Abstract
Background: The development and spread of antimalarial drug resistant parasites contributes to the global impact of the disease. In vivo efficacy assessments of treatments for Plasmodium falciparum malaria are essential for ensuring effective case management. Artemisinin-based combinations have been adopted as the first-line treatment for uncomplicated P. falciparum malaria in Cameroon since 2004. Methods: A total of 177 children aged six-months to 10 years with uncomplicated mono-infected falciparum malaria were randomized (1:1) to receive artesunate/sulphadoxine-pyrimethamine (AS/SP) or artesunate/amodiaquine (AS/AQ) pediatric tablets and followed up for 28 days according to the standard World Health Organization in vivo drug efficacy monitoring protocol. The primary and secondary endpoints were PCR uncorrected and corrected cure rates, as measured by adequate clinical and parasitological response (ACPR) on day 28. Results: The PCR corrected cure rate was high, overall (88.1%, 95% CI 83.1–93.1), 85.9% (95% CI 78.2–93.6), and 90.2% (95% CI 83.8–96.6) for AS/SP and AS/AQ, respectively. Twenty-one treatment failures were observed during follow-up, constituting one (4.6%), 14 (8.2%), and six (3.5%) early treatment failure (ETF), late clinical failure (LCF), and late parasitological failure (LPF), respectively. The drugs were well tolerated with no serious adverse events. Conclusions: Both AS/SP and AS/AQ are highly effective and well-tolerated treatments for uncomplicated P. falciparum malaria around the slope of Mount Cameroon.
Highlights
Malaria due to Plasmodium falciparum is the leading cause of morbidity and mortality in Africa, especially in children under the age of five years, where a child dies every minute [1]
Of the 565 patients screened from the two study sites, 180 were positive for malaria parasites, of which 179 had P. falciparum mono-infection
At the Buea Regional Hospital (BRH), the slide positivity rate was 40.0% (6/15), of which P. falciparum mono-infection accounted for 100% (6/6); whereas, at the Tole health post, the slide positivity rate was 31.6% (174/550) of which P. falciparum mono-infection accounted for 99.4%
Summary
Malaria due to Plasmodium falciparum is the leading cause of morbidity and mortality in Africa, especially in children under the age of five years, where a child dies every minute [1]. The disease remains a major public health concern in spite of the scale up in control interventions [2,3] due partly to the development and spread of antimalarial drug resistant parasites [4]. Led to sweeping changes in antimalarial treatment recommendations These therapies have been compromised by the spread of drug resistance leading to the World Health Organization (WHO). Recommending the use of Artemisinin-based combination therapies (ACTs) as the first-line treatment regimen for uncomplicated malaria in all endemic regions [5]. ACTs combine an artemisinin-derivative, usually dihydroartemisinin, artesunate or artemether, with another longer-lasting drug such as lumefantrine, mefloquine, amodiaquine, sulfadoxine/pyrimethamine, and piperaquine, with different mode of action to try and reduce the risk of further resistance developing and to lower the treatment course [6]. Artemisinin-based combinations have been adopted as the first-line treatment for uncomplicated P. falciparum malaria in Cameroon since
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