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Effectiveness of artemether-lumefantrine provided by community health workers in under-five children with uncomplicated malaria in rural Tanzania: an open label prospective study

2011Journal article Open access
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dc.contributor.authorNgasala, Billy E.
dc.contributor.authorMalmberg, Maja
dc.contributor.authorCarlsson, Anja M.
dc.contributor.authorFerreira, Pedro
dc.contributor.authorPetzold, Max G.
dc.contributor.authorBlessborn, Daniel
dc.contributor.authorBergqvist, Yngve
dc.contributor.authorGil, José Pedro
dc.contributor.authorPremji, Zul
dc.contributor.authorMartensson, Andreas
dc.date.accessioned2018-12-07T14:53:21Z
dc.date.available2018-12-07T14:53:21Z
dc.date.issued2011
dc.description.abstractBackground: Home-management of malaria (HMM) strategy improves early access of anti-malarial medicines to high-risk groups in remote areas of sub-Saharan Africa. However, limited data are available on the effectiveness of using artemisinin-based combination therapy (ACT) within the HMM strategy. The aim of this study was to assess the effectiveness of artemether-lumefantrine (AL), presently the most favoured ACT in Africa, in under-five children with uncomplicated Plasmodium falciparum malaria in Tanzania, when provided by community health workers (CHWs) and administered unsupervised by parents or guardians at home. Methods: An open label, single arm prospective study was conducted in two rural villages with high malaria transmission in Kibaha District, Tanzania. Children presenting to CHWs with uncomplicated fever and a positive rapid malaria diagnostic test (RDT) were provisionally enrolled and provided AL for unsupervised treatment at home. Patients with microscopy confirmed P. falciparum parasitaemia were definitely enrolled and reviewed weekly by the CHWs during 42 days. Primary outcome measure was PCR corrected parasitological cure rate by day 42, as estimated by Kaplan-Meier survival analysis. This trial is registered with ClinicalTrials.gov, number NCT00454961. Results: A total of 244 febrile children were enrolled between March-August 2007. Two patients were lost to follow up on day 14, and one patient withdrew consent on day 21. Some 141/241 (58.5%) patients had recurrent infection during follow-up, of whom 14 had recrudescence. The PCR corrected cure rate by day 42 was 93.0% (95% CI 88.3%-95.9%). The median lumefantrine concentration was statistically significantly lower in patients with recrudescence (97 ng/mL [IQR 0-234]; n = 10) compared with reinfections (205 ng/mL [114-390]; n = 92), or no parasite reappearance (217 [121-374] ng/mL; n = 70; p <= 0.046). Conclusions: Provision of AL by CHWs for unsupervised malaria treatment at home was highly effective, which provides evidence base for scaling-up implementation of HMM with AL in Tanzania.
dc.description.sponsorshipSIDA
dc.identifier.doi10.1186/1475-2875-10-64
dc.identifier.issn1475-2875
dc.identifier.urihttp://hdl.handle.net/10400.1/11472
dc.language.isoeng
dc.peerreviewedyes
dc.publisherBiomed Central Ltd
dc.subjectPlasmodium-Falciparum Malaria
dc.subjectPlus Sulfadoxine-Pyrimethamine
dc.subjectIn-Vivo Selection
dc.subjectRandomized-Trial
dc.subjectBurkina-Faso
dc.subjectAmodiaquine
dc.subjectAlleles
dc.subjectResistance
dc.subjectUganda
dc.subjectPharmacokinetics
dc.titleEffectiveness of artemether-lumefantrine provided by community health workers in under-five children with uncomplicated malaria in rural Tanzania: an open label prospective study
dc.typejournal article
dspace.entity.typePublication
oaire.citation.startPage64
oaire.citation.titleMalaria Journal
oaire.citation.volume10
person.familyNameFerreira
person.familyNameGil
person.givenNamePedro
person.givenNameJosé Pedro
person.identifier332675
person.identifier.ciencia-id5E15-DD6D-50E6
person.identifier.ciencia-idD01A-B30E-BCD5
person.identifier.orcid0000-0002-2682-7722
person.identifier.orcid0000-0002-6107-9379
person.identifier.ridQ-6748-2016
person.identifier.scopus-author-id55427200100
person.identifier.scopus-author-id7201625436
rcaap.rightsopenAccess
rcaap.typearticle
relation.isAuthorOfPublicatione0a51049-1676-475b-a9e8-1d911386238d
relation.isAuthorOfPublicationcb728715-0e4c-4ae5-9e21-b6a8f35a8313
relation.isAuthorOfPublication.latestForDiscoverye0a51049-1676-475b-a9e8-1d911386238d

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