Abstract
BackgroundRegular monitoring of anti-malarial drug efficacy is vital for establishing rational malaria treatment guidelines and ensuring adequate treatment outcomes. This study aimed to synthesize the available evidence on the efficacy of artemether–lumefantrine for the management of uncomplicated falciparum malaria in Ethiopia.MethodsThe Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. Relevant published studies were searched from the databases (PubMed, Google Scholar and Clinical trial registry) on published artemether–lumefantrine therapeutic efficacy studies conducted in Ethiopia from 2004 to 2020. The retrieved studies were assessed for quality using the modified Newcastle Ottawa Scale for observational studies and modified Jadad scale for interventional studies. Risk of bias was also assessed by using ROBINS-I tool. OpenMeta-Analyst software was used for the statistical analysis. The review protocol is registered in PROSPERO, number CRD42020201859.ResultsFifteen studies (1523 participants) were included in the final analysis. The overall PCR-uncorrected pooled proportion of treatment success of artemether–lumefantrine therapy for uncomplicated falciparum malaria was 98.4% (95%CI 97.6–99.1). A random-effects model was used because of considerable heterogeneity [χ2 = 20.48, df (14), P = 0.011 and I2 = 31.65]. PCR-corrected pooled proportion of treatment success of artemether–lumefantrine therapy was 98.7% (95% CI 97.7–99.6). A random-effects model was used [χ2 = 7.37, df(6), P = 0.287 and I2 = 18.69]. Most studies included in the present review achieved a rapid reduction of fevers and parasitaemia between D0 and D3 of assessment. Adverse events were mostly mild and only two cases were reported as serious, but were not directly attributed to the drug.ConclusionThe present meta-analysis suggests that artemether–lumefantrine therapy is efficacious and safe in treating uncomplicated falciparum malaria in Ethiopia. However, owing to the high risk of bias in the included studies, strong conclusions cannot be drawn. Further high-quality RCTs assessing anti-malarial efficacy and safety should be performed to demonstrates strong evidence of changes in parasite sensitivity to artemether–lumefantrine in Ethiopia.
Highlights
Regular monitoring of anti-malarial drug efficacy is vital for establishing rational malaria treatment guidelines and ensuring adequate treatment outcomes
Methodological quality assessment Two review authors independently assessed the methodological quality of the selected studies by using methodological quality assessment forms and the criteria outlined in the Cochrane Handbook for Systematic Reviews of Interventions [22, 23].Any disagreements between the two review authors were resolved through discussion
The study results showed that most recurrent parasitaemia occur after day 28 and this emphasizes the need for follow-up periods of at least 42 days
Summary
Regular monitoring of anti-malarial drug efficacy is vital for establishing rational malaria treatment guidelines and ensuring adequate treatment outcomes. This study aimed to synthesize the available evidence on the efficacy of artemether–lumefantrine for the management of uncomplicated falciparum malaria in Ethiopia. Malaria is one of the leading health problems in Ethiopia. 60% of the total populations in Ethiopia live in malaria-endemic area. Sixty percent of malaria infections in Ethiopia are due to Plasmodium falciparum and 40% of infections are due to Plasmodium vivax [1, 2]. Resistance of P. falciparum to the traditional antimalarial drugs (such as chloroquine, sulfadoxine– pyrimethamine, amodiaquine, and mefloquine) is a growing problem and is thought to have contributed to increased malaria mortality in recent years [3]. There is high‐ level resistance to sulfadoxine‐pyrimethamine throughout South East Asia and increasingly in Africa, including Ethiopia, and mefloquine resistance is common in the border areas of Cambodia, Myanmar, and Thailand [3, 4]
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