***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: 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 We investigated the impact of pre-packaging antimalarial drugs and counselling on compliance with treatment of malaria at the Adult Outpatient Department of Port Moresby General Hospital . Adult patients who were prescribed st and ard antimalarial drugs following clinical and microscopic diagnosis of malaria were r and omly assigned to one of three groups : an intervention group , where pre-packaging and counselling instructions were applied ; control group A , with counselling but no pre-packaging ; and control group B , with neither counselling nor pre-packaging . Patients were interviewed on two occasions , day 1 of treatment and day 4 post treatment . Of a total of 436 patients , 322 patients ( 179 males and 143 females ) completed the study . Our data indicate an increase of 18 % in compliance with treatment in the intervention group and 16 % in control group A , when compared with control group B. While compliance with treatment was gender independent , the language spoken and used for giving instructions and counselling may have influenced patients ' behaviour on prescribed medication . The results of our study indicate that a simple pre-packaging system and proper counselling could improve compliance with antimalarial drug treatment . As an additional beneficial observation , pre-packaging is likely to eliminate errors and possible contamination of the products during dispensing Described are the results of a trial carried out from January to June 1996 in southern Malawi to determine the effectiveness of a treatment pack  for infants and children under the age of 6 years , who presented as emergencies to rural health centres with presumptive diagnoses of severe/cerebral malaria or meningitis . Each complete treatment pack ( approximate cost , US$ 6 ) contained , inter alia , intramuscular quinine , intramuscular choloramphenicol , dextrose , paraldehyde , a nasogastric tube , prepacked syringes , and sterile water . A modified coma score and drug dosage nomogram were also included in the package . Despite a considerable drop in overall mortality , problems arose with regard to the incomplete treatment of possible meningitis and in the development of a rational referral policy A study conducted in 1994 showed that the use of blister packs containing antimalarial drugs significantly increased patients '  compliance , compared with traditional means of dispensing drugs in a paper envelope . The present study assessed patients ' compliance and compared the difference between 3-day chloroquine and 8-day primaquine courses of treatment for vivax malaria . The level of real compliance was determined by making the drugs with phenobarbital , and measuring its level in the blood following treatment . The results show that blister packaging significantly improved patients ' compliance ( p < 0.001 ) over traditional means of dispensing antimalarial drugs ; there was no difference in treatment compliance between 3-day and 8-day courses when the drugs were in blister packs . However , with ordinary packaging the treatment compliance rate for an 8-day course was significantly less than for a 3-day course ( P < 0.05 ) This article reports a r and omized controlled trial design ed to test the effects of special packaging of antihypertensive medication on compliance and blood pressure control . One hundred eighty subjects who had exhibited elevated blood pressure greater than 90 mmHg in the two years prior to the study were recruited from patients receiving care at a community hospital-based family medicine practice . After completing preenrollment interviews and blood pressure measurements , subjects were r and omly assigned to receive their antihypertensive medications either in the usual vials or in special unit dose-reminder packaging . Follow-up interviews  , pill counts , and blood pressure measurements were performed at three-month intervals . There were no statistically significant differences between the control and experimental groups with regard to age , sex , race , employment , education , marital status , insurance coverage , or blood pressure regimens . Prior to the intervention , the experimental group had slightly lower diastolic blood pressure and reported better compliance than the control group . Analyses performed on 165 subjects completing the first follow-up visit revealed no significant improvements in blood pressure control or compliance for patients receiving special medication packaging . While some patients found it easy to remember to take pills packaged using this format , they also found the packages somewhat more difficult and inconvenient to use . In contrast to previously reported work , this study did not demonstrate any significant improvement in compliance with special packaging of antihypertensive medications OBJECTIVE : The aim of this study was to compare cure rates of Helicobacter pylori ( H. pylori ) infection , compliance , and side effects in patients given 10 days of omeprazole 20 mg b.d . , amoxycillin 500 mg t.d.s . , and metronidazole 400 mg t.d.s . ( OAM ) or 10 days OAM plus compliance enhancing measures . METHODS : A total of 119 H. pylori-positive patients were prospect ively r and omized to receive either 10 days OAM or 10 days OAM plus compliance enhancing measures ( medication in a dose dispensing unit , medication chart , an information sheet about H. pylori treatment , and phone call 2 days after starting therapy ) . H. pylori eradication was assessed by 13C-UBT at least 4 wk after cessation of therapy , compliance by phone interview on the last day of therapy and returned pill count , and side effects by phone interview and returned side effects form . RESULTS : In 113 patients attending 13C-UBT  H. pylori was eradicated in 51 of 57 patients ( 89.5 % ) after 10 days OAM and in 48 of 56 ( 85.7 % ) after 10 days OAM plus compliance enhancing measures ( p= 0.54 ) . In both groups 97 % of medications were taken . Side effects were common ( 82 % of patients ) . Both side effects ( p= 0.001 ) and ulcer versus nonulcer at endoscopy ( p= 0.016 ) were independent predictors of treatment failure ; side effects also predicted noncompliance ( p= 0.02 ) . CONCLUSIONS : Ten days of OAM was effective for H. pylori eradication in our clinical population . Patient compliance was excellent and attempts to increase compliance had no impact on outcome or compliance . Side effects were very common and were significantly associated with treatment failure and decreased compliance Three studies were carried out to determine the need , acceptability , and efficacy of adding mefloquine to artemisinin derivatives ( AD ) for the first-line treatment of uncomplicated falciparum malaria . The first was a retrospective study of 255 basic health workers which showed that their recommendation of AD to patients depended on their level of training . None of the paramedics/midwives and only 9 % of 129 doctors had prescribed AD , and no one had recommended AD in combination with mefloquine ; 72 % of patients used courses that were too short for parasitological cure . To promote the addition of mefloquine to AD regimens we conducted intervention workshops with health care providers and subsidized the cost of mefloquine to patients . In the second study , we interviewed 200 patients before and after the intervention to evaluate drug compliance with full doses of AD and use of subsidized mefloquine . After the intervention , we found that only 3.6 % had used  mefloquine  and 62 % had taken non-curative doses of AD . In the third study , we provided blister packs of medication in daily doses and compared the intake of AD + placebo ( 158 patients ) with that of AD + mefloquine ( 222 patients ) for 5 days . The compliance with both regimens was 99 % . Blood smears for parasites on day 28 showed one positive in the AD + mefloquine group and 7 positive in the AD group . We conclude that provision of blister packs of daily doses is a very effective way to improve compliance with short courses and drug combinations , but the efficacy of the combination in Myanmar in this particular study was only marginally higher than that of AD alone Summary : Fifty‐three hospital out patients with epilepsy were r and omly allocated to either a control or an intervention group . Patients in the intervention group were subjected to a combination of compliance‐improving strategies : patient counselling , a special medication container , self‐recording of medication intake and seizures , and mailed reminders to collect prescription refills and attend clinic appointments .  Compliance  with anticonvulsant therapy ( as measured by plasma anticonvulsant levels and prescription refill frequencies ) , and seizure frequency , were evaluated in each patient prior to intervention and 6 months afterwards . Patient compliance and clinical control improved significantly in the intervention group patients . Seizure frequency was , on average , halved following intervention . Compliance and seizure frequency were unaltered in the control group . Intervention failed to improve clinic appointment keeping . Poor compliance with drug therapy commonly confounds the treatment of epilepsy . This study shows that compliance can be improved and seizure frequency lessened by strategies that are easily incorporated into the routine management of epileptic patients Malaria is a major cause of morbidity and mortality among children under five in sub-Saharan Africa . Prompt diagnosis and adequate treatment of acute clinical episodes are essential to reduce morbidity and prevent complications and mortality . In many countries , chloroquine syrup is the mainstay of malaria treatment for children under five . Not only is syrup more expensive than tablets , adherence to the prescribed dose at home is a problem because mothers use wrongly sized measuring devices or have difficulty with the instructions . We investigated the impact of introducing pre-packed tablets for children on adherence to treatment and compared the total cost of the tablets with that of syrup .  Children aged 0 - -5 years diagnosed with malaria at the clinic over a 6-week period received either pre-packed tablets or syrup by r and om assignment . The principal caregivers were interviewed at home on day 4 after attending the clinic . Of the 155 caregivers given pre-packed tablets , 91 % ( n=141 ) adhered to the recommended dosage , while only 42 % ( n=61 ) of 144 who were provided syrup did . Only 20 % of caregivers who received syrup used an accurate 5 ml measure . The cost of treatment with tablets was about one-quarter that of syrup and 62 % ( n=96 ) of caregivers preferred tablets . Pre-packed chloroquine tablets are a viable alternative to syrup The combination of artesunate and mefloquine is currently one of the most effective treatments against multidrug-resistant Plasmodium falciparum malaria . To improve patient compliance to such a combination , the two agents have been combined in a prepacked single blister . Patients were instructed to simultaneously co-administer the drugs once a day for three days . In the present r and omized , double-blind , parallel group , comparative , single center study in Thail and , this concept was investigated in 204 adults and children with acute , uncomplicated P. falciparum malaria . Patients were r and omized into two treatment groups and received once a day over a three-day period the following : Group A received artesunate , 4 - 5 mg/kg/day , and mefloquine , total dose = 25 mg/kg , approximately 8.5 mg/kg/day , simultaneously . Group B received artesunate , 4 - 5 mg/kg/day , and mefloquine , total dose = 25 mg/kg , sequentially ( i.e. , no mefloquine dose on the first day , 15 mg/kg on the second day , and 10 mg/kg on the third day ) . Both treatment groups showed no relevant differences in baseline demographic and clinical characteristics . Intent-to-treat analysis revealed a cure rate at day 28 ( primary endpoint ) of 100 % in group A and 99 % in group B ( difference not significant ) . The secondary endpoints of mean time to fever clearance ( group A = 34 hours , group B = 31 hours ) and mean time to parasite clearance ( group A = 44 hours group B = 48 hours ) were similar between groups ( both differences not significant ) . Tolerability was good in both treatment groups , with no difference in the overall incidence of adverse events . There was a low incidence of nausea/vomiting ( 4.9 % in both groups ) and central nervous system side effects ( 4.9 % in group A versus 8.8 % in group B ) . These were comparable between groups and generally of a mild nature . The three-day combination of artesunate and mefloquine ( Artequin , Mepha , Ltd. , Aesch , Switzerl and ) with the introduction of mefloquine on day 1 offers a practical dosing regimen that is highly effective and well tolerated in patients of different ages with uncomplicated P. falciparum malaria . It is likely that the prepacked blister approach translates clinical ly into a better patient compliance , thereby contributing to limit the development of drug resistance In rural , malaria-endemic Burkina Faso , we evaluated the impact of the use of pre-packaged antimalarial drugs ( PPAM ) , by mothers in the home , on the progression of 
    Output:
    
There is insufficient evidence to determine the effect of unit-dose packaged antimalarial drugs on treatment failure .