Abstract
BackgroundEmergence of Plasmodium falciparum resistance to artemisinin and its derivatives poses a threat to the global effort to control malaria. The emergence of anti-malarial resistance has become a great public health challenge and continues to be a leading threat to ongoing malaria control efforts. The aim of this review was to synthesize available evidence on the efficacy of dihydroartemisinin-piperaquine (DHA-PQ) compared to artemether-lumefantrine (AL) for the treatment of uncomplicated falciparum malaria among children in Africa.MethodsA systematic literature search was done to identify relevant articles from online databases PubMed/ MEDLINE, Embase, and Cochrane Central Register of Controlled Trials’ database (CENTRAL) for retrieving randomized control trials comparing efficacy of DHA-PQ and AL for treatment of uncomplicated falciparum malaria in African children. The search was performed from August 2020 to April 2021. Using Rev-Man software (V5.4.1), R-studio and Comprehensive Meta-analysis software version 3, the extracted data from eligible studies were pooled as risk ratio (RR) with 95% confidence interval (CI).ResultsIn this review, 25 studies which involved a total of 13,198 participants were included. PCR-unadjusted treatment failure in children aged between 6 months and 15 years was significantly lower in the DHA-PQ treatment arm on day 28 than that of AL (RR 0.14, 95% CI 0.08–0.26; participants = 1302; studies = 4; I2 = 0%, high quality of evidence). Consistently, the PCR-adjusted treatment failure was significantly lower with DHA-PQ treatment group on day 28 (RR 0.45, 95% CI 0.29–0.68; participants = 8508; studies = 16; I2 = 51%, high quality of evidence) and on day 42 (RR 0.60, 95% CI 0.47–0.78; participants = 5959; studies = 17; I2 = 0%, high quality of evidence). However, the efficacy was ≥ 95% in both treatment groups on day 28.ConclusionFrom this review, it can be concluded that DHA-PQ reduces new infection and recrudescence on days 28 and 42 more than AL. This may trigger DHA-PQ to become a first-line treatment option.
Highlights
Emergence of Plasmodium falciparum resistance to artemisinin and its derivatives poses a threat to the global effort to control malaria
Effect of interventions Polymerase chain reaction (PCR)‐unadjusted total failure on day 28 The PCR-unadjusted treatment failure in patients aged between 6 months and 15 years was lower in patients who were treated with DHA-PQ than that of AL [risk ratio (RR) 0.14, 95% confidence interval (CI) 0.08–0.26; participants = 1302; studies = 4; I2 = 0%, high quality of evidence (Fig. 3)]
In 12/13 studies, the risk of treatment failure unadjusted by genotyping in children under five was significantly lower in the DHA-PQ treatment group than that of AL
Summary
Emergence of Plasmodium falciparum resistance to artemisinin and its derivatives poses a threat to the global effort to control malaria. The emergence of anti-malarial resistance has become a great public health challenge and continues to be a leading threat to ongoing malaria control efforts. In 2019, an estimated 229 million cases were reported globally from 87 malaria-endemic countries [3], of which 215 million cases were reported by the World Health Organization (WHO) African Region [3]. The risk of malaria infections among children aged under five years was higher in 2018, and the Plasmodium falciparum parasite was responsible for an estimated 24 million malaria cases in African children [1]. All African counties where falciparum malaria is endemic have introduced currently recommended artemisinin-based combination therapy (ACT) in confirmed cases of falciparum malaria since 2004 [1]. Artemisinin and partner drugs protect each other to prevent resistance development [5,6,7,8]
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