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Title: Adherence and efficacy of supervised versus non-supervised treatment with artemether/lumefantrine for the treatment of uncomplicated Plasmodium falciparum malaria in Bangladesh: a randomised controlled trial
Authors: Md Mushfiqur Rahman
Arjen M. Dondorp
Nicholas P.J. Day
Niklas Lindegardh
Mallika Imwong
M. A. Faiz
A. Mannan Bangali
A. T.M.Mustafa Kamal
Jahirul Karim
Jaranit Kaewkungwal
Pratap Singhasivanon
Mahidol University
Nuffield Department of Clinical Medicine
Dhaka Medical College
Organisation Mondiale de la Sante
Directorate General of Family Planning
Keywords: Immunology and Microbiology;Medicine
Issue Date: 1-Sep-2008
Citation: Transactions of the Royal Society of Tropical Medicine and Hygiene. Vol.102, No.9 (2008), 861-867
Abstract: As artemether/lumefantrine is now deployed as the first-line treatment for uncomplicated falciparum malaria in Bangladesh, information on its efficacy and adherence to its use is important. A randomised controlled non-inferiority trial comparing directly observed treatment (DOT) and non-directly observed treatment (NDOT) was conducted in 320 patients with uncomplicated falciparum malaria in Bandarban Hill Tract District, Bangladesh. Both regimens showed similar high levels of PCR-corrected 42-day parasitological and clinical cure rates (99.3% in the NDOT group and 100% in the DOT group; P = 0.49). Survival analysis for the time to recurrence of infection showed no difference between treatment groups (log rank, P = 0.98). Adherence, as assessed by counting remaining tablets and oral interviews, was 93% in the NDOT group and was confirmed by Day 7 lumefantrine concentrations. Adherence was independent of educational level. Patients with plasma lumefantrine concentrations <280 ng/ml at Day 7 were at greater risk for re-infection (relative risk 5.62; P = 0.027). The efficacy of artemether/lumefantrine for the treatment of uncomplicated falciparum malaria in Bangladesh is high and is similar for DOT and NDOT. Adherence to therapy is high. © 2008 Royal Society of Tropical Medicine and Hygiene.
ISSN: 00359203
Appears in Collections:Scopus 2006-2010

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