Therapeutic efficacy of artemether-lumefantrine, artesunate-amodiaquine and dihydroartemisinin-piperaquine in the treatment of uncomplicated Plasmodium falciparum malaria in Sub-Saharan Africa: A systematic review and meta-analysis

Marwa, Karol; Kapesa, Anthony; Baraka, Vito; Konje, Evelyne; Kidenya, Benson R.; Mukonzo, Jackson; Kamugisha, Erasmus; Swedberg, Göte

doi:10.1371/journal.pone.0264339

Cited by 32 publications

(25 citation statements)

References 76 publications

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“…PCR-corrected cure rates for all three sites on day 42 were over 90% (failure rates below WHO's threshold of 10% for partner drug resistance) (WHO, 2020), and therefore supports the inclusion of DHAP in the treatment policy for Ghana (MOH, 2020). High efficacy of DHAP has also been reported in other sub-Saharan African countries (Marwa et al, 2022) including Nigeria (Ebenebe et al, 2018), Sierra Leone (Smith et al, 2018), Mali (Dama et al, 2018), Guinea-Bissau (Ursing et al, 2016), Kenya (Westercamp et al, 2022), Tanzania (Mandara et al, 2019), Uganda (Ebong et al, 2021), Somalia (Warsame et al, 2019), Rwanda (Uwimana et al, 2019), and Angola (Davlantes et al, 2018). This notwithstanding PCRcorrected cure rate for WMH was significantly lower than HMH and EWP suggesting possible lower parasite susceptibility to piperaquine in WMH.…”

Section: Discussionmentioning

confidence: 75%

Therapeutic efficacy of dihydroartemisinin-piperaquine combination for the treatment of uncomplicated malaria in Ghana

Abuaku

Boateng

Peprah

et al. 2023

Front. Cell. Infect. Microbiol.

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In 2020, Dihydroartemisinin-Piperaquine (DHAP) was adopted as a second-line antimalarial for treatment of uncomplicated malaria in Ghana following a review of the country’s antimalarial medicines policy. Available data obtained in 2007 had shown PCR-uncorrected therapeutic efficacy of 93.3% using a 28-day follow-up schedule. In 2020, the standard 42-day follow-up schedule for DHAP was used to estimate efficacy levels among febrile children aged 6 months to 9 years in three malaria sentinel sites representing the three main ecological zones of the country- savannah, forest, and coastal. PCR genotyping distinguished between recrudescence and re-infection using merozoite surface protein 2 (MSP2)-specific primers for FC27 and 3D7 strains. Per protocol analyses showed day 28 efficacy of 100% in all three sentinel sites with day 42 PCR-corrected efficacy ranging between 90.3% (95% CI: 80.1 – 96.4%) in the savannah zone and 100% in the forest and coastal zones, yielding a national average of 97.0% (95% CI: 93.4 – 98.8). No day 3 parasitemia was observed in all three sites. Prevalence of measured fever (axillary temperature ≥ 37.5°C) declined from 50.0 - 98.8% on day 0 to 7.1-11.5% on day 1 whilst parasitemia declined from 100% on day 0 to 1.2 - 2.3% on day 1. Mean haemoglobin levels on days 28 and 42 were significantly higher than pre-treatment levels in all three sites. We conclude that DHAP is highly efficacious in the treatment of uncomplicated malaria in Ghana. This data will serve as baseline for subsequent DHAP efficacy studies in the country.

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Section: Discussionmentioning

confidence: 75%

Therapeutic efficacy of dihydroartemisinin-piperaquine combination for the treatment of uncomplicated malaria in Ghana

Abuaku

Boateng

Peprah

et al. 2023

Front. Cell. Infect. Microbiol.

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“…[17][18][19][20][21][22] Artemesinin-based Combination Therapies (ACTs) are the most commonly used antimalarials in our study, which is consistent with their demonstrated efficacy for uncomplicated malaria in African settings in recent systematic reviews and meta-analyses. 23,24 Nonetheless, indiscriminate use of antimalarial drugs (ACTs) for self-diagnosed malaria will eventually lead to increased drug resistance, treatment failure, and complications. 25,26 Before treating children with malaria-like illnesses, appropriate rapid diagnostic testing should be performed.…”

Section: Discussionmentioning

confidence: 99%

Incidence, pattern and determinants of self-medication for fevers in children: A survey of caregivers in an emergency unit in Benin City, Nigeria

Abiodun

Ayinboumwan²

2022

Ann Clin Biomed Res

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Self-medication is common in medically underserved areas, with disastrous consequences. It is necessary to determine the frequency and risk factors in our area. The purpose of this study was to find out the frequency, pattern, and risk factors for self-medication for febrile childhood illnesses among caregivers seen in the emergency paediatric unit. A descriptive, cross-sectional design was used for this study. Participants included caregivers for children seen in the unit. A semi-structured questionnaire was used to collect data, which included sections on demography, determinants, pattern, and reasons for self-medication, as well as actual reports of self-medication in the previous three weeks. In order to identify risk factors for self-medication, inferential analyses were performed. P-values less than 0.05 were considered significant. The study included 153 caregivers, with an average (SD) age of 45.6 (13.8) years. Self-medication for fevers in children was 25.5%, with 20 (51.3%) of the children treated being under the age of five. Antipyretics (20.3%) and antimalarials (13.7%), particularly artemisinin-based combination therapy (ACT), were the most commonly used drugs. Place of residence (p= 0.011), living arrangement (p= 0.030), and awareness of an adverse drug event (p= 0.045) are factors that influence self-medication in the previous three weeks. Having health insurance, NHIS (OR = 2.734, 95% CI: 1.120-6.678; p=0.027), and using an insecticide-treated net (OR = 0.272, 95% CI: 0.117-0.634; p=0.003) are also independent predictors of self-medication. With multifactorial determinants in the setting, self-medication is common. There is a need for increased access to subsidized healthcare for children, as well as caregiver education on the potential harms of self-medication.

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“…Several alternative ACT regimens are also available. A recent systematic review and meta-analysis on the efficacy of ACTs used in Sub Saharan Africa from 2010 to 2020 reports an overall high success rate in the treatment of malaria using artesunate-amodiaquine, artemetherlumefantrine, and dihydroartemisinin-piperaquine in this region (Marwa et al, 2022). With the emergence of partial artemisininresistant P. falciparum in east Africa (Uwimana et al, 2020;Balikagala et al, 2021;Uwimana et al, 2021), regular surveillance of ACTs efficacy is critical and the availability of several ACTs in the region would be beneficial if properly used.…”

Section: The Alternate Use Of Different Antimalarial Regimensmentioning

confidence: 99%

Artemisinin resistance and malaria elimination: Where are we now?

et al. 2022

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The emergence of artemisinin resistance is a major obstacle to the global malaria eradication/elimination programs. Artemisinin is a very fast-acting antimalarial drug and is the most important drug in the treatment of severe and uncomplicated malaria. For the treatment of acute uncomplicated falciparum malaria, artemisinin derivatives are combined with long half-life partner drugs and widely used as artemisinin-based combination therapies (ACTs). Some ACTs have shown decreased efficacy in the Southeast Asian region. Fortunately, artemisinin has an excellent safety profile and resistant infections can still be treated successfully by modifying the ACT. This review describes the pharmacological properties of ACTs, mechanisms of artemisinin resistance and the potential changes needed in the treatment regimens to overcome resistance. The suggested ACT modifications are extension of the duration of the ACT course, alternating use of different ACT regimens, and addition of another antimalarial drug to the standard ACTs (Triple-ACT). Furthermore, a malaria vaccine (e.g., RTS,S vaccine) could be added to mass drug administration (MDA) campaigns to enhance the treatment efficacy and to prevent further artemisinin resistance development. This review concludes that artemisinin remains the most important antimalarial drug, despite the development of drug-resistant falciparum malaria.

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Therapeutic efficacy of artemether-lumefantrine, artesunate-amodiaquine and dihydroartemisinin-piperaquine in the treatment of uncomplicated Plasmodium falciparum malaria in Sub-Saharan Africa: A systematic review and meta-analysis

Cited by 32 publications

References 76 publications

Therapeutic efficacy of dihydroartemisinin-piperaquine combination for the treatment of uncomplicated malaria in Ghana

Therapeutic efficacy of dihydroartemisinin-piperaquine combination for the treatment of uncomplicated malaria in Ghana

Incidence, pattern and determinants of self-medication for fevers in children: A survey of caregivers in an emergency unit in Benin City, Nigeria

Artemisinin resistance and malaria elimination: Where are we now?

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