Sentinel study on the efficacy of three artemisinin–based antimalarial combination therapies in Kaduna, Northwest – Nigeria

Abstract

Background. Resistance still remains the major obstacle in the fight against malaria and reports from Southeast Asia on resistance to ACTs are disturbing. The study was a clinical and parasitological evaluation of artemether-lumefantrine (AL), artesunate-mefloquine (AM) and dihydroartemisininpiperaquine (DP) for treatment of uncomplicated falciparum malaria in Kaduna State, North -Western Nigeria conducted in 2011.

Materials and Methods. Patients aged 6 months to 60 years who were confirmed malaria falciparum positive were randomly placed in one of three treatment groups and administered with either AL, AM or DP standard doses. Patients were followed-up for either 28 or 42 days. Fever, parasite clearance times and therapeutic efficacy of study drugs were determined.

Results. A total of 324 patients were enrolled for the study. Study drugs had excellent fever and parasite clearance times of 1.44 and 1.41 days respectively. A total of 28 (9.2%) patients had re-appearance of parasitaemia. PCRUncorrected success rates were 96.3% and 90.6% after 28 and 42 days follow-up respectively. Artemetherlumefantrine, AM and DP had 91.1%, 86.2%, 94.9% individual success rates respectively. Ninety per cent of failures were seen in patients 5 to 14 years.

Conclusion. The study reported the therapeutic efficacy of three commonly used ACTs in Nigeria for the year 2011 and showed it to be effective in the treatment of uncomplicated malaria, however continuous monitoring of the ACTs is required.

Keywords: Uncomplicated malaria, treatment, efficacy study, artemisinin combination therapy, Plasmodium falciparum, resistance, artemether – lumefantrine, artesunate – amodiaquine, dihydroartemisinin – piperaquine