Tropical Medicine and International Health
Volume 10, Issue 2, 2005, Pages 139-145

Efficacy and effectiveness of the combination of sulfadoxine/pyrimethamine and a 3-day course of artesunate for the treatment of uncomplicated falciparum malaria in a refugee settlement in Zambia (Article)

Depoortere E.* , Guthmann J.-P. , Pressé J. , Sipilanyambe N. , Nkandu E. , Balkan S. , De Pécoulas P.E. , Legros D.
  • a Epicentre, Paris, France, Epicentre, 8 rue Saint Sabin, 75011 Paris, France
  • b Epicentre, Paris, France, Epicentre, 8 rue Saint Sabin, 75011 Paris, France
  • c Medecins Sans Frontieres, Paris, France, Medecins Sans Frontieres, 8 rue Saint Sabin, 75011 Paris, France
  • d Central Board of Health, National Malaria Control Centre, Lusaka, Zambia, Central Board of Health, National Malaria Control Centre, Ndeke House, PO Box 32588, Lusaka, Zambia
  • e University of Zambia, School of Medicine, Lusaka, Zambia, University of Zambia, School of Medicine, PO Box 50110, Lusaka, Zambia
  • f Medecins Sans Frontieres, Paris, France, Medecins Sans Frontieres, 8 rue Saint Sabin, 75011 Paris, France
  • g Laboratory of Microbiology, Hospital of Côte de Nacre, Caen, France, Laboratory of Microbiology, Hospital of Côte de Nacre, Avenue Côte de Nacre, 14033 Caen Cedex, France
  • h Epicentre, Paris, France, Epicentre, 8 rue Saint Sabin, 75011 Paris, France

Abstract

In the Maheba Refugee Settlement, in the clinics supported by Médecins Sans Frontières, all children aged up to 5 years with a confirmed diagnosis of uncomplicated falciparum malaria are treated with the combination of sulfadoxine/pyrimethamine (SP) and artesunate (AS). We compared the treatment's efficacy and effectiveness. Patients were randomized in order to receive the treatment supervised (efficacy) or unsupervised (effectiveness). Therapeutic response was determined after 28 days of follow up. The difference between recrudescence and re-infection was ascertained by polymerase chain reaction (PCR). We also assessed genetic markers associated to SP resistance (dhfr and dhps). Eighty-five patients received treatment under supervision and 84 received it unsupervised. On day 28, and after PCR adjustment, efficacy was found to be 83.5% (95% CI: 74.1-90.5), and effectiveness 63.4% (95% CI: 52.6-73.3) (P < 0.01). Point mutations on dhfr (108) and dhps (437) were found for 92.0% and 44.2% respectively of the PCR samples analysed. The significant difference in therapeutic response after supervised and unsupervised treatment intake can only be explained by insufficient patient adherence. When implementing new malaria treatment policies, serious investment in ensuring patient adherence is essential to ascertain the effectiveness of the new treatment schedules.

Author Keywords

Refugee settlement Zambia Effectiveness Efficacy Malaria Artemisinin-based combination therapy Plasmodium falciparum

Index Keywords

pyrimethamine sulfadoxine drug prescribing artemether monotherapy point mutation refugee controlled clinical trial laboratory diagnosis Sub-Saharan Africa reinfection clinical trial disease treatment follow up human Zambia Refugees Developing Countries Drug Combinations Southern Africa controlled study Malaria randomized controlled trial artesunate drug efficacy Eastern Hemisphere Drug Administration Schedule restriction fragment length polymorphism Treatment Failure Humans genetic marker Genomics Treatment Outcome Genetic Markers Antimalarials male gametocyte preschool child female Infant Child, Preschool Cinchona pubescens Africa polymerase chain reaction prevalence Protozoa Article Drug Therapy, Combination disease transmission Parasitemia patient compliance major clinical study Sesquiterpenes Malaria, Falciparum malaria falciparum Plasmodium falciparum World drug monitoring world health organization drug resistance Artemisinins fansidar quinine
Link
https://www.scopus.com/inward/record.uri?eid=2-s2.0-13944273060&doi=10.1111%2fj.1365-3156.2004.01363.x&partnerID=40&md5=38c3107701374ca830bd6e70477ad565
DOI: 10.1111/j.1365-3156.2004.01363.x
ISSN: 13602276
Cited by: 30
Original Language: English