Assessment of Therapeutic Efficacy of Coartem® in Patients with Uncomplicated Plasmodium Falciparum Malaria in Halaba Special Woreda, Southern Ethiopia

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Addis Ababa University


Emergence of malaria parasite drug resistance is a serious problem in malaria control. Artemetherlumefantrine (Coartem®) is used as a first line treatment for uncomplicated falciparum malaria since 2004 in Ethiopia. The objective of the study was to assess the efficacy of Coartem® against falciparum malaria in Halaba Special Woreda, Southern Ethiopia. 5922 individuals that were clinically suspected of malaria were screened for infection. Giemsa stained thin smears were used for identification of Plasmodium species, and thick smears for detection and quantification of the parasites. Among the screened, 1826 (30.8%) were malaria positive, of which 273 (14.9%) were due to Plasmodium flaciparum and 1553 (85.1%), due to Plasmodium vivax. Among Plasmodium flaciparum positive patients, 89 (32.6%) fulfilled the inclusion criteria and were enrolled in the study. Haemoglobin concentration of the study participants was measured on days 0, 14 and 28 using portable spectrophotometer. Study outcomes were classified as early treatment failure (ETF), late clinical failure (LCF), late parasitological failure (LPF) and adequate clinical and parasitological response (ACPR). Out of the 89 study participants, 6 (6.7%) were lost to follow up and 3 (3.4%) withdrew from the study. Following drug administration, parasitemia cleared from all the study participants on day 3, and almost all fever cleared on day 2. Gametocytes were detected in 9% of the study participants on the day of inclusion into the study, and none could be detected after day 7. During follow up, one patient became positive for Plasmodium flaciparum, amounting to a 1.3% LCF, as a result of which the cure rate of Coartem® in the study area was 98.7% (95% CI=93.2-100%). However, as a confirmation of emergence of Coartem® resistance in the study area, it will be necessary to do a PCR correction to determine whether the 1.3% LCF was a new infection or a recrudescence. The mean haemoglobin level of the study participants was 10.8g/dl (Range: 9.2g/dl- 13.7g/dl) on day 0, of which 57.3% were anemic. On day 28 of follow up, mean haemoglobin level significantly increased (P=0.002), compared to day 0, and the proportion of anemic individuals declined. The overall findings of the study have shown high efficacy and safety of Coartem® for treatment of uncomplicated falciparum malaria, in the study area. Also, the high prevalence of P. falciparum and P. vivax malaria, detected in the study area, indicated the ineffectiveness of the control measures in practice. Therefore, the malaria situation in Halaba Special Woreda requires initiation of more effective integrated control measures and periodic monitoring of anti-malarial drug efficacy. Key words: Coartem®, falciparum malaria, fever clearance, gametocyte clearance, Halaba Special District,Parasiteclearance,Haemoglobin



Coartem®, falciparum malaria, fever clearance, gametocyte clearance, Halaba Special, District,Parasiteclearance,Haemoglobin