Department of Community Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
Trans R Soc Trop Med Hyg. 2012 Jan;106(1):3-9. doi: 10.1016/j.trstmh.2011.09.006. Epub 2011 Nov 17.
A follow-up study was conducted to determine the magnitude of and factors related to adherence to artemether/lumefantrine (ALu) treatment in rural settings in Tanzania. Children in five villages of Kilosa District treated at health facilities were followed-up at their homes on Day 7 after the first dose of ALu. For those found to be positive using a rapid diagnostic test for malaria and treated with ALu, their caretakers were interviewed on drug administration habits. In addition, capillary blood samples were collected on Day 7 to determine lumefantrine concentrations. The majority of children (392/444; 88.3%) were reported to have received all doses, in time. Non-adherence was due to untimeliness rather than missing doses and was highest for the last two doses. No significant difference was found between blood lumefantrine concentrations among adherent (median 286 nmol/l) and non-adherent [median 261 nmol/l; range 25 nmol/l (limit of quantification) to 9318 nmol/l]. Children from less poor households were more likely to adhere to therapy than the poor [odds ratio (OR)=2.45, 95% CI 1.35-4.45; adjusted OR=2.23, 95% CI 1.20-4.13]. The high reported rate of adherence to ALu in rural areas is encouraging and needs to be preserved to reduce the risk of emergence of resistant strains. The age-based dosage schedule and lack of adherence to ALu treatment guidelines by health facility staff may explain both the huge variability in observed lumefantrine concentrations and the lack of difference in concentrations between the two groups.
一项随访研究旨在确定坦桑尼亚农村地区使用青蒿素-哌喹（ALu）治疗的依从性程度及其相关因素。在基洛萨区的五个村庄，在卫生机构接受治疗的儿童在首次服用 ALu 后的第 7 天在家中接受随访。对于使用快速诊断测试发现疟原虫阳性并接受 ALu 治疗的儿童，其护理人员接受了关于药物管理习惯的访谈。此外，还在第 7 天采集毛细血管血样以确定青蒿素浓度。大多数儿童（392/444；88.3%）按时报告服用了所有剂量。不依从的原因是不及时，而不是漏服，最后两剂的不依从率最高。在依从治疗的儿童（中位数 286 nmol/l）和不依从治疗的儿童（中位数 261 nmol/l；范围 25 nmol/l（定量下限）至 9318 nmol/l）之间，血液青蒿素浓度无显著差异。来自较不贫困家庭的儿童比贫困家庭的儿童更有可能坚持治疗[比值比（OR）=2.45，95%置信区间 1.35-4.45；调整后的 OR=2.23，95%置信区间 1.20-4.13]。农村地区报告的 ALu 高依从率令人鼓舞，需要加以保护以降低耐药株出现的风险。基于年龄的剂量方案以及卫生机构工作人员不遵守 ALu 治疗指南，可能解释了观察到的青蒿素浓度的巨大差异，以及两组之间浓度无差异的原因。
