Cluster Randomized Trial of Text Message Reminders to Retail Staff in Tanzanian Drug Shops Dispensing Artemether-Lumefantrine: Effect on Dispenser Knowledge and Patient Adherence
Identifieur interne : 002135 ( Pmc/Curation ); précédent : 002134; suivant : 002136Cluster Randomized Trial of Text Message Reminders to Retail Staff in Tanzanian Drug Shops Dispensing Artemether-Lumefantrine: Effect on Dispenser Knowledge and Patient Adherence
Auteurs : Katia Bruxvoort ; Charles Festo ; Admirabilis Kalolella ; Matthew Cairns ; Peter Lyaruu ; Mitya Kenani ; S. Patrick Kachur ; Catherine Goodman ; David SchellenbergSource :
- The American Journal of Tropical Medicine and Hygiene [ 0002-9637 ] ; 2014.
Abstract
Artemisinin combination therapies are available in private outlets, but patient adherence might be compromised by poor advice from dispensers. In this cluster randomized trial in drug shops in Tanzania, 42 of 82 selected shops were randomized to receive text message reminders about what advice to provide when dispensing artemether-lumefantrine (AL). Eligible patients purchasing AL at shops in both arms were followed up at home and questioned about each dose taken. Dispensers were interviewed regarding knowledge of AL dispensing practices and receipt of the malaria-related text messages. We interviewed 904 patients and 110 dispensers from 77 shops. Although there was some improvement in dispenser knowledge, there was no difference between arms in adherence measured as completion of all doses (intervention 68.3%, control 69.8%,
Url:
DOI: 10.4269/ajtmh.14-0126
PubMed: 25002300
PubMed Central: 4183415
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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Cluster Randomized Trial of Text Message Reminders to Retail Staff in Tanzanian Drug Shops Dispensing Artemether-Lumefantrine: Effect on Dispenser Knowledge and Patient Adherence</title><author><name sortKey="Bruxvoort, Katia" sort="Bruxvoort, Katia" uniqKey="Bruxvoort K" first="Katia" last="Bruxvoort">Katia Bruxvoort</name></author><author><name sortKey="Festo, Charles" sort="Festo, Charles" uniqKey="Festo C" first="Charles" last="Festo">Charles Festo</name></author><author><name sortKey="Kalolella, Admirabilis" sort="Kalolella, Admirabilis" uniqKey="Kalolella A" first="Admirabilis" last="Kalolella">Admirabilis Kalolella</name></author><author><name sortKey="Cairns, Matthew" sort="Cairns, Matthew" uniqKey="Cairns M" first="Matthew" last="Cairns">Matthew Cairns</name></author><author><name sortKey="Lyaruu, Peter" sort="Lyaruu, Peter" uniqKey="Lyaruu P" first="Peter" last="Lyaruu">Peter Lyaruu</name></author><author><name sortKey="Kenani, Mitya" sort="Kenani, Mitya" uniqKey="Kenani M" first="Mitya" last="Kenani">Mitya Kenani</name></author><author><name sortKey="Kachur, S Patrick" sort="Kachur, S Patrick" uniqKey="Kachur S" first="S. Patrick" last="Kachur">S. Patrick Kachur</name></author><author><name sortKey="Goodman, Catherine" sort="Goodman, Catherine" uniqKey="Goodman C" first="Catherine" last="Goodman">Catherine Goodman</name></author><author><name sortKey="Schellenberg, David" sort="Schellenberg, David" uniqKey="Schellenberg D" first="David" last="Schellenberg">David Schellenberg</name></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">25002300</idno><idno type="pmc">4183415</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4183415</idno><idno type="RBID">PMC:4183415</idno><idno type="doi">10.4269/ajtmh.14-0126</idno><date when="2014">2014</date><idno type="wicri:Area/Pmc/Corpus">002136</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">002136</idno><idno type="wicri:Area/Pmc/Curation">002135</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Curation">002135</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Cluster Randomized Trial of Text Message Reminders to Retail Staff in Tanzanian Drug Shops Dispensing Artemether-Lumefantrine: Effect on Dispenser Knowledge and Patient Adherence</title><author><name sortKey="Bruxvoort, Katia" sort="Bruxvoort, Katia" uniqKey="Bruxvoort K" first="Katia" last="Bruxvoort">Katia Bruxvoort</name></author><author><name sortKey="Festo, Charles" sort="Festo, Charles" uniqKey="Festo C" first="Charles" last="Festo">Charles Festo</name></author><author><name sortKey="Kalolella, Admirabilis" sort="Kalolella, Admirabilis" uniqKey="Kalolella A" first="Admirabilis" last="Kalolella">Admirabilis Kalolella</name></author><author><name sortKey="Cairns, Matthew" sort="Cairns, Matthew" uniqKey="Cairns M" first="Matthew" last="Cairns">Matthew Cairns</name></author><author><name sortKey="Lyaruu, Peter" sort="Lyaruu, Peter" uniqKey="Lyaruu P" first="Peter" last="Lyaruu">Peter Lyaruu</name></author><author><name sortKey="Kenani, Mitya" sort="Kenani, Mitya" uniqKey="Kenani M" first="Mitya" last="Kenani">Mitya Kenani</name></author><author><name sortKey="Kachur, S Patrick" sort="Kachur, S Patrick" uniqKey="Kachur S" first="S. Patrick" last="Kachur">S. Patrick Kachur</name></author><author><name sortKey="Goodman, Catherine" sort="Goodman, Catherine" uniqKey="Goodman C" first="Catherine" last="Goodman">Catherine Goodman</name></author><author><name sortKey="Schellenberg, David" sort="Schellenberg, David" uniqKey="Schellenberg D" first="David" last="Schellenberg">David Schellenberg</name></author></analytic><series><title level="j">The American Journal of Tropical Medicine and Hygiene</title><idno type="ISSN">0002-9637</idno><idno type="eISSN">1476-1645</idno><imprint><date when="2014">2014</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><p>Artemisinin combination therapies are available in private outlets, but patient adherence might be compromised by poor advice from dispensers. In this cluster randomized trial in drug shops in Tanzania, 42 of 82 selected shops were randomized to receive text message reminders about what advice to provide when dispensing artemether-lumefantrine (AL). Eligible patients purchasing AL at shops in both arms were followed up at home and questioned about each dose taken. Dispensers were interviewed regarding knowledge of AL dispensing practices and receipt of the malaria-related text messages. We interviewed 904 patients and 110 dispensers from 77 shops. Although there was some improvement in dispenser knowledge, there was no difference between arms in adherence measured as completion of all doses (intervention 68.3%, control 69.8%, <italic>p</italic> [adjusted] = 0.6), or as completion of each dose at the correct time (intervention 33.1%, control 32.6%, <italic>p</italic> [adjusted] = 0.9). 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<front><journal-meta><journal-id journal-id-type="nlm-ta">Am J Trop Med Hyg</journal-id><journal-id journal-id-type="iso-abbrev">Am. J. Trop. Med. Hyg</journal-id><journal-id journal-id-type="publisher-id">tpmd</journal-id><journal-title-group><journal-title>The American Journal of Tropical Medicine and Hygiene</journal-title></journal-title-group><issn pub-type="ppub">0002-9637</issn><issn pub-type="epub">1476-1645</issn><publisher><publisher-name>The American Society of Tropical Medicine and Hygiene</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">25002300</article-id><article-id pub-id-type="pmc">4183415</article-id><article-id pub-id-type="doi">10.4269/ajtmh.14-0126</article-id><article-categories><subj-group subj-group-type="heading"><subject>Articles</subject></subj-group></article-categories><title-group><article-title>Cluster Randomized Trial of Text Message Reminders to Retail Staff in Tanzanian Drug Shops Dispensing Artemether-Lumefantrine: Effect on Dispenser Knowledge and Patient Adherence</article-title><alt-title alt-title-type="left-running-head">BRUXVOORT AND OTHERS</alt-title><alt-title alt-title-type="right-running-head">EFFECT OF TEXT MESSAGES TO RETAIL STAFF ON PATIENT ADHERENCE</alt-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Bruxvoort</surname><given-names>Katia</given-names></name><xref ref-type="corresp" rid="COR1">*</xref></contrib><contrib contrib-type="author"><name><surname>Festo</surname><given-names>Charles</given-names></name></contrib><contrib contrib-type="author"><name><surname>Kalolella</surname><given-names>Admirabilis</given-names></name></contrib><contrib contrib-type="author"><name><surname>Cairns</surname><given-names>Matthew</given-names></name></contrib><contrib contrib-type="author"><name><surname>Lyaruu</surname><given-names>Peter</given-names></name></contrib><contrib contrib-type="author"><name><surname>Kenani</surname><given-names>Mitya</given-names></name></contrib><contrib contrib-type="author"><name><surname>Kachur</surname><given-names>S. Patrick</given-names></name></contrib><contrib contrib-type="author"><name><surname>Goodman</surname><given-names>Catherine</given-names></name></contrib><contrib contrib-type="author"><name><surname>Schellenberg</surname><given-names>David</given-names></name></contrib></contrib-group><aff id="AFF1">Department of Global Health and Development, Department of Infectious Disease Epidemiology, and Department of Disease Control, London School of Hygiene and Tropical Medicine, London, United Kingdom; Impact Evaluation Thematic Group, Ifakara Health Institute, Dar es Salaam, Tanzania; Malaria Branch, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia</aff><author-notes><corresp id="COR1">*Address correspondence to Katia Bruxvoort, 15-17 Tavistock Place, London, WC1H 9SH. E-mail: <email>katia.bruxvoort@lshtm.ac.uk</email></corresp></author-notes><pub-date pub-type="ppub"><day>01</day><month>10</month><year>2014</year></pub-date><pub-date pub-type="pmc-release"><day>01</day><month>10</month><year>2014</year></pub-date><pmc-comment> PMC Release delay is 0 months and 0 days and was based on the
<volume>91</volume><issue>4</issue><fpage>844</fpage><lpage>853</lpage><history><date date-type="received"><day>28</day><month>2</month><year>2014</year></date><date date-type="accepted"><day>24</day><month>5</month><year>2014</year></date></history><permissions><copyright-statement>©The American Society of Tropical Medicine and Hygiene</copyright-statement><copyright-year>2014</copyright-year><license license-type="open-access"><license-p>This is an open-access article distributed under the terms of the <ext-link ext-link-type="uri" xlink:href="http://creativecommons.org/licenses/by/4.0/">Creative Commons Attribution License</ext-link>, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.</license-p></license></permissions><abstract><p>Artemisinin combination therapies are available in private outlets, but patient adherence might be compromised by poor advice from dispensers. In this cluster randomized trial in drug shops in Tanzania, 42 of 82 selected shops were randomized to receive text message reminders about what advice to provide when dispensing artemether-lumefantrine (AL). Eligible patients purchasing AL at shops in both arms were followed up at home and questioned about each dose taken. Dispensers were interviewed regarding knowledge of AL dispensing practices and receipt of the malaria-related text messages. We interviewed 904 patients and 110 dispensers from 77 shops. Although there was some improvement in dispenser knowledge, there was no difference between arms in adherence measured as completion of all doses (intervention 68.3%, control 69.8%, <italic>p</italic> [adjusted] = 0.6), or as completion of each dose at the correct time (intervention 33.1%, control 32.6%, <italic>p</italic> [adjusted] = 0.9). Further studies on the potential of text messages to improve adherence are needed.</p></abstract></article-meta></front><floats-group><table-wrap id="T1" position="float"><label>Table 1</label><caption><p>Characteristics of accredited drug dispensing outlets (ADDOs)</p></caption><table frame="hsides" rules="groups"><thead><tr><th align="center" rowspan="1" colspan="1"></th><th align="center" rowspan="1" colspan="1">Control</th><th align="center" rowspan="1" colspan="1">Intervention</th></tr></thead><tbody><tr><td rowspan="1" colspan="1">Number (<italic>N</italic>)</td><td rowspan="1" colspan="1">37</td><td rowspan="1" colspan="1">40</td></tr><tr><td rowspan="1" colspan="1">Number urban (%)</td><td rowspan="1" colspan="1">26 (70%)</td><td rowspan="1" colspan="1">28 (70%)</td></tr><tr><td rowspan="1" colspan="1">Median number of dispensers per ADDO (range)</td><td rowspan="1" colspan="1">1 (1–3)</td><td rowspan="1" colspan="1">1 (1–4)</td></tr><tr><td rowspan="1" colspan="1">Number with one or more trained medical staff (%)<xref ref-type="table-fn" rid="TFN1">*</xref></td><td rowspan="1" colspan="1">36 (97%)</td><td rowspan="1" colspan="1">37 (92%)</td></tr><tr><td rowspan="1" colspan="1">Number with any ACTs in stock on day of interview (%)</td><td rowspan="1" colspan="1">35 (95%)</td><td rowspan="1" colspan="1">40 (100%)</td></tr><tr><td rowspan="1" colspan="1">Number with all four weight-based packs in stock on day of interview (%)</td><td rowspan="1" colspan="1">11 (30%)</td><td rowspan="1" colspan="1">14 (35%)</td></tr><tr><td rowspan="1" colspan="1">Median number of customers purchasing ACTs in last 7 days (range)</td><td rowspan="1" colspan="1">13 (0–82)</td><td rowspan="1" colspan="1">19 (0–147)</td></tr><tr><td rowspan="1" colspan="1">Number with ADDO accreditation certificate (%)</td><td rowspan="1" colspan="1">16 (43%)</td><td rowspan="1" colspan="1">8 (20%)</td></tr><tr><td rowspan="1" colspan="1">Number with drinking water available in ADDO (%)</td><td rowspan="1" colspan="1">30 (81%)</td><td rowspan="1" colspan="1">37 (93%)</td></tr></tbody></table><table-wrap-foot><fn id="TFN1"><label>*</label><p>Medical staff is defined as pharmacists, pharmacist assistants, medical doctors, assistant medical doctors, clinical officers, assistant clinical officers, midwives, nurses, nurse assistants, and laboratory technologists. Most were nurse assistants or nurses.</p></fn><fn id="TFN2"><p>ACTs = artemisinin-based combination therapies.</p></fn></table-wrap-foot></table-wrap><table-wrap id="T2" position="float"><label>Table 2</label><caption><p>Characteristics of dispensers (post-intervention)</p></caption><table frame="hsides" rules="groups"><thead><tr><th align="center" rowspan="1" colspan="1"></th><th align="center" rowspan="1" colspan="1">Control</th><th align="center" rowspan="1" colspan="1">Intervention</th></tr></thead><tbody><tr><td rowspan="1" colspan="1">Total number of dispensers</td><td rowspan="1" colspan="1">53</td><td rowspan="1" colspan="1">59</td></tr><tr><td rowspan="1" colspan="1">Number interviewed (<italic>N</italic>)</td><td rowspan="1" colspan="1">51</td><td rowspan="1" colspan="1">59</td></tr><tr><td rowspan="1" colspan="1">Male (%)<xref ref-type="table-fn" rid="TFN3">*</xref></td><td rowspan="1" colspan="1">10 (20%)</td><td rowspan="1" colspan="1">13 (22%)</td></tr><tr><td colspan="3" rowspan="1">Age (%)<xref ref-type="table-fn" rid="TFN3">*</xref></td></tr><tr><td rowspan="1" colspan="1"> Under 35 years of age</td><td rowspan="1" colspan="1">18 (35%)</td><td rowspan="1" colspan="1">23 (39%)</td></tr><tr><td rowspan="1" colspan="1"> 35–49 years of age</td><td rowspan="1" colspan="1">23 (45%)</td><td rowspan="1" colspan="1">17 (29%)</td></tr><tr><td rowspan="1" colspan="1"> 50 years and above</td><td rowspan="1" colspan="1">10 (20%)</td><td rowspan="1" colspan="1">19 (32%)</td></tr><tr><td rowspan="1" colspan="1"> Number with a medical qualification (%)<xref ref-type="table-fn" rid="TFN3">*</xref><xref ref-type="table-fn" rid="TFN4">†</xref></td><td rowspan="1" colspan="1">44 (86%)</td><td rowspan="1" colspan="1">47 (81%)</td></tr><tr><td colspan="3" rowspan="1">Socioeconomic status (%)<xref ref-type="table-fn" rid="TFN5">‡</xref><xref ref-type="table-fn" rid="TFN6">§</xref></td></tr><tr><td rowspan="1" colspan="1"> 1st quintile (most poor)</td><td rowspan="1" colspan="1">9 (18%)</td><td rowspan="1" colspan="1">13 (22%)</td></tr><tr><td rowspan="1" colspan="1"> 2nd quintile</td><td rowspan="1" colspan="1">12 (24%)</td><td rowspan="1" colspan="1">10 (17%)</td></tr><tr><td rowspan="1" colspan="1"> 3rd quintile</td><td rowspan="1" colspan="1">9 (18%)</td><td rowspan="1" colspan="1">13 (22%)</td></tr><tr><td rowspan="1" colspan="1"> 4th quintile</td><td rowspan="1" colspan="1">8 (16%)</td><td rowspan="1" colspan="1">14 (24%)</td></tr><tr><td rowspan="1" colspan="1"> 5th quintile (least poor)</td><td rowspan="1" colspan="1">12 (24%)</td><td rowspan="1" colspan="1">9 (15%)</td></tr><tr><td rowspan="1" colspan="1"> Number that had attended training on ACTs (%)<xref ref-type="table-fn" rid="TFN3">*</xref></td><td rowspan="1" colspan="1">35 (69%)</td><td rowspan="1" colspan="1">35 (60%)</td></tr><tr><td rowspan="1" colspan="1">Median year of training (range)</td><td rowspan="1" colspan="1">2011 (2005–2012)</td><td rowspan="1" colspan="1">2009 (2001–2012)</td></tr></tbody></table><table-wrap-foot><fn id="TFN3"><label>*</label><p>Data missing for one dispenser in intervention arm.</p></fn><fn id="TFN4"><label>†</label><p>Medical staff is defined as pharmacists, pharmacist assistants, medical doctors, assistant medical doctors, clinical officers, assistant clinical officers, midwives, nurses, nurse assistants, and laboratory technologists. Most were nurse assistants or nurses.</p></fn><fn id="TFN5"><label>‡</label><p>Data missing for one dispenser in control arm.</p></fn><fn id="TFN6"><label>§</label><p>Wealth quintiles determined using a principal component analysis of sampled dispensers based on standard Demographic and Health Survey variables.</p></fn></table-wrap-foot></table-wrap><table-wrap id="T3" position="float"><label>Table 3</label><caption><p>Characteristics of patients</p></caption><table frame="hsides" rules="groups"><thead><tr><th align="center" rowspan="1" colspan="1"></th><th align="center" rowspan="1" colspan="1">Control</th><th align="center" rowspan="1" colspan="1">Intervention</th></tr></thead><tbody><tr><td rowspan="1" colspan="1">Number (<italic>N</italic>)</td><td rowspan="1" colspan="1">451</td><td rowspan="1" colspan="1">453</td></tr><tr><td rowspan="1" colspan="1">Male</td><td rowspan="1" colspan="1">240 (53%)</td><td rowspan="1" colspan="1">211 (47%)</td></tr><tr><td colspan="3" rowspan="1">Age<xref ref-type="table-fn" rid="TFN7">*</xref></td></tr><tr><td rowspan="1" colspan="1"> Under 3 years</td><td rowspan="1" colspan="1">81 (18%)</td><td rowspan="1" colspan="1">78 (17%)</td></tr><tr><td rowspan="1" colspan="1"> 3 years to under 8 years</td><td rowspan="1" colspan="1">104 (23%)</td><td rowspan="1" colspan="1">91 (20%)</td></tr><tr><td rowspan="1" colspan="1"> 8 years to under 12 years</td><td rowspan="1" colspan="1">41 (9%)</td><td rowspan="1" colspan="1">42 (9%)</td></tr><tr><td rowspan="1" colspan="1"> 12 years and above</td><td rowspan="1" colspan="1">225 (50%)</td><td rowspan="1" colspan="1">242 (53%)</td></tr><tr><td colspan="3" rowspan="1">Blister pack obtained</td></tr><tr><td rowspan="1" colspan="1"> 1 × 6 (6 tablets)</td><td rowspan="1" colspan="1">109 (24%)</td><td rowspan="1" colspan="1">107 (23%)</td></tr><tr><td rowspan="1" colspan="1"> 2 × 6 (12 tablets)</td><td rowspan="1" colspan="1">95 (21%)</td><td rowspan="1" colspan="1">88 (19%)</td></tr><tr><td rowspan="1" colspan="1"> 3 × 6 (18 tablets)</td><td rowspan="1" colspan="1">50 (11%)</td><td rowspan="1" colspan="1">43 (10%)</td></tr><tr><td rowspan="1" colspan="1"> 4 × 6 (24 tablets)</td><td rowspan="1" colspan="1">197 (44%)</td><td rowspan="1" colspan="1">215 (48%)</td></tr><tr><td rowspan="1" colspan="1"> Patient (or caregiver if patient below age 12) completed primary school<xref ref-type="table-fn" rid="TFN8">†</xref></td><td rowspan="1" colspan="1">323 (72%)</td><td rowspan="1" colspan="1">343 (76%)</td></tr><tr><td colspan="3" rowspan="1">Socioeconomic status<xref ref-type="table-fn" rid="TFN9">‡</xref></td></tr><tr><td rowspan="1" colspan="1"> 1st quintile (most poor)</td><td rowspan="1" colspan="1">87 (19%)</td><td rowspan="1" colspan="1">94 (21%)</td></tr><tr><td rowspan="1" colspan="1"> 2nd quintile</td><td rowspan="1" colspan="1">99 (22%)</td><td rowspan="1" colspan="1">82 (18%)</td></tr><tr><td rowspan="1" colspan="1"> 3rd quintile</td><td rowspan="1" colspan="1">97 (22%)</td><td rowspan="1" colspan="1">84 (19%)</td></tr><tr><td rowspan="1" colspan="1"> 4th quintile</td><td rowspan="1" colspan="1">85 (19%)</td><td rowspan="1" colspan="1">96 (21%)</td></tr><tr><td rowspan="1" colspan="1"> 5th quintile (least poor)</td><td rowspan="1" colspan="1">83 (18%)</td><td rowspan="1" colspan="1">97 (21%)</td></tr><tr><td rowspan="1" colspan="1"> Slept under any bed net the night before the follow up interview</td><td rowspan="1" colspan="1">321 (71%)</td><td rowspan="1" colspan="1">357 (79%)</td></tr><tr><td rowspan="1" colspan="1"> Sought care before attending study ADDO</td><td rowspan="1" colspan="1">171 (38%)</td><td rowspan="1" colspan="1">163 (36%)</td></tr><tr><td rowspan="1" colspan="1"> Median days since illness onset before seeking care at ADDO<xref ref-type="table-fn" rid="TFN10">§</xref></td><td rowspan="1" colspan="1">1</td><td rowspan="1" colspan="1">1</td></tr><tr><td colspan="3" rowspan="1">Symptoms<xref ref-type="table-fn" rid="TFN11">¶</xref></td></tr><tr><td rowspan="1" colspan="1"> Fever or headache</td><td rowspan="1" colspan="1">410 (91%)</td><td rowspan="1" colspan="1">416 (92%)</td></tr><tr><td rowspan="1" colspan="1"> Respiratory</td><td rowspan="1" colspan="1">34 (8%)</td><td rowspan="1" colspan="1">34 (8%)</td></tr><tr><td rowspan="1" colspan="1"> Stomach upset</td><td rowspan="1" colspan="1">220 (49%)</td><td rowspan="1" colspan="1">209 (46%)</td></tr><tr><td rowspan="1" colspan="1"> Other<xref ref-type="table-fn" rid="TFN12">∥</xref></td><td rowspan="1" colspan="1">216 (48%)</td><td rowspan="1" colspan="1">211 (47%)</td></tr><tr><td rowspan="1" colspan="1"> mRDT positive at follow up<xref ref-type="table-fn" rid="TFN13">**</xref></td><td rowspan="1" colspan="1">121 (28%)</td><td rowspan="1" colspan="1">108 (25%)</td></tr><tr><td rowspan="1" colspan="1"> Blood smear positive at follow up<xref ref-type="table-fn" rid="TFN14">††</xref></td><td rowspan="1" colspan="1">6 (1.4%)</td><td rowspan="1" colspan="1">7 (1.6%)</td></tr></tbody></table><table-wrap-foot><fn id="TFN7"><label>*</label><p>Age categories based on recommended age breakdown for artemether-lumefantrine (AL) blister packs in Tanzania.</p></fn><fn id="TFN8"><label>†</label><p>Caregiver education missing for 3 patients < 12 in intervention arm.</p></fn><fn id="TFN9"><label>‡</label><p>Wealth quintiles determined using a principal component analysis of sampled patients based on standard Demographic and Health Survey variables.</p></fn><fn id="TFN10"><label>§</label><p>Eleven patients in control arm and 4 patients in intervention arm did not remember the number of days after illness onset when they sought care at the study accredited drug dispensing outlets (ADDO).</p></fn><fn id="TFN11"><label>¶</label><p>Percents do not add to 100% as patients experienced multiple symptoms.</p></fn><fn id="TFN12"><label>∥</label><p>Includes fatigue, body aches, dizziness, shaking, convulsions, unusually-colored urine, yellow mouth/eyes/body, etc.</p></fn><fn id="TFN13"><label>**</label><p>Malaria rapid diagnostic test (mRDT) data missing for 12 patients in control arm and 12 patients in intervention arm.</p></fn><fn id="TFN14"><label>††</label><p>Blood smear data missing for 18 patients in control arm and 13 patients in intervention arm.</p></fn></table-wrap-foot></table-wrap><table-wrap id="T4" position="float"><label>Table 4</label><caption><p>Dispenser knowledge of correct advice (mean of cluster summaries)</p></caption><table frame="hsides" rules="groups"><thead><tr><th align="center" rowspan="1" colspan="1"></th><th align="center" rowspan="1" colspan="1">Control<xref ref-type="table-fn" rid="TFN15">*</xref> (<italic>N</italic> = 37) % (SD)</th><th align="center" rowspan="1" colspan="1">Intervention<xref ref-type="table-fn" rid="TFN15">*</xref> (<italic>N</italic> = 40) % (SD)</th><th align="center" rowspan="1" colspan="1">Adjusted prevalence ratio (95% CI)<xref ref-type="table-fn" rid="TFN16">†</xref></th><th align="center" rowspan="1" colspan="1">Adjusted <italic>P</italic> value<xref ref-type="table-fn" rid="TFN16">†</xref></th></tr></thead><tbody><tr><td colspan="5" rowspan="1">Proportion that gave correct advice on:</td></tr><tr><td rowspan="1" colspan="1"> Correct AL regimen for adult<xref ref-type="table-fn" rid="TFN17">‡</xref></td><td rowspan="1" colspan="1">78.4 (38.3)</td><td rowspan="1" colspan="1">90.0 (33.7)</td><td rowspan="1" colspan="1">1.19 (0.95, 1.49)</td><td rowspan="1" colspan="1">0.075</td></tr><tr><td rowspan="1" colspan="1"> Correct AL regimen for a child (4 years and 20 kg)<xref ref-type="table-fn" rid="TFN17">‡</xref></td><td rowspan="1" colspan="1">63.5 (46.6)</td><td rowspan="1" colspan="1">74.6 (40.4)</td><td rowspan="1" colspan="1">1.20 (0.85, 1.70)</td><td rowspan="1" colspan="1">0.2</td></tr><tr><td rowspan="1" colspan="1"> Take with fatty food</td><td rowspan="1" colspan="1">20.3 (38.1)</td><td rowspan="1" colspan="1">60.0 (45.6)</td><td rowspan="1" colspan="1">3.41 (1.63, 7.12)</td><td rowspan="1" colspan="1">0.0001</td></tr><tr><td rowspan="1" colspan="1"> Continue treatment if minor side effects occur</td><td rowspan="1" colspan="1">42.8 (42.8)</td><td rowspan="1" colspan="1">67.5 (45.2)</td><td rowspan="1" colspan="1">1.58 (1.03, 2.42)</td><td rowspan="1" colspan="1">0.019</td></tr><tr><td rowspan="1" colspan="1"> Return to ADDO or go to a health facility if condition worsens</td><td rowspan="1" colspan="1">91.0 (25.3)</td><td rowspan="1" colspan="1">100.0</td><td rowspan="1" colspan="1">1.04 (0.84, 1.31)</td><td rowspan="1" colspan="1">0.7</td></tr><tr><td rowspan="1" colspan="1"> Take second dose after 8 hours</td><td rowspan="1" colspan="1">86.9 (32.2)</td><td rowspan="1" colspan="1">97.5 (15.8)</td><td rowspan="1" colspan="1">1.11 (0.93, 1.32)</td><td rowspan="1" colspan="1">0.1</td></tr><tr><td rowspan="1" colspan="1"> Take replacement dose in case of vomiting within half hour of taking dose</td><td rowspan="1" colspan="1">49.5 (45.7)</td><td rowspan="1" colspan="1">55.0 (46.4)</td><td rowspan="1" colspan="1">1.20 (0.77, 1.86)</td><td rowspan="1" colspan="1">0.4</td></tr><tr><td rowspan="1" colspan="1"> Complete treatment even if feeling better</td><td rowspan="1" colspan="1">98.6 (8.2)</td><td rowspan="1" colspan="1">98.8 (7.9)</td><td rowspan="1" colspan="1">1.07 (0.88, 1.30)</td><td rowspan="1" colspan="1">0.5</td></tr></tbody></table><table-wrap-foot><fn id="TFN15"><label>*</label><p>Total number of dispensers interviewed was 51 in the control arm and 59 in the intervention arm.</p></fn><fn id="TFN16"><label>†</label><p>Adjusted for accredited drug dispensing outlet (ADDO) accreditation, number of customers at ADDO purchasing artemisinin-based combination therapies (ACTs) (< 20 vs. 20 or more), dispenser medical qualification, and training on ACTs</p></fn><fn id="TFN17"><label>‡</label><p>To be considered correct, responses had to identify artemether-lumefantrine (AL) as first-line treatment and specify that six doses should be taken, with each dose consisting of four pills (adult) or 2 pills (child 4 years of age). Dose intervals considered correct included (A) taking a dose morning and evening for 3 days or (B) taking the second dose 8 hours after the first dose and the remaining doses 12 hours apart (or morning and evening for the next 2 days).</p></fn></table-wrap-foot></table-wrap><table-wrap id="T5" position="float"><label>Table 5</label><caption><p>Patient report of advice received from dispenser (mean of cluster summaries)</p></caption><table frame="hsides" rules="groups"><thead><tr><th align="center" rowspan="1" colspan="1"></th><th align="center" rowspan="1" colspan="1">Control* (<italic>N</italic> = 37) % (SD)</th><th align="center" rowspan="1" colspan="1">Intervention<xref ref-type="table-fn" rid="TFN18">*</xref> (<italic>N</italic> = 40) % (SD)</th><th align="center" rowspan="1" colspan="1">Adjusted prevalence ratio (95% CI)<xref ref-type="table-fn" rid="TFN19">†</xref></th><th align="center" rowspan="1" colspan="1">Adjusted <italic>P</italic> value<xref ref-type="table-fn" rid="TFN19">†</xref></th></tr></thead><tbody><tr><td rowspan="1" colspan="1">Explained correct dose regimen<xref ref-type="table-fn" rid="TFN20">‡</xref></td><td rowspan="1" colspan="1">60.6 (21.2)</td><td rowspan="1" colspan="1">62.9 (21.5)</td><td rowspan="1" colspan="1">1.00 (0.84, 1.20)</td><td rowspan="1" colspan="1">0.9</td></tr><tr><td rowspan="1" colspan="1">Told to take second dose after 8 hours</td><td rowspan="1" colspan="1">64.2 (19.6)</td><td rowspan="1" colspan="1">63.0 (20.2)</td><td rowspan="1" colspan="1">1.00 (0.87, 1.15)</td><td rowspan="1" colspan="1">0.9</td></tr><tr><td rowspan="1" colspan="1">Told to complete treatment even if feeling better</td><td rowspan="1" colspan="1">61.3 (25.3)</td><td rowspan="1" colspan="1">59.3 (27.3)</td><td rowspan="1" colspan="1">0.94 (0.76, 1.17)</td><td rowspan="1" colspan="1">0.5</td></tr><tr><td rowspan="1" colspan="1">Told not to give drug to anyone else or save for future illnesses</td><td rowspan="1" colspan="1">41.3 (23.3)</td><td rowspan="1" colspan="1">35.1 (25.1)</td><td rowspan="1" colspan="1">0.88 (0.65, 1.18)</td><td rowspan="1" colspan="1">0.4</td></tr><tr><td rowspan="1" colspan="1">Told to return to ADDO or go to a health facility if condition worsens</td><td rowspan="1" colspan="1">34.1 (20.5)</td><td rowspan="1" colspan="1">35.0 (22.4)</td><td rowspan="1" colspan="1">1.01 (0.75, 1.35)</td><td rowspan="1" colspan="1">0.9</td></tr><tr><td rowspan="1" colspan="1">Told to take replacement dose in case of vomiting</td><td rowspan="1" colspan="1">3.3 (8.9)</td><td rowspan="1" colspan="1">3.2 (3.2)</td><td rowspan="1" colspan="1">1.48 (0.56, 3.90)</td><td rowspan="1" colspan="1">0.5</td></tr><tr><td rowspan="1" colspan="1">Told about possible side effects</td><td rowspan="1" colspan="1">2.8 (5.1)</td><td rowspan="1" colspan="1">2.0 (5.1)</td><td rowspan="1" colspan="1">0.60 (0.13, 2.77)</td><td rowspan="1" colspan="1">0.4</td></tr><tr><td rowspan="1" colspan="1">Told to take each dose with fatty food or milk<xref ref-type="table-fn" rid="TFN21">§</xref></td><td rowspan="1" colspan="1">2.2 (8.4)</td><td rowspan="1" colspan="1">4.2 (9.7)</td><td rowspan="1" colspan="1">1.70 (0.40, 7.24)</td><td rowspan="1" colspan="1">0.4</td></tr><tr><td rowspan="1" colspan="1">First dose was observed at ADDO</td><td rowspan="1" colspan="1">5.4 (9.1)</td><td rowspan="1" colspan="1">6.9 (12.7)</td><td rowspan="1" colspan="1">1.32 (0.63, 2.76)</td><td rowspan="1" colspan="1">0.5</td></tr></tbody></table><table-wrap-foot><fn id="TFN18"><label>*</label><p>Total number of patients interviewed was 451 in the control arm and 453 in the intervention arm.</p></fn><fn id="TFN19"><label>†</label><p>Adjusted for accredited drug dispensing outlet (ADDO) accreditation, number of customers at ADDO purchasing artemisinin-based combination therapies (ACTs) (< 20 vs. 20 or more), dispenser medical qualification, and training on ACTs</p></fn><fn id="TFN20"><label>‡</label><p>To be considered correct, responses had to include the correct number of pills per dose for blister pack obtained, two doses per day, and 3 days duration (or 4 days to account for artemether-lumefantrine [AL] obtained late on Day 1)</p></fn><fn id="TFN21"><label>§</label><p>If taking with any food or milk is considered correct, percentages increase to 60.2 (22.1) in the control arm and 58.8 (26.0) in the intervention arm, <italic>P</italic> = 0.8)</p></fn></table-wrap-foot></table-wrap><table-wrap id="T6" position="float"><label>Table 6</label><caption><p>Patient adherence (mean of cluster summaries)</p></caption><table frame="hsides" rules="groups"><thead><tr><th align="center" rowspan="1" colspan="1"></th><th align="center" rowspan="1" colspan="1">Control* (<italic>N</italic> = 37) % (SD)</th><th align="center" rowspan="1" colspan="1">Intervention<xref ref-type="table-fn" rid="TFN22">*</xref> (<italic>N</italic> = 40) % (SD)</th><th align="center" rowspan="1" colspan="1">Adjusted prevalence ratio (95% CI)<xref ref-type="table-fn" rid="TFN23">†</xref></th><th align="center" rowspan="1" colspan="1">Adjusted <italic>P</italic> value<xref ref-type="table-fn" rid="TFN23">†</xref></th></tr></thead><tbody><tr><td rowspan="1" colspan="1">Completed treatment<xref ref-type="table-fn" rid="TFN24">‡</xref></td><td rowspan="1" colspan="1">69.8 (20.9)</td><td rowspan="1" colspan="1">68.3 (23.4)</td><td rowspan="1" colspan="1">0.96 (0.82, 1.12)</td><td rowspan="1" colspan="1">0.6</td></tr><tr><td rowspan="1" colspan="1">1 × 6 (6 tablets)</td><td rowspan="1" colspan="1">68.2 (33.3)</td><td rowspan="1" colspan="1">73.4 (30.9)</td><td rowspan="1" colspan="1">1.04 (0.81, 1.33)</td><td rowspan="1" colspan="1">0.7</td></tr><tr><td rowspan="1" colspan="1">2 × 6 (12 tablets)</td><td rowspan="1" colspan="1">62.0 (33.4)</td><td rowspan="1" colspan="1">70.7 (40.5)</td><td rowspan="1" colspan="1">1.10 (0.85, 1.43)</td><td rowspan="1" colspan="1">0.5</td></tr><tr><td rowspan="1" colspan="1">3 × 6 (18 tablets)</td><td rowspan="1" colspan="1">73.0 (35.7)</td><td rowspan="1" colspan="1">62.5 (39.7)</td><td rowspan="1" colspan="1">0.86 (0.66, 1.13)</td><td rowspan="1" colspan="1">0.4</td></tr><tr><td rowspan="1" colspan="1">4 × 6 (24 tablets)</td><td rowspan="1" colspan="1">73.8 (23.1)</td><td rowspan="1" colspan="1">67.8 (29.1)</td><td rowspan="1" colspan="1">0.89 (0.74, 1.08)</td><td rowspan="1" colspan="1">0.2</td></tr><tr><td rowspan="1" colspan="1">Timely completion<xref ref-type="table-fn" rid="TFN25">§</xref></td><td rowspan="1" colspan="1">32.6 (18.4)</td><td rowspan="1" colspan="1">33.1 (21.6)</td><td rowspan="1" colspan="1">1.01 (0.76, 1.36)</td><td rowspan="1" colspan="1">0.9</td></tr><tr><td rowspan="1" colspan="1">1 × 6 (6 tablets)</td><td rowspan="1" colspan="1">37.2 (36.7)</td><td rowspan="1" colspan="1">26.4 (34.5)</td><td rowspan="1" colspan="1">0.67 (0.35, 1.28)</td><td rowspan="1" colspan="1">0.2</td></tr><tr><td rowspan="1" colspan="1">2 × 6 (12 tablets)</td><td rowspan="1" colspan="1">25.7 (24.9)</td><td rowspan="1" colspan="1">33.1 (36.6)</td><td rowspan="1" colspan="1">1.32 (0.86, 2.00)</td><td rowspan="1" colspan="1">0.4</td></tr><tr><td rowspan="1" colspan="1">3 × 6 (18 tablets)</td><td rowspan="1" colspan="1">35.5 (41.3)</td><td rowspan="1" colspan="1">37.9 (41.4)</td><td rowspan="1" colspan="1">1.02 (0.57, 1.81)</td><td rowspan="1" colspan="1">0.9</td></tr><tr><td rowspan="1" colspan="1">4 × 6 (24 tablets)</td><td rowspan="1" colspan="1">38.1 (27.6)</td><td rowspan="1" colspan="1">34.8 (29.3)</td><td rowspan="1" colspan="1">0.90 (0.57, 1.41)</td><td rowspan="1" colspan="1">0.6</td></tr></tbody></table><table-wrap-foot><fn id="TFN22"><label>*</label><p>Total number of patients interviewed was 451 in the control arm and 453 in the intervention arm.</p></fn><fn id="TFN23"><label>†</label><p>Adjusted for accredited drug dispensing outlet (ADDO) accreditation, number of customers at ADDO purchasing artemisinin-based combination therapies (ACTs) (< 20 vs. 20 or more), and patient education (patient or caregiver completed primary school).</p></fn><fn id="TFN24"><label>‡</label><p>Completed treatment unknown for three patients in the control arm and two patients in the intervention arm.</p></fn><fn id="TFN25"><label>§</label><p>Timely completion unknown for 10 patients in the control arm and 11 patients in the intervention arm.</p></fn></table-wrap-foot></table-wrap></floats-group></pmc></record>Pour manipuler ce document sous Unix (Dilib)
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