Effectiveness of artemisinin-based combination therapy used in the context of home management of malaria: A report from three study sites in sub-Saharan Africa

Abstract

Background: The use of artemisinin-based combination therapy (ACT) at the community level has been advocated as a means to increase access to effective antimalarial medicines by high risk groups living in underserved areas, mainly in sub-Saharan Africa. This strategy has been shown to be feasible and acceptable to the community. However, the parasitological effectiveness of ACT when dispensed by community medicine distributors (CMDs) within the context of home management of malaria (HMM) and used unsupervised by caregivers at home has not been evaluated.

Compliance, Safety, and Effectiveness of Fixed-Dose Artesunate-Amodiaquine for Presumptive Treatment of Non-Severe Malaria in the Context of Home Management of Malaria in Madagascar

“…The PCR-adjusted cure rate on day 42 varied between sites from 97.6% to 100%, which was higher than the threshold of 90% recommended by WHO. 18,24 The failure rates recorded were consistent with previous reports of therapeutic efficacy from studies carried out at the health-center level with non-fixed doses of ASAQ 11 and at the community level with various ACTs in Africa. 25 In the non-malaria group (M-/PCR-), more than 50% of the children were asymptomatic by day 42, which is consistent with febrile viral infections in these cases.…”

“…Malaria prevalence among febrile children ranged from 38.6% in areas with high levels of transmission to 28.4% in areas of low transmission and was considerably lower than that reported in studies in Tanzania (42%), Uganda (61%), Nigeria (71%), and Ghana (71%). 24 Malaria prevalence estimates among febrile children obtained by PCR were significantly higher than those obtained by microscopy in areas with high transmission rates (difference between positive microscopy results and positive PCR results was 17.1% in high transmission areas versus 3.6% in low transmission areas; P < 0.0001). Moreover, the pyrogenic threshold was approximately two-fold higher in high transmission areas than in low transmission areas (mean parasitemia in symptomatic children ¼ 3,064 parasites/mL in areas with high transmission rates versus 1,302 parasites/mL in areas with low transmission rates), which indicates that anti-disease immunity to malaria may have occurred earlier among children living in areas of highest transmission of malaria in Madagascar.…”

Progress toward elimination of malaria in Nigeria: Uptake of artemisinin-based combination therapies for the treatment of malaria in households in Benin City

“…[22][23][24] At the end of December 2010, the National Malaria Control Strategic Plan shifted the set date for the achievement of its redefined goals to 2013. [4] One of these goals is that by the end of 2013, at least 80% of patients attending any health facility would get appropriate testing and treatment for malaria according to national guidelines.…”

Dried Blood Spot Analysis to Assess Medication Adherence and to Inform Personalization of Treatment

“…The effectiveness of the home management of malaria (HMM) for children, was assessed across selected sites from Ghana, Nigeria and Uganda by comparing thick blood smears and DBS samples from finger prick blood with carer reports of adherence to a prescribed regimen [61]. 1740 children were initially recruited with 1189 exhibiting parasitaemia at baseline.…”