High adherence to antimalarials and antibiotics under integrated community case management of illness in children less than five years in eastern Uganda.

<h4>Background</h4>Development of resistance to first line antimalarials led to recommendation of artemisinin based combination therapies (ACTs). High adherence to ACTs provided by community health workers (CHWs) gave reassurance that community based interventions did not increase the ri...

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Autores principales:	Joan N Kalyango, Elizeus Rutebemberwa, Charles Karamagi, Edison Mworozi, Sarah Ssali, Tobias Alfven, Stefan Peterson
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2013
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/5ab1c064dc174c8ea9eabce82d0be2da
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spelling	oai:doaj.org-article:5ab1c064dc174c8ea9eabce82d0be2da2021-11-18T07:51:18ZHigh adherence to antimalarials and antibiotics under integrated community case management of illness in children less than five years in eastern Uganda.1932-620310.1371/journal.pone.0060481https://doaj.org/article/5ab1c064dc174c8ea9eabce82d0be2da2013-01-01T00:00:00Zhttps://www.ncbi.nlm.nih.gov/pmc/articles/pmid/23555980/pdf/?tool=EBIhttps://doaj.org/toc/1932-6203<h4>Background</h4>Development of resistance to first line antimalarials led to recommendation of artemisinin based combination therapies (ACTs). High adherence to ACTs provided by community health workers (CHWs) gave reassurance that community based interventions did not increase the risk of drug resistance. Integrated community case management of illnesses (ICCM) is now recommended through which children will access both antibiotics and antimalarials from CHWs. Increased number of medicines has been shown to lower adherence.<h4>Objective</h4>To compare adherence to antimalarials alone versus antimalarials combined with antibiotics under ICCM in children less than five years.<h4>Methods</h4>A cohort study was nested within a cluster randomized trial that had CHWs treating children less than five years with antimalarials and antibiotics (intervention areas) and CHWs treating children with antimalarials only (control areas). Children were consecutively sampled from the CHWs' registers in the control areas (667 children); and intervention areas (323 taking antimalarials only and 266 taking antimalarials plus antibiotics). The sampled children were visited at home on day one and four of treatment seeking. Adherence was assessed using self reports and pill counts.<h4>Results</h4>Adherence in the intervention arm to antimalarials alone and antimalarials plus antibiotics arm was similar (mean 99% in both groups) but higher than adherence in the control arm (antimalarials only) (mean 96%). Forgetfulness (38%) was the most cited reason for non-adherence. At adjusted analysis: absence of fever (OR = 3.3, 95%CI =1.6-6.9), seeking care after two or more days (OR = 2.2, 95%CI = 1.3-3.7), not understanding instructions given (OR = 24.5, 95%CI = 2.7-224.5), vomiting (OR = 2.6, 95%CI = 1.2-5.5), and caregivers' perception that the child's illness was not severe (OR = 2.0, 95%CI = 1.1-3.8) were associated with non-adherence.<h4>Conclusions</h4>Addition of antibiotics to antimalarials did not lower adherence. However, caregivers should be adequately counseled to understand the dosing regimens; continue with medicines even when the child seems to improve; and re-administer doses that have been vomited.Joan N KalyangoElizeus RutebemberwaCharles KaramagiEdison MworoziSarah SsaliTobias AlfvenStefan PetersonPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 8, Iss 3, p e60481 (2013)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Joan N Kalyango Elizeus Rutebemberwa Charles Karamagi Edison Mworozi Sarah Ssali Tobias Alfven Stefan Peterson High adherence to antimalarials and antibiotics under integrated community case management of illness in children less than five years in eastern Uganda.
description	<h4>Background</h4>Development of resistance to first line antimalarials led to recommendation of artemisinin based combination therapies (ACTs). High adherence to ACTs provided by community health workers (CHWs) gave reassurance that community based interventions did not increase the risk of drug resistance. Integrated community case management of illnesses (ICCM) is now recommended through which children will access both antibiotics and antimalarials from CHWs. Increased number of medicines has been shown to lower adherence.<h4>Objective</h4>To compare adherence to antimalarials alone versus antimalarials combined with antibiotics under ICCM in children less than five years.<h4>Methods</h4>A cohort study was nested within a cluster randomized trial that had CHWs treating children less than five years with antimalarials and antibiotics (intervention areas) and CHWs treating children with antimalarials only (control areas). Children were consecutively sampled from the CHWs' registers in the control areas (667 children); and intervention areas (323 taking antimalarials only and 266 taking antimalarials plus antibiotics). The sampled children were visited at home on day one and four of treatment seeking. Adherence was assessed using self reports and pill counts.<h4>Results</h4>Adherence in the intervention arm to antimalarials alone and antimalarials plus antibiotics arm was similar (mean 99% in both groups) but higher than adherence in the control arm (antimalarials only) (mean 96%). Forgetfulness (38%) was the most cited reason for non-adherence. At adjusted analysis: absence of fever (OR = 3.3, 95%CI =1.6-6.9), seeking care after two or more days (OR = 2.2, 95%CI = 1.3-3.7), not understanding instructions given (OR = 24.5, 95%CI = 2.7-224.5), vomiting (OR = 2.6, 95%CI = 1.2-5.5), and caregivers' perception that the child's illness was not severe (OR = 2.0, 95%CI = 1.1-3.8) were associated with non-adherence.<h4>Conclusions</h4>Addition of antibiotics to antimalarials did not lower adherence. However, caregivers should be adequately counseled to understand the dosing regimens; continue with medicines even when the child seems to improve; and re-administer doses that have been vomited.
format	article
author	Joan N Kalyango Elizeus Rutebemberwa Charles Karamagi Edison Mworozi Sarah Ssali Tobias Alfven Stefan Peterson
author_facet	Joan N Kalyango Elizeus Rutebemberwa Charles Karamagi Edison Mworozi Sarah Ssali Tobias Alfven Stefan Peterson
author_sort	Joan N Kalyango
title	High adherence to antimalarials and antibiotics under integrated community case management of illness in children less than five years in eastern Uganda.
title_short	High adherence to antimalarials and antibiotics under integrated community case management of illness in children less than five years in eastern Uganda.
title_full	High adherence to antimalarials and antibiotics under integrated community case management of illness in children less than five years in eastern Uganda.
title_fullStr	High adherence to antimalarials and antibiotics under integrated community case management of illness in children less than five years in eastern Uganda.
title_full_unstemmed	High adherence to antimalarials and antibiotics under integrated community case management of illness in children less than five years in eastern Uganda.
title_sort	high adherence to antimalarials and antibiotics under integrated community case management of illness in children less than five years in eastern uganda.
publisher	Public Library of Science (PLoS)
publishDate	2013
url	https://doaj.org/article/5ab1c064dc174c8ea9eabce82d0be2da
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High adherence to antimalarials and antibiotics under integrated community case management of illness in children less than five years in eastern Uganda.

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