Efficacy of Artemisinin-Based Combination Treatments of Uncomplicated Falciparum Malaria in Under-Five-Year-Old Nigerian Children

Abstract

The efficacy of 3-day regimens of artemether-lumefantrine and artesunate-amodiaquine were evaluated in 747 children < 5 years of age with uncomplicated malaria from six geographical areas of Nigeria. Fever clearance was significantly faster (P = 0.006) and the proportion of children with parasitemia 1 day after treatment began was significantly lower (P = 0.016) in artesunate-amodiaquine—compared with artemether-lumefantrine-treated children. Parasite clearance times were similar with both treatments. Overall efficacy was 96.3% (95% confidence interval [CI] 94.5–97.6%), and was similar for both regimens. Polymerase chain reaction-corrected parasitologic cure rates on Day 28 were 96.9% (95% CI 93.9–98.2%) and 98.3% (95% CI 96.1–99.3%) for artemether-lumefantrine and artesunate-amodiaquine, respectively. Gametocyte carriage post treatment was significantly lower than pretreatment (P < 0.0001). In anemic children, mean time to recovery from anemia was 10 days (95% CI 9.04–10.9) and was similar for both regimens. Both treatments were well tolerated and are safe and efficacious treatments of uncomplicated falciparum malaria in young Nigerian children.

Effect of Primaquine on Gametocyte Carriage in the Case-Management of Uncomplicated Falciparum Malaria with Acts: Nigerian Perspective

“…This is higher than the 25.5% prevalence documented by Oguche and colleagues in a study in Nigerian children published in 2014 [20]. Their slightly lower prevalence might be because they reported the national average from different regions rather than a single region done by this study.…”

Evaluation of Plasmodium falciparum K13 gene polymorphism and susceptibility to dihydroartemisinin in an endemic area

“…In Nigeria, studies indicate that malaria transmission is still high 21,34 , with recent studies from regions in Nigeria reporting high mutations in genes that modulate response to nonartemisinin drugs by P. falciparum [35][36][37] . Conversely, other studies have reported high in-vivo response after ACTs with parasitemia half-life <5 hours, and 42-day cure rates >90% 38 . However, few studies elsewhere have recently evaluated the WHO benchmarks for artemisinin resistance using RSA value and K13 gene polymorphism 17,20 .…”

Anaemia following Artemisinin-Based Combination Treatments of Uncomplicated Plasmodium falciparum Malaria in Children: Temporal Patterns of Haematocrit and the Use of Uncomplicated Hyperparasitaemia as a Model for Evaluating Late-Appearing Anaemia

“…The later study was conducted from 2009 to 2014 in malarious children ≤10 years old in Ibadan. The details of the efficacy and gametocyte carriage study have been reported elsewhere [8,9]. The study profile is shown in Figure 1.…”

“…The day of presentation was regarded as day zero. Patients were treated with artemether-lumefantrine (AL) or artesunate-amodiaquine (AA) co-formulated for 3 days (days 0-2) as previously described [9]. In the initial study, follow-up was done daily on days 1-3 and on days 7, 14, 21, and 28, and this was extended to days 35 and 42 in the later study.…”

“…Parasitaemia was quantified, and fever clearance and parasite clearance times were determined as previously described [9,10]. Hyperparasitaemia was defined as asexual parasitaemia >250,000/µL.…”