Abstract
BackgroundVery few data on anti-malarial efficacy are available from the Democratic Republic of Congo (DRC). DRC changed its anti-malarial treatment policy to amodiaquine (AQ) and artesunate (AS) in 2005.MethodsThe results of two in vivo efficacy studies, which tested AQ and sulphadoxine-pyrimethamine (SP) monotherapies and AS+SP and AS+AQ combinations in Boende (Equatorial province), and AS+SP, AS+AQ and SP in Kabalo (Katanga province), between 2003 and 2004 are presented. The methodology followed the WHO 2003 protocol for assessing the efficacy of anti-malarials in areas of high transmission.ResultsOut of 394 included patients in Boende, the failure rates on day 28 after PCR-genotyping adjustment of AS+SP and AS+AQ were estimated as 24.6% [95% CI: 16.6–35.5] and 15.1% [95% CI: 8.6–25.7], respectively. For the monotherapies, failure rates were 35.9% [95% CI: 27.0–46.7] for SP and 18.3% [95% CI: 11.6–28.1] for AQ. Out of 207 patients enrolled in Kabalo, the failure rate on day 28 after PCR-genotyping adjustment was 0 [1-sided 95% CI: 5.8] for AS+SP and AS+AQ [1-sided 95% CI: 6.2]. It was 19.6% [95% CI: 11.4–32.7] for SP monotherapy.ConclusionThe finding of varying efficacy of the same combinations at two sites in one country highlights one difficulty of implementing a uniform national treatment policy in a large country. The poor efficacy of AS+AQ in Boende should alert the national programme to foci of resistance and emphasizes the need for systems for the prospective monitoring of treatment efficacy at sentinel sites in the country.
Highlights
Very few data on anti-malarial efficacy are available from the Democratic Republic of Congo (DRC)
The Democratic Republic of Congo (DRC) is a vast country covering more than two million square kilometres and with an estimated population of 60 million people
Another study conducted in Rutshuru, a district near the Rwandan border in Eastern DRC, reported day 14 PCRunadjusted cure rates of 63% and 24% for SP monotherapy and AS+SP, respectively [3]
Summary
Very few data on anti-malarial efficacy are available from the Democratic Republic of Congo (DRC). DRC changed its anti-malarial treatment policy to amodiaquine (AQ) and artesunate (AS) in 2005. In 2004, one study presented day 28 PCR genotyping-adjusted failure rates of 19.7% for artesunate+sulphadoxine-pyrimethamine (AS+SP) and 6.7% for AS+amodiaquine (AS+AQ) in South Kivu province [2]. Another study conducted in Rutshuru, a district near the Rwandan border in Eastern DRC, reported day 14 PCRunadjusted cure rates of 63% and 24% for SP monotherapy and AS+SP, respectively [3]. The results of two in vivo efficacy studies conducted independently in DRC in 2003–2004, when the National Malaria Control Programme (NMCP) was in the process of changing treatment policy to an artemisinin combination therapy (ACT) are presented. A good correlation has been shown between mutations in the dihydrofolate reductase (dhfr) and dihydropteroate synthase (dhps) genes of Plasmodium falciparum and resistance to pyrimethamine and sulphadoxine, respectively [3,4,5]
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