***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: Background Home-management of malaria ( HMM ) strategy improves early access of anti-malarial medicines to high-risk groups in remote areas of sub-Saharan Africa . However , limited data are available on the effectiveness of using artemisinin-based combination therapy ( ACT ) within the HMM strategy . The aim of this study was to assess the effectiveness of artemether-lumefantrine ( AL ) , presently the most favoured ACT in Africa , in under-five children with uncomplicated Plasmodium falciparum malaria in Tanzania , when provided by community health workers ( CHWs ) and administered unsupervised by parents or guardians at home . Methods An open label , single arm prospect i ve study was conducted in two rural villages with high malaria transmission in Kibaha District , Tanzania . Children presenting to CHWs with uncomplicated fever and a positive rapid malaria diagnostic test ( RDT ) were provisionally enrolled and provided AL for unsupervised treatment at home . Patients with microscopy confirmed P. falciparum parasitaemia were definitely enrolled and review ed weekly by the CHWs during 42 days . Primary outcome measure was PCR corrected parasitological cure rate by day 42 , as estimated by Kaplan-Meier survival analysis . This trial is registered with Clinical Trials.gov , number NCT00454961 . Results A total of 244 febrile children were enrolled between March-August 2007 . Two patients were lost to follow up on day 14 , and one patient withdrew consent on day 21 . Some 141/241 ( 58.5 % ) patients had recurrent infection during follow-up , of whom 14 had recrudescence . The PCR corrected cure rate by day 42 was 93.0 % ( 95 % CI 88.3%-95.9 % ) . The median lumefantrine concentration was statistically significantly lower in patients with recrudescence ( 97 ng/mL [ IQR 0 - 234 ] ; n = 10 ) compared with reinfections ( 205 ng/mL [ 114 - 390 ] ; n = 92 ) , or no parasite reappearance ( 217 [ 121 - 374 ] ng/mL ; n = 70 ; p ≤ 0.046 ) . Conclusions Provision of AL by CHWs for unsupervised malaria treatment at home was highly effective , which provides evidence base for scaling-up implementation of HMM with AL in Tanzania BACKGROUND Between 1995 and 2000 , KwaZulu-Natal province , South Africa , experienced a marked increase in Plasmodium falciparum malaria , fuelled by pyrethroid and sulfadoxine-pyrimethamine resistance . In response , vector control was strengthened and artemether-lumefantrine ( AL ) was deployed in the first Ministry of Health artemisinin-based combination treatment policy in Africa . In South Africa , effective vector and parasite control had historically ensured low-intensity malaria transmission . Malaria is diagnosed definitively and treatment is provided free of charge in reasonably accessible public-sector health-care facilities . METHODS AND FINDINGS We review ed four years of malaria morbidity and mortality data at four sentinel health-care facilities within KwaZulu-Natal 's malaria-endemic area . In the year following improved vector control and implementation of AL treatment , malaria-related admissions and deaths both declined by 89 % , and outpatient visits decreased by 85 % at the sentinel facilities . By 2003 , malaria-related outpatient cases and admissions had fallen by 99 % , and malaria-related deaths had decreased by 97 % . There was a concomitant marked and sustained decline in notified malaria throughout the province . No serious adverse events were associated causally with AL treatment in an active sentinel pharmacovigilance survey . In a prospect i ve study with 42 d follow up , AL cured 97/98 ( 99 % ) and prevented gametocyte developing in all patients . Consistent with the findings of focus group discussion s , a household survey found self-reported adherence to the six-dose AL regimen was 96 % . CONCLUSION Together with concurrent strengthening of vector control measures , the antimalarial treatment policy change to AL in KwaZulu-Natal contributed to a marked and sustained decrease in malaria cases , admissions , and deaths , by greatly improving clinical and parasitological cure rates and reducing gametocyte carriage Background The Home Management of Malaria ( HMM ) strategy was developed using chloroquine , a now obsolete drug , which has been replaced by artemisinin-based combination therapy ( ACT ) in health facility setting s. Incorporation of ACT in HMM would greatly exp and access to effective antimalarial therapy by the population s living in underserved areas in malaria endemic countries . The feasibility and acceptability of incorporating ACT in HMM needs to be evaluated . Methods A multi-country study was performed in four district-size sites in Ghana ( two sites ) , Nigeria and Ug and a , with population s ranging between 38,000 and 60,000 . Community medicine distributors ( CMDs ) were trained in each village to dispense pre-packaged ACT to febrile children aged 6–59 months , after exclusion of danger signs . A community mobilization campaign accompanied the programme . Artesunate-amodiaquine ( AA ) was used in Ghana and artemether-lumefantrine ( AL ) in Nigeria and Ug and a. Harmonized qualitative and quantitative data collection methods were used to evaluate CMD performance , caregiver adherence and treatment coverage of febrile children with ACTs obtained from CMDs . Results Some 20,000 fever episodes in young children were treated with ACT by CMDs across the four study sites . Cross-sectional surveys identified 2,190 children with fever in the two preceding weeks , of whom 1,289 ( 59 % ) were reported to have received ACT from a CMD .  Coverage varied from 52 % in Nigeria to 75 % in Ho District , Ghana . Coverage rates did not appear to vary greatly with the age of the child or with the educational level of the caregiver . A very high proportion of children were reported to have received the first dose on the day of onset or the next day in all four sites ( range 86–97 % , average 90 % ) . The proportion of children correctly treated in terms of dose and duration was also high ( range 74–97 % , average 85 % ) . Overall , the proportion of febrile children who received prompt treatment and the correct dose for the assigned duration of treatment ranged from 71 % to 87 % ( average 77 % ) . Almost all caregivers perceived ACT to be effective , and no severe adverse events were reported . Conclusion ACTs can be successfully integrated into the HMM strategy OBJECTIVE To examine the extent to which district health teams could reduce the burden of malaria , a continuing major cause of mortality and morbidity , in a situation where severe re source constraints existed and integrated care was provided . METHODS Antimalarial drugs were prepackaged into unit doses in an attempt to improve compliance with full courses of chemotherapy . FINDINGS Compliance improved by approximately 20 % in both adults and children . There were 50 % reductions in cost to patients , waiting time at dispensaries and drug wastage at facilities . The intervention , which tended to improve both case and drug management at facilities , was well accepted by health staff and did not involve them in additional working time . CONCLUSION The prepackaging of antimalarials at the district level offers the prospect of improved compliance and a reduction in the spread of resistance A r and omized , controlled , malaria-clinic-based field trial was conducted to compare compliance with a 7-day quinine + tetracycline regimen and a 5-day 700-mg artesunate regimen for the treatment of uncomplicated falciparum malaria in a community in Thail and . Of 137 patients , aged 15 - 60 years attending a malaria clinic , 77 received artesunate  and 60 received quinine + tetracycline .  Compliance and cure rates were evaluated on days 5 ( artesunate ) and 7 ( quinine + tetracycline ) using patient interview/residual pill counts and peripheral blood smear , respectively . Data were analysed using the intention-to-treat approach , and the reasons for compliance and noncompliance were investigated . Compliance was significantly higher ( 98.4 % ) with artesunate than with quinine + tetracycline ( 71.7 % ) ( relative risk adjusted for sex ( aRR ) = 1.39 ( 95 % C.I. = 1.15 - 1.68 ) ; referent : quinine + tetracycline ) . Cure rate ( 100 % ) was higher in those receiving artesunate than quinine + tetracycline ( 77.4 % ) ( aRR = 1.32 ( 95 % C.I. = 1.12 - 1.55 ) ) . Reasons for compliance included the desire to be cured and to follow the advice of malaria staff/employer , and the simple dosing regimen . Noncompliance was mostly due to adverse reactions and forgetting to take the drugs . These results can serve as a baseline for design ing and evaluating new interventions to improve compliance , as well as for study ing cost-effectiveness to help drug policy decision-making . We recommend a strategy which integrates a short-course , once-a-day regimen ( with minimal adverse reactions ) , a better delivery system for antimalarial drugs and health education , and an enhanced advisory role of malaria staff . Considering the higher compliance rate and curative effectiveness of artesunate , we recommend its use instead of quinine + tetracycline for the treatment of uncomplicated malaria in clinics in Thail and Background Over the years , reports implicate improper anti-malarial use as a major contributor of morbidity and mortality amongst millions of residents in malaria endemic areas , Kenya included . However , there are limited reports on improper use of Artemisinin-based Combination Therapy ( ACT ) which is a first-line drug in the treatment of malaria in Kenya . Knowing this is important for ensured sustainable cure rates and also protection against the emergence of resistant malarial parasites . We therefore investigated ACT adherence level , factors associated with non-adherence and accessibility in households ( n = 297 ) in rural location of Southeast Alego location in Siaya County in western Kenya . Methods  ACT Adherence level was assessed with reference to the duration of treatment and number of tablets taken .  Using systematic r and om sampling technique , a question naire was administered to a particular household member who had the most recent malaria episode ( < 2 weeks ) and used ACT for cure . Parents/caretakers provided information for children aged < 13 years .  Key Informant Interviews ( KIIs ) were also conducted with healthcare providers and private dispensing chemist operators . Results Adherence to ACT prescription remained low at 42.1 % and 57.9 % among individuals above 13 and less than 13 years , respectively . Stratification by demographic and socio-economic characteristics in relation to ACT adherence revealed that age ( P = 0.011 ) , education level ( P < 0.01 ) , ability to read ( P < 0.01 ) and household ( HH ) monthly income ( P = 0.002 ) significantly affected the level of ACT adherence . Consistently , logistic regression model demonstrated that low age ( OR , 0.571 , 95 % CI , 0.360 - 0.905 ; P = 0.017 ) , higher education level ( OR , 0.074 ; 95 % CI 0.017 - 0.322 ; P < 0.01 ) , ability to read ( OR , 0.285 , 95 % CI , 0.167 - 0.486 ; P < 0.01 ) and higher income ( Ksh . > 9000 ; OR , 0.340 ; 95 % CI , 0.167 - 0.694 ; P = 0.003 ) were associated with ACT adherence . In addition , about 52.9 % of the respondents reported that  ACT  was not always available at the source and that drug availability ( P = 0.020 ) and distance to drug source ( P < 0.01 ) significantly affected accessibility . Conclusions This study demonstrates that more than half of those who get ACT prescription do not take recommended dose and that accessibility is of concern . The findings of this study suggest a potential need to improve accessibility and also initiate programmatic interventions to encourage patient-centred care BACKGROUND Artemisinin-based combination therapies are the recommended first-line treatments of falciparum malaria in all countries with endemic disease . There are recent concerns that the efficacy of such therapies has declined on the Thai-Cambodian border , historically a site of emerging antimalarial-drug resistance . METHODS In two open-label , r and omized trials , we compared the efficacies of two treatments for uncomplicated falciparum malaria in Pailin , western Cambodia , and Wang Pha , northwestern Thail and : oral artesunate given at a dose of 2 mg per kilogram of body weight per day , for 7 days , and artesunate given at a dose of 4 mg per kilogram per day , for 3 days , followed by mefloquine at two doses totaling 25 mg per kilogram . We assessed in vitro and in vivo Plasmodium falciparum susceptibility , artesunate pharmacokinetics , and molecular markers of resistance . RESULTS We studied 40 patients in each of the two locations . The overall median parasite clearance times 
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Conclusions This review highlights the weak evidence base on ACT adherence .
Results suggest that ACT adherence levels varied substantially between study population s , but comparison between studies was challenging due to differences in study design , definitions , and methods used to measure adherence .