Abstract
BackgroundCase management based on prompt diagnosis and adequate treatment using artemisinin-based combination therapy (ACT) remains the main focus of malaria control in Ghana. As part of routine surveillance on the therapeutic efficacy of ACT in Ghana, the efficacy of amodiaquine-artesunate (AS-AQ) and artemether-lumefantrine (AL) were studied in six sentinel sites representing the forest and savannah zones of the country.MethodsThree sites representing the two ecological zones studied AS-AQ whilst the other three sites studied AL. In each site, the study was a one-arm prospective evaluation of the clinical, parasitological, and haematological responses to directly observed therapy for uncomplicated malaria with either AS-AQ or AL among children aged 6 months and 9 years. The WHO 2009 protocol for monitoring anti-malarial drug efficacy was used for the study between July 2013 and March 2014.ResultsPer-protocol analyses on day 28 showed an overall PCR-corrected cure rate of 100 % for AS-AQ and 97.6 % (95 % CI 93.1, 99.5) for AL: 97.2 % (95 % CI 92.0, 99.4) in the forest zone and 100 % in the savannah zone. Kaplan–Meier survival analysis showed similar outcomes. Prevalence of fever decreased by about 75 % after the first day of treatment with each ACT in the two ecological zones. No child studied was parasitaemic on day 3, and gametocytaemia was generally maintained at low levels (<5 %). Post-treatment mean haemoglobin concentrations significantly increased in the two ecological zones.ConclusionsTherapeutic efficacy of AS-AQ and AL remains over 90 % in the forest and savannah zones of Ghana. Additionally, post-treatment parasitaemia on day 3 is rare suggesting that artemisinin is still efficacious in Ghana.
Highlights
Case management based on prompt diagnosis and adequate treatment using artemisinin-based combination therapy (ACT) remains the main focus of malaria control in Ghana
Baseline characteristics A cumulative total of 310 children participated in the study in the two ecological zones: 140 received AS-AQ and 170 received AL
For the same group of children, mean axillary temperature was significantly higher in the savannah zone compared with the forest zone whilst geometric mean parasite count was significantly higher in the forest zone (Table 1)
Summary
Case management based on prompt diagnosis and adequate treatment using artemisinin-based combination therapy (ACT) remains the main focus of malaria control in Ghana. Malaria remains a major public health problem in the world after decades of deployment of different interventions. It is estimated that in 2013 there were approximately 198 million cases of malaria worldwide, representing a decline of 30 % since year 2000. Malaria accounted for approximately 584,000 deaths worldwide, representing a decline of 47 % since year 2000. It is estimated that about 78 % of all malaria deaths occur among children aged under 5 years [1]. In 2013, malaria was estimated to account for 44 % of all outpatient clinic visits and 22.3 % of all under-five deaths in Ghana [2]
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