Assessment of Therapeutic Efficacy of Coartem® in Patients with Uncomplicated Plasmodium Falciparum Malaria in Halaba Special Woreda, Southern Ethiopia
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Date
2012-06
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Addis Ababa University
Abstract
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
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Keywords
Coartem®, falciparum malaria, fever clearance, gametocyte clearance, Halaba Special, District,Parasiteclearance,Haemoglobin