Artemisinin Derivatives Based Therapeutic Combinations for The Treatment of Uncomplicated Plasmodium Falciparum Malaria: Find-Ings of a Meta-Analysis of Surveys Carried Out in Senegal
Journal Title: Biomedical Journal of Scientific & Technical Research (BJSTR) - Year 2018, Vol 8, Issue 4
Abstract
bjectives: The objective of this study was to analyze studies comparing efficacy of various Artemisinin-based combination therapies (ACTs). Study Design: Meta-analysis of 11 selected studies: 10 were comparative with AL and 1 without AL. Method: The patient groups were comparable at the inclusion. Patients were followed for 28 days (D) according to the WHO protocol with regular clinical and laboratory evaluations. Results: Very good efficacy (>95%) were obtained at D28, for all the combinations tested, with no statistically significant difference. The total clearance of fever was obtained at D3 for all patients. The fever was more persistent at D2 in children with ASAQ and ASMQ than in those with AL. Parasitic clearance was better for all ACTs than for AL, except for DHPQTMP. At D2, gametocyte carriage was similar for the treatment groups analyzed. Side effects were more marked in patients treated with ASMQ than in those on AL. Conclusion: ACTs are of great benefit in the management of uncomplicated P. falciparum malaria. The ASAQ, ASMQ, DHAPQ and DHPQTMP associations are as effective and well tolerated as the AL association.As the largest human parasitic disease globally, malaria is a significant public health problem [1-3]. In the world, 40% of the population are at risk of malaria infection. Programs have reduce the incidence of the disease and the associated mortality by 30% and 47% respectively between 2000 and 2013 4. However, although progress has been good, a lot remains to be done; 198 million cases of malaria and 584 000 associated deaths still occur every year [4]. Early and proper treatment of cases is one of the pillars of malaria control. It has unfortunately come up against the emergence of resistance to the anti-malaria molecules used in mono-therapies so far. The WHO had therefore recommended bi-therapies with artimisinin combination therapies (ACTs) [5,6] and asked countries to ensure a permanent monitoring of their effectiveness [7].In Africa, most cases and fatalities occur in non-immunized persons, pregnant women and children. Every minute, a child dies of malaria. That represents 22% of all child deaths. But, with an increase in funds for malaria control, RDTs and ACTs has grown from 68% in 2005 to 75% in 2011, especially in sub-Saharan Africa. In Senegal, malaria related morbidity has dropped from 33.57% in 2006 to 3.07% in 2009. The National Malaria Control Program (PNLP) adopted ACTs in 2006 as the recommended treatment for uncomplicated malaria with Plasmodium falciparum [8]. Back then, Artemether-Lumefantrin and Artesunate-Amodiaquin were used as first line therapy. In 2010, the combination Dihydro-Artemisinin- Piperaquin was introduced to respond to the ACT stock-outs which were observed countrywide. That scale-up included also RDTs and it was accompanied by the setting up of a pharmacovigilance system [9] and an annual plan for the surveillance of the sensitivity of P. falciparum to ACTs under which several clinical trials were performed. The objective of this meta-analysis was to compare dthe clinical and parasitological effectiveness, the thermal and parasitic clearance, lethe gametocyte carriage and the tolerance level of various ACTs used to treat uncomplicated P. falciparum malaria in Senegal.
Authors and Affiliations
Papa Ndiaye, Annie Wassiatou Abiola, Roger Clement Tine, Kouvidjin Ekoue, Coumba Cisse, Khadime Sylla, Doudou Sow, Ibrahima Diallo, Thwing J, Jean Louis Ndiaye, Magatte Ndiaye, Aminata Colle Lo, Oumar Gaye, Babacar Faye
Keywords
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- EP ID EP591048
- DOI 10.26717/BJSTR.2018.08.001674
- Views 156
- Downloads 0
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