Efficiency of Artemether-Lumefantrine for the treatment of uncomplicated malaria in Malawian Children

Abstract

Background: Malaria is still one of the leading causes of mortality among under-five year’s children in sub-Saharan Africa despite efforts to control it. It affects mostly pregnant women and children under the age of five years in Africa. In 2010, an estimated 216 million cases of malaria were reported worldwide, eighty-one per cent of which were in the African region. To improve treatment of the malaria cases, artemisinin based combination therapies (ACTs) are being used worldwide. The Malawi Ministry of Health introduced Artemether-lumefantrine (AL) as first-line drug in the treatment of uncomplicated malaria in 2007, replacing Sulfadoxine-pyrimethermine. Continuous monitoring is needed after introduction of these new drugs to deliver appropriate information on trends of their efficacy and safety. Objective: This study aimed to determine the efficacy and safety of AL as treatment for uncomplicated plasmodium falciparum malaria among six to fifty-nine months old Malawian children. Methods: This was a prospective study of children 6 to 59 months old treated with AL after presenting to the outpatient department with uncomplicated malaria in six health facilities in Malawi. The children were followed up on days 1, 2, 3, 7, 14, 21 and 28 days post-treatment and assessed for clinical and parasitological responses. The Kaplan Meier survival estimate was used to measure the efficacy of AL by calculating the cumulative risk of failure at day 28. Results: A total of 322 children were recruited into the study across the six sites. The overall intention-to-treat (ITT) Polymerase Chain Reaction (PCR)-corrected cure rate was 93.4%. Per protocol overall PCR- corrected cure rate of 92% (95% CI: 88, 95) with PCR-corrected cure rates for the study sites were; Karonga 98.0%, Kawale 97.4%, Machinga 90.2%, Mangochi 95.4% and Rumphi 91.3%. Nkhotakota study site had the lowest cure rate of 78%. Conclusion: There is evidence of good efficacy of AL in Malawi notwithstanding geographical contrasts and this supports the continued use of AL as the first-line drug for uncomplicated malaria. However there may be need to further investigate the comparatively low efficacy rate found in Nkhotakota district in order to identify possible determinants of treatment failure. viii