Amodiaquine-artesunate vs artemether-lumefantrine for uncomplicated malaria in Ghanaian children: a randomized efficacy and safety trial with one year follow-up

Adjei, George; Kurtzhals, Jørgen A. L.; Rodrigues, Onike; Alifrangis, Michael; Hoegberg, Lotte Christine Groth; Kitcher, Emmanuel D.; Badoe, Ebenezer; Lamptey, Roberta; Goka, Bamenla Q.

doi:10.1186/1475-2875-7-127

Cited by 92 publications

(90 citation statements)

References 46 publications

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“…The results showed a high cure rate for both regimens after a standard 28-day follow-up. These results are consistent with efficacy results reported from several sub-Saharan African countries, [34][35][36] indicating a high overall cure rate with these regimens in the short term (28-day). Therefore, the data are in line with studies conducted in Ghanaian children showing lower parasitological and clinical failure rates in the ASAQ compared with the AL arm.…”

Section: Discussionsupporting

confidence: 91%

Assessment of the efficacy of first-line antimalarial drugs after 5 years of deployment by the National Malaria Control Programme in Côte d'Ivoire

Offianan¹,

Assi²,

A³

et al. 2011

OAJCT

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Background:The emergence of artemisinin resistance has raised concerns that the most potent antimalarial drug may be under threat. Artesunate + amodiaquine (ASAQ) and artemetherlumefantrine (AL) are respectively the first-and second-line treatments for uncomplicated falciparum malaria in Côte d'Ivoire. A comparison of the efficacy and safety of these two drug combinations was necessary to make evidence-based drug treatment policies. Methods:In an open-label, non inferiority, randomized, controlled clinical trial, children aged 6-59 months were randomized to receive ASAQ or AL. Both drug regimens were given for 3 days, and follow-up was for 28 days. The primary endpoint was the 28-day cure rates and was defined as proportion of patients with polymerase chain reaction (PCR)-corrected cure rate after 28 days of follow-up. Findings: A total of 251 patients who were attending the Ayame and Dabakala hospitals and presenting with symptomatic acute uncomplicated falciparum malaria were randomized to receive ASAQ (128) and AL (123). The intention-to-treat analysis showed effectiveness rates of 94.5% and 93.5% for ASAQ and AL, respectively on day 28. After adjustment for PCR results, these rates were 96.1% and 96.8%, respectively. On day 28, the per-protocol analysis showed effectiveness rates of 98.4% and 96.6% for ASAQ and AL, respectively. After adjustment by PCR for reinfection, these rates were 100% for each drug, and both regimens were well tolerated. Conclusion: ASAQ and AL remain efficacious treatments of uncomplicated falciparum malaria in Ivorian children 5 years after adoption. The efficacy of ASAQ and AL in Côte d'Ivoire requires, therefore, continuous monitoring and evaluation.

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Section: Discussionsupporting

confidence: 91%

Assessment of the efficacy of first-line antimalarial drugs after 5 years of deployment by the National Malaria Control Programme in Côte d'Ivoire

Offianan¹,

Assi²,

A³

et al. 2011

OAJCT

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“…However, if one considers all patients and observations, we cannot quantitate the changes in a manner that is easily transposed into net gains or losses. Regarding direction of changes, there was a net decrease in leukocyte counts resulting from a decrease in neutrophil counts (also reported by Adjei and others 1 ) that was proportionally greater than the increase in lymphocyte counts. Hemoglobin levels and platelet counts also increased.…”

Section: Discussionsupporting

confidence: 65%

“…1 Except for anemia, little is known about children in Africa with P. falciparum malaria; other hematologic parameters pre-antimalarial and post-antimalarial treatments have not been studied (or at least reported) systematically for this population. Most of the (limited) data available from the existing literature concerns adult malaria patients from areas of low malaria endemicity.…”

Section: Introductionmentioning

confidence: 99%

Hematologic Parameters in Pediatric Uncomplicated Plasmodium falciparum Malaria in Sub-Saharan Africa

Olliaro

Djimdé²,

Dorsey³

et al. 2011

The American Society of Tropical Medicine and Hygiene

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Hematologic changes in acute and convalescent uncomplicated Plasmodium falciparum malaria have not been well studied, particularly in young children in Africa. Hematologic data were obtained for 3,044 children less than five years of age in seven randomized controlled trials at 14 sites. Using paired analysis between day 28 and baseline in patients without parasitologic failure as a proxy for malaria-induced effects, we found a statistically significant but clinically modest increase in leukocyte counts (5%) resulting from a larger increase in neutrophils (43%) than the decrease in lymphocytes counts (–16%); levels of hemoglobin and platelets decreased (–13% and –49%, respectively). Multivariate random effects analysis showed trends during follow-up (increased levels of hemoglobin, platelets and lymphocytes, and decreased levels of leukocytes and neutrophils) and identified explanatory variables. The risk of neutropenia increased with follow-up time independent of treatment outcome, and was lower with age, higher baseline parasitemia, and artemisinin combination treatment. These analyses provides information on hematologic variations caused by malaria.

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“…The full details of the trial have been reported previously elsewhere 7 . Briefly, children with uncomplicated malaria fulfilling inclusion and exclusion criteria of the trial were randomized to treatment with artesunate+amodiaquine, artemether-lumefantrine, or amodiaquine monotherapy and then followed up, initially for 28 days, and then monthly for up to one year.…”

Section: Methodsmentioning

confidence: 99%

Parents’ perceptions, attitudes and acceptability of Treatment of childhood malaria with artemisinin combination therapies in Ghana

Adjei

Darkwah²,

Goka³

et al. 2010

Ghana Medical Journal

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SUMMARYBackground: There is little information on sociocultural and contextual factors that may influence attitudes of patients to new treatments, such as artemisinin combination therapies (ACT). Methods: Semi-structured questionnaires and focus group discussions were used to assess views of parents of children with uncomplicated malaria treated with ACT in a low socio-economic area in Accra, Ghana. Results: The majority of parents reported a favourable experience, in terms of perceived i) rapidity of symptom resolution, compared to their previous experience of other therapies for childhood malaria, or ii) when their experience was compared that of parents of children treated with monotherapy. The parents of children treated with ACT were more willing to pay for the treatment, or adhere to the full treatment course. The explanations given for adherence were consistent with conventional biomedical explanations. Although careseeking practices for childhood malaria were considered appropriate, perceived or real barriers to accessible health care were also important factors in the decision to seek treatment. Household dynamics and perceived inequities at the care-provider-patient interface were identified as having potential negative impact on care-seeking practices and adherence. Conclusions: Health education messages aimed at improving the response to childhood febrile illness should include other strategic stakeholders, such as decisionmakers at the household level. The effectiveness and implementation success of the ACT policy could be enhanced by highlighting and reinforcing messages intrinsic to these regimens. Integrating the views of caretakers during the clinical encounter was validated as an empowerment tool that could aid in the appropriate responses to childhood illness.

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Amodiaquine-artesunate vs artemether-lumefantrine for uncomplicated malaria in Ghanaian children: a randomized efficacy and safety trial with one year follow-up

Cited by 92 publications

References 46 publications

Assessment of the efficacy of first-line antimalarial drugs after 5 years of deployment by the National Malaria Control Programme in Côte d'Ivoire

Assessment of the efficacy of first-line antimalarial drugs after 5 years of deployment by the National Malaria Control Programme in Côte d'Ivoire

Hematologic Parameters in Pediatric Uncomplicated Plasmodium falciparum Malaria in Sub-Saharan Africa

Parents’ perceptions, attitudes and acceptability of Treatment of childhood malaria with artemisinin combination therapies in Ghana

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Amodiaquine-artesunate vs artemether-lumefantrine for uncomplicated malaria in Ghanaian children: a randomized efficacy and safety trial with one year follow-up

Cited by 92 publications

References 46 publications

Assessment of the efficacy of first-line antimalarial drugs after 5 years of deployment by the National Malaria Control Programme in C&ocirc;te d'Ivoire

Assessment of the efficacy of first-line antimalarial drugs after 5 years of deployment by the National Malaria Control Programme in C&ocirc;te d'Ivoire

Hematologic Parameters in Pediatric Uncomplicated Plasmodium falciparum Malaria in Sub-Saharan Africa

Parents’ perceptions, attitudes and acceptability of Treatment of childhood malaria with artemisinin combination therapies in Ghana

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Product

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Assessment of the efficacy of first-line antimalarial drugs after 5 years of deployment by the National Malaria Control Programme in Côte d'Ivoire

Assessment of the efficacy of first-line antimalarial drugs after 5 years of deployment by the National Malaria Control Programme in Côte d'Ivoire