health 7 : 309–316. [Google Scholar]
  31. Okonkwo PO, Akpala CO, Okafor HU, Mbah AU, Nwaiwu O, 2001. Compliance to correct dose of chloroquine in uncomplicated malaria correlates with improvement in the condition of rural Nigerian children. Trans R Soc Trop Med Hyg 95 : 320–324. [Google Scholar]
  32. Ansah EK, Gyapong JO, Agyepong IA, Evans DB, 2001. Improving adherence to malaria treatment for children: the use of pre-packed chloroquine tablets vs. chloroquine syrup. Trop Med Int Health 6 : 496–504. [Google Scholar]
  33. Li GQ, Guo XB, Fu LC, Jian HX, Wang XH, 1994. Clinical trials of artemisinin and its derivatives in the treatment of malaria in China. Trans R Soc Trop Med Hyg 88 : 5–6. [Google Scholar]
  34. Bunnag D, Viravan C, Looareesuwan S, Karbwang J, Harinasuta T, 1991. Clinical trial of artesunate and artemether on multi-drug resistant falciparum malaria in Thailand. A preliminary report. Southeast Asian J Trop Med Public Health 22 : 380–385. [Google Scholar]
  35. Barradell LB, Fitton A, 1995. Artesunate: a review of its pharmacology and therapeutic efficacy in the treatment of malaria. Drugs 50 : 714–741. [Google Scholar]
  36. Edwards G, 1994. Measurement of artemisinin and its derivatives in biological fluids. Trans R Soc Trop Med Hyg 88 : 37–39. [Google Scholar]

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  • Received : 30 Jan 2004
  • Accepted : 22 Jun 2004

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