Monitoring the efficacy of Coartem® for uncomplicated falciparum malaria in Selekleka town, Tigray Region, Northern Ethiopia
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Date
2011-06
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Addis Ababa University
Abstract
Drug resistance is the most serious problem in achieving control of malaria. The spread of
Plasmodium falciparum resistance to almost all available affordable mono-therapy, in many
malaria endemic regions, is a serious impediment on malaria control. The current WHO
recommendation for treatment of uncomplicated P. falciparum malaria is the use of Coartem®,
an artemisinin based combination therapy (ACT). Coartem® (20mg artemether and 120mg
lumefantrine) is an artemisinin based tablet that provides effective antimalarial treatment against
uncomplicated falciparum malaria in many parts of the world, including sub-saharan Africa. The
present study was conducted to monitor the efficacy of this drug in patients 6 months with
uncomplicated falciparum malaria in Selekleka town, Northwestern Tigray, Ethiopia. A total of
98 study participants, microscopically confirmed for P. falciparum mono-infection, were
included in the study. Majority of the study participants were adults above 15 years (87.8%). At
enrollment, 65 (66%) patients were febrile (T 37.5ºC) and the overall parasite mean density
was 22,679. Six doses of Coartem were given over 3 days, two doses each day, on D0, D1, and
D2; with a follow up on D3, D7, D14, D21 and D28. The clinical and parasitological conditions
of the patients were assessed at each visit. The level of hemoglobin in the study participants was
determined by using hemocue reader. 89 (90.8%) patients completed the 28-day follow-up while
9 (9.2%) patients were excluded from the study because of loss-to-follow-up and withdrawal of
consent. The ACT treatment rapidly cleared parasitaemia and fever by D2 and complete
gametocyte clearance was obtained on D21. Significant (p= 0.05) hemoglobin recovery was
observed among patients with adequate clinical and parasitological response. No severe adverse
side-effects, clinical failures or parasitological failures were observed among these patients.
Overall, the 28-day clinical and parasitological cure rate was 100%. Coartem, therefore, was
efficacious for the treatment of uncomplicated falciparum malaria in Selekleka town. However,
the reported increasing trend in P. falciparum prevalence since 2007/8 in Selekleka, despite free
availability of Coartem and ITN coverage, needs further investigation on the efficacy of the
malaria measures in use.
Key words: Malaria, P. falciparum, Coartem, Selekleka town, Cure rate, Hemoglobin recovery, Adverse effects
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Keywords
Malaria, P. falciparum, Coartem, Selekleka town, Cure rate, Hemoglobin recovery, Adverse effects