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Kayode AT, Akano K, Ajogbasile FV, Uwanibe JN, Oluniyi PE, Bankole BE, Eromon PJ, Sowunmi A, Folarin OA, Volkman SK, McInnis B, Sabeti P, Wirth DF, Happi CT. Polymorphisms in Plasmodium falciparum chloroquine resistance transporter (Pfcrt) and multidrug-resistant gene 1 (Pfmdr-1) in Nigerian children 10 years post-adoption of artemisinin-based combination treatments. Int J Parasitol 2021; 51:301-310. [PMID: 33359205 PMCID: PMC7940560 DOI: 10.1016/j.ijpara.2020.10.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 09/08/2020] [Accepted: 10/03/2020] [Indexed: 12/13/2022]
Abstract
The emergence and spread of Plasmodium falciparum parasites resistant to artemisinin derivatives and their partners in southeastern Asia threatens malaria control and elimination efforts, and heightens the need for an alternative therapy. We have explored the distribution of P. falciparum chloroquine resistance transporter (Pfcrt) and multidrug-resistant gene 1 (Pfmdr-1) haplotypes 10 years following adoption of artemisinin-based combination therapies in a bid to investigate the possible re-emergence of Chloroquine-sensitive parasites in Nigeria, and investigated the effect of these P. falciparum haplotypes on treatment outcomes of patients treated with artemisinin-based combination therapies. A total of 271 children aged <5 years with uncomplicated falciparum malaria were included in this study. Polymorphisms on codons 72-76 of the Pfcrt gene and codon 86 and 184 of Pfmdr-1 were determined using the high resolution melting assay. Of 240 (88.6%) samples successfully genotyped with HRM for Pfcrt, wildtype C72M74N75K76 (42.9%) and mutant C72I74E75T76 (53.8%) were observed. Also, wildtype N86Y184 (62.9%) and mutant N86F184 (21.1%), Y86Y184 (6.4%), and Y86F184 (0.4%) haplotypes of Pfmdr-1 were observed. Measures of responsiveness to ACTs were similar in children infected with P. falciparum crt haplotypes (C72I74E75T76 and C72M74N75K76) and major mdr-1 haplotypes (N86Y184, N86F184 and Y86Y184). Despite a 10 year gap since the malaria treatment policy changed to ACTs, over 50% of the P. falciparum parasites investigated in this study harboured the Chloroquine-resistant C72I74E75T76 haplotype, however this did not compromise the efficacy of artemisinin-based combination therapies. Should complete artemisinin resistance emerge from or spread to Nigeria, chloroquine might not be a good alternative therapy.
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Affiliation(s)
- Adeyemi T Kayode
- African Centre of Excellence for Genomics of Infectious Diseases, Redeemer's University, Ede, Nigeria; Department of Biological Sciences, Redeemer's University, Ede, Nigeria
| | - Kazeem Akano
- African Centre of Excellence for Genomics of Infectious Diseases, Redeemer's University, Ede, Nigeria; Department of Biological Sciences, Redeemer's University, Ede, Nigeria
| | - Fehintola V Ajogbasile
- African Centre of Excellence for Genomics of Infectious Diseases, Redeemer's University, Ede, Nigeria; Department of Biological Sciences, Redeemer's University, Ede, Nigeria
| | - Jessica N Uwanibe
- African Centre of Excellence for Genomics of Infectious Diseases, Redeemer's University, Ede, Nigeria; Department of Biological Sciences, Redeemer's University, Ede, Nigeria
| | - Paul E Oluniyi
- African Centre of Excellence for Genomics of Infectious Diseases, Redeemer's University, Ede, Nigeria; Department of Biological Sciences, Redeemer's University, Ede, Nigeria
| | - Bolajoko E Bankole
- African Centre of Excellence for Genomics of Infectious Diseases, Redeemer's University, Ede, Nigeria; Department of Biological Sciences, Redeemer's University, Ede, Nigeria
| | - Philomena J Eromon
- African Centre of Excellence for Genomics of Infectious Diseases, Redeemer's University, Ede, Nigeria
| | - Akintunde Sowunmi
- Institute of Medical Research and Training, College of Medicine, University of Ibadan; Department of Pharmacology and Therapeutics, University of Ibadan, Ibadan, Nigeria
| | - Onikepe A Folarin
- African Centre of Excellence for Genomics of Infectious Diseases, Redeemer's University, Ede, Nigeria; Department of Biological Sciences, Redeemer's University, Ede, Nigeria
| | - Sarah K Volkman
- Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, MA, USA; The Broad Institute of Harvard and MIT, Cambridge, MA, USA
| | | | - Pardis Sabeti
- Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, MA, USA; The Broad Institute of Harvard and MIT, Cambridge, MA, USA
| | - Dyann F Wirth
- Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, MA, USA; The Broad Institute of Harvard and MIT, Cambridge, MA, USA
| | - Christian T Happi
- African Centre of Excellence for Genomics of Infectious Diseases, Redeemer's University, Ede, Nigeria; Department of Biological Sciences, Redeemer's University, Ede, Nigeria; Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
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Severe Malaria: A Case of a Significant Rapid Rise in the Parasite Level. Case Rep Infect Dis 2020; 2020:5206186. [PMID: 32257469 PMCID: PMC7102467 DOI: 10.1155/2020/5206186] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 02/25/2020] [Accepted: 02/26/2020] [Indexed: 11/17/2022] Open
Abstract
Malaria is transmitted by the Plasmodium parasite, and most of the cases reported in the United States are often as a result of patients with recent return from endemic areas. Prompt diagnosis and treatment, particularly if there is severe parasitemia and drug failure, is essential in preventing mortality. Our patient had an unusual rapid rise in parasite but susceptible to intravenous artesunate.
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Sowunmi A, Ntadom G, Akano K, Ibironke FO, Ayede AI, Agomo C, Folarin OA, Gbotosho GO, Happi C, Oguche S, Okafor HU, Meremikwu M, Agomo P, Ogala W, Watila I, Mokuolu O, Finomo F, Ebenebe JC, Jiya N, Ambe J, Wammanda R, Emechebe G, Oyibo W, Useh F, Aderoyeje T, Dokunmu TM, Alebiosu OT, Amoo S, Basorun OK, Wewe OA, Okafor C, Akpoborie O, Fatunmbi B, Adewoye EO, Ezeigwe NM, Oduola A. Declining responsiveness of childhood Plasmodium falciparum infections to artemisinin-based combination treatments ten years following deployment as first-line antimalarials in Nigeria. Infect Dis Poverty 2019; 8:69. [PMID: 31383040 PMCID: PMC6683392 DOI: 10.1186/s40249-019-0577-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Accepted: 07/09/2019] [Indexed: 12/12/2022] Open
Abstract
Background The development and spread of artemisinin-resistant Plasmodium falciparum malaria in Greater Mekong Subregion has created impetus for continuing global monitoring of efficacy of artemisinin-based combination therapies (ACTs). This post analyses is aimed to evaluate changes in early treatment response markers 10 years after the adoption of ACTs as first-line treatments of uncomplicated falciparum malaria in Nigeria. Methods At 14 sentinel sites in six geographical areas of Nigeria, we evaluated treatment responses in 1341 children under 5 years and in additional 360 children under 16 years with uncomplicated malaria enrolled in randomized trials of artemether-lumefantrine versus artesunate-amodiaquine at 5-year interval in 2009–2010 and 2014–2015 and at 2-year interval in 2009–2010 and 2012–2015, respectively after deployment in 2005. Results Asexual parasite positivity 1 day after treatment initiation (APPD1) rose from 54 to 62% and 2 days after treatment initiation from 5 to 26% in 2009–2010 to 2014–2015 (P = 0.002 and P < 0.0001, respectively). Parasite clearance time increased significantly from 1.6 days (95% confidence interval [CI]: 1.55–1.64) to 1.9 days (95% CI, 1.9–2.0) and geometric mean parasite reduction ratio 2 days after treatment initiation decreased significantly from 11 000 to 4700 within the same time period (P < 0.0001 for each). Enrolment parasitaemia > 75 000 μl− 1, haematocrit > 27% 1 day post-treatment initiation, treatment with artemether-lumefantrine and enrolment in 2014–2015 independently predicted APPD1. In parallel, Kaplan-Meier estimated risk of recurrent infections by day 28 rose from 8 to 14% (P = 0.005) and from 9 to 15% (P = 0.02) with artemether-lumefantrine and artesunate-amodiaquine, respectively. Mean asexual parasitaemia half-life increased significantly from 1.1 h to 1.3 h within 2 years (P < 0.0001). Conclusions These data indicate declining parasitological responses through time to the two ACTs may be due to emergence of parasites with reduced susceptibility or decrease in immunity to the infections in these children. Trial registration Pan African Clinical Trial Registration PACTR201508001188143, 3 July 2015; PACTR201508001191898, 7 July 2015 and PACTR201508001193368, 8 July 2015 PACTR201510001189370, 3 July 2015; PACTR201709002064150, 1 March 2017; https://www.pactr.samrca.ac.za Electronic supplementary material The online version of this article (10.1186/s40249-019-0577-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Akintunde Sowunmi
- Antimalarial Therapeutic Efficacy Monitoring Group, National Malaria Elimination Programme, The Federal Ministry of Health, Abuja, Nigeria. .,Department of Pharmacology and Therapeutics, University of Ibadan, Ibadan, Nigeria. .,Institute for Medical Research and Training, University of Ibadan, Ibadan, Nigeria. .,Department of Clinical Pharmacology, University College Hospital, Ibadan, Ibadan, Nigeria.
| | - Godwin Ntadom
- Antimalarial Therapeutic Efficacy Monitoring Group, National Malaria Elimination Programme, The Federal Ministry of Health, Abuja, Nigeria.,Department of Pharmacology and Therapeutics, University of Ibadan, Ibadan, Nigeria
| | - Kazeem Akano
- Antimalarial Therapeutic Efficacy Monitoring Group, National Malaria Elimination Programme, The Federal Ministry of Health, Abuja, Nigeria.,Department of Pharmacology and Therapeutics, University of Ibadan, Ibadan, Nigeria.,Department of Biological Sciences and African Centre of Excellence for Genomics of Infectious Diseases (ACEGID), Redeemer University, Ede, Nigeria
| | - Folasade O Ibironke
- Department of Clinical Pharmacology, University College Hospital, Ibadan, Ibadan, Nigeria
| | | | - Chimere Agomo
- Antimalarial Therapeutic Efficacy Monitoring Group, National Malaria Elimination Programme, The Federal Ministry of Health, Abuja, Nigeria.,Department of Medical Laboratory Science, University of Lagos, Lagos, Nigeria
| | - Onikepe A Folarin
- Department of Biological Sciences and African Centre of Excellence for Genomics of Infectious Diseases (ACEGID), Redeemer University, Ede, Nigeria
| | - Grace O Gbotosho
- Department of Pharmacology and Therapeutics, University of Ibadan, Ibadan, Nigeria.,Institute for Medical Research and Training, University of Ibadan, Ibadan, Nigeria.,Department of Pharmacology and Toxicology, University of Ibadan, Ibadan, Nigeria
| | - Christian Happi
- Antimalarial Therapeutic Efficacy Monitoring Group, National Malaria Elimination Programme, The Federal Ministry of Health, Abuja, Nigeria.,Department of Biological Sciences and African Centre of Excellence for Genomics of Infectious Diseases (ACEGID), Redeemer University, Ede, Nigeria
| | - Stephen Oguche
- Antimalarial Therapeutic Efficacy Monitoring Group, National Malaria Elimination Programme, The Federal Ministry of Health, Abuja, Nigeria.,Department of Paediatrics, University of Jos, Jos, Nigeria
| | - Henrietta U Okafor
- Antimalarial Therapeutic Efficacy Monitoring Group, National Malaria Elimination Programme, The Federal Ministry of Health, Abuja, Nigeria.,Department of Pediatrics, Institute of Child Health, University of Nigeria Teaching Hospital, Enugu, Nigeria
| | - Martin Meremikwu
- Antimalarial Therapeutic Efficacy Monitoring Group, National Malaria Elimination Programme, The Federal Ministry of Health, Abuja, Nigeria.,Department of Paediatrics, University of Calabar, Calabar, Cross River State, Nigeria
| | - Philip Agomo
- Antimalarial Therapeutic Efficacy Monitoring Group, National Malaria Elimination Programme, The Federal Ministry of Health, Abuja, Nigeria.,Nigeria Institute of Medical Research, Lagos, Nigeria
| | - William Ogala
- Antimalarial Therapeutic Efficacy Monitoring Group, National Malaria Elimination Programme, The Federal Ministry of Health, Abuja, Nigeria.,Department of Paediatrics, Ahmadu Bello University, Zaria, Nigeria
| | - Ismaila Watila
- Antimalarial Therapeutic Efficacy Monitoring Group, National Malaria Elimination Programme, The Federal Ministry of Health, Abuja, Nigeria.,Department of Paediatrics, Specialist Hospital, Maiduguri, Nigeria
| | - Olugbenga Mokuolu
- Antimalarial Therapeutic Efficacy Monitoring Group, National Malaria Elimination Programme, The Federal Ministry of Health, Abuja, Nigeria.,Department of Paediatrics and Child Health, University of Ilorin, Ilorin, Nigeria
| | - Finomo Finomo
- Antimalarial Therapeutic Efficacy Monitoring Group, National Malaria Elimination Programme, The Federal Ministry of Health, Abuja, Nigeria.,Department of Paediatrics, Federal Medical Centre, Yenagoa, Nigeria
| | - Joy C Ebenebe
- Antimalarial Therapeutic Efficacy Monitoring Group, National Malaria Elimination Programme, The Federal Ministry of Health, Abuja, Nigeria.,Department of Paediatrics, Nnamdi Azikiwe University, Awka, Nigeria
| | - Nma Jiya
- Antimalarial Therapeutic Efficacy Monitoring Group, National Malaria Elimination Programme, The Federal Ministry of Health, Abuja, Nigeria.,Department of Paediatrics, Uthman Dan Fodio University, Sokoto, Nigeria
| | - Jose Ambe
- Antimalarial Therapeutic Efficacy Monitoring Group, National Malaria Elimination Programme, The Federal Ministry of Health, Abuja, Nigeria.,Department of Paediatrics, University of Maiduguri, Maiduguri, Nigeria
| | - Robinson Wammanda
- Antimalarial Therapeutic Efficacy Monitoring Group, National Malaria Elimination Programme, The Federal Ministry of Health, Abuja, Nigeria.,Department of Paediatrics, Ahmadu Bello University, Zaria, Nigeria
| | - George Emechebe
- Antimalarial Therapeutic Efficacy Monitoring Group, National Malaria Elimination Programme, The Federal Ministry of Health, Abuja, Nigeria.,Department of Paediatrics, Imo State University Teaching Hospital, Orlu, Nigeria
| | - Wellington Oyibo
- Antimalarial Therapeutic Efficacy Monitoring Group, National Malaria Elimination Programme, The Federal Ministry of Health, Abuja, Nigeria.,Department of Medical Microbiology and Parasitology, University of Lagos, Lagos, Nigeria
| | - Francis Useh
- Antimalarial Therapeutic Efficacy Monitoring Group, National Malaria Elimination Programme, The Federal Ministry of Health, Abuja, Nigeria.,Department of Medical Laboratory Science, University of Calabar, Calabar, Nigeria
| | - Temitope Aderoyeje
- Department of Clinical Pharmacology, University College Hospital, Ibadan, Ibadan, Nigeria
| | | | - Omobolaji T Alebiosu
- Department of Pharmacology and Therapeutics, University of Ibadan, Ibadan, Nigeria
| | - Sikiru Amoo
- Department of Pharmacology and Therapeutics, University of Ibadan, Ibadan, Nigeria
| | - Oluwabunmi K Basorun
- Department of Pharmacology and Therapeutics, University of Ibadan, Ibadan, Nigeria
| | - Olubunmi A Wewe
- Department of Pharmacology and Therapeutics, University of Ibadan, Ibadan, Nigeria
| | - Chukwuebuka Okafor
- Department of Pharmacology and Therapeutics, University of Ibadan, Ibadan, Nigeria
| | - Odafe Akpoborie
- Department of Pharmacology and Therapeutics, University of Ibadan, Ibadan, Nigeria
| | - Bayo Fatunmbi
- Antimalarial Therapeutic Efficacy Monitoring Group, National Malaria Elimination Programme, The Federal Ministry of Health, Abuja, Nigeria.,World Health Organization, Country Office, Kampala, Uganda
| | - Elsie O Adewoye
- Department of Physiology, University of Ibadan, Ibadan, Nigeria
| | - Nnenna M Ezeigwe
- Antimalarial Therapeutic Efficacy Monitoring Group, National Malaria Elimination Programme, The Federal Ministry of Health, Abuja, Nigeria
| | - Ayoade Oduola
- University of Ibadan Research Foundation, University of Ibadan, Ibadan, Nigeria
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4
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Akano K, Ntadom G, Agomo C, Happi CT, Folarin OA, Gbotosho GO, Mokuolu O, Finomo F, Ebenebe JC, Jiya N, Ambe J, Wammanda R, Emechebe G, Basorun OK, Wewe OA, Amoo S, Ezeigwe N, Oguche S, Fatunmbi B, Sowunmi A. Parasite reduction ratio one day after initiation of artemisinin-based combination therapies and its relationship with parasite clearance time in acutely malarious children. Infect Dis Poverty 2018; 7:122. [PMID: 30522524 PMCID: PMC6284283 DOI: 10.1186/s40249-018-0503-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Accepted: 11/13/2018] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND In acute falciparum malaria, asexual parasite reduction ratio two days post-treatment initiation (PRRD2) ≥ 10 000 per cycle has been used as a measure of the rapid clearance of parasitaemia and efficacy of artemisinin derivatives. However, there is little evaluation of alternative measures; for example, parasite reduction ratio one day after treatment initiation (PRRD1) and its relationship with parasite clearance time (PCT) or PRRD2. This study evaluated the use of PRRD1 as a measure of responsiveness to antimalarial drugs. METHODS In acutely malarious children treated with artesunate-amodiaquine (AA), artemether-lumefantrine (AL) or dihydroartemisinin-piperaquine (DHP), the relationships between PRRD1 or PRRD2 and PCT, and between PRRD1 and PRRD2 were evaluated using linear regression. Agreement between estimates of PCT using PRRD1 and PRRD2 linear regression equations was evaluated using the Bland-Altman analysis. Predictors of PRRD1 > 5000 per half cycle and PRRD2 ≥ 10 000 per cycle were evaluated using stepwise multiple logistic regression models. Using the linear regression equation of the relationship between PRRD1 and PCT previously generated in half of the DHP-treated children during the early study phase, PCT estimates were compared in a prospective blinded manner with PCTs determined by microscopy during the later study phase in the remaining half. RESULTS In 919 malarious children, PRRD1 was significantly higher in DHP- and AA-treated compared with AL-treated children (P < 0.0001). PRRD1 or PRRD2 values correlated significantly negatively with PCT values (P < 0.0001 for each) and significantly positively with each other (P < 0.0001). PCT estimates from linear regression equations for PRRD1 and PRRD2 showed insignificant bias on the Bland-Altman plot (P = 0.7) indicating the estimates can be used interchangeably. At presentation, age > 15 months, parasitaemia > 10 000/μl and DHP treatment independently predicted PRRD1 > 5000 per half cycle, while age > 30 months, haematocrit ≥31%, body temperature > 37.4 °C, parasitaemia > 100 000/μl, PRRD1 value > 1000 and no gametocytaemia independently predicted PRRD2 ≥ 10 000 per cycle. Using the linear regression equation generated during the early phase in 166 DHP-treated children, PCT estimates and PCTs determined by microscopy in the 155 children in the later phase were similar in the same patients. CONCLUSIONS PRRD1 and estimates of PCT using PRRD1 linear regression equation of PRRD1 and PCT can be used in therapeutic efficacy studies. TRIAL REGISTRATION Pan African Clinical Trial Registration PACTR201709002064150, 1 March 2017, http://www.pactr.org.
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Affiliation(s)
- Kazeem Akano
- Department of Pharmacology and Therapeutics, University of Ibadan, Ibadan, Nigeria
- Antimalarial Therapeutic Efficacy Monitoring Group, National Malaria Elimination Programme, The Federal Ministry of Health, Abuja, Nigeria
| | - Godwin Ntadom
- Department of Pharmacology and Therapeutics, University of Ibadan, Ibadan, Nigeria
- Antimalarial Therapeutic Efficacy Monitoring Group, National Malaria Elimination Programme, The Federal Ministry of Health, Abuja, Nigeria
| | - Chimere Agomo
- Antimalarial Therapeutic Efficacy Monitoring Group, National Malaria Elimination Programme, The Federal Ministry of Health, Abuja, Nigeria
- Department of Medical Laboratory Science, University of Lagos, Lagos, Nigeria
| | - Christian T. Happi
- Antimalarial Therapeutic Efficacy Monitoring Group, National Malaria Elimination Programme, The Federal Ministry of Health, Abuja, Nigeria
- Department of Biological Sciences and African Centre of Excellence for Genomics of Infectious Diseases (ACEGID), Redeemer University, Ede, Nigeria
| | - Onikepe A. Folarin
- Department of Biological Sciences and African Centre of Excellence for Genomics of Infectious Diseases (ACEGID), Redeemer University, Ede, Nigeria
| | - Grace O. Gbotosho
- Department of Pharmacology and Therapeutics, University of Ibadan, Ibadan, Nigeria
- Institute for Medical Research and Training, University of Ibadan, Ibadan, Nigeria
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, University of Ibadan, Ibadan, Nigeria
| | - Olugbenga Mokuolu
- Antimalarial Therapeutic Efficacy Monitoring Group, National Malaria Elimination Programme, The Federal Ministry of Health, Abuja, Nigeria
- Department of Paediatrics, University of Ilorin, Ilorin, Nigeria
| | - Finomo Finomo
- Antimalarial Therapeutic Efficacy Monitoring Group, National Malaria Elimination Programme, The Federal Ministry of Health, Abuja, Nigeria
- Department of Paediatrics, Federal Medical Centre, Yenagoa, Nigeria
| | - Joy C. Ebenebe
- Antimalarial Therapeutic Efficacy Monitoring Group, National Malaria Elimination Programme, The Federal Ministry of Health, Abuja, Nigeria
- Department of Paediatrics, Nnamdi Azikiwe University, Awka, Nigeria
| | - Nma Jiya
- Antimalarial Therapeutic Efficacy Monitoring Group, National Malaria Elimination Programme, The Federal Ministry of Health, Abuja, Nigeria
- Department of Paediatrics, Uthman Dan Fodio University, Sokoto, Nigeria
| | - Jose Ambe
- Antimalarial Therapeutic Efficacy Monitoring Group, National Malaria Elimination Programme, The Federal Ministry of Health, Abuja, Nigeria
- Department of Paediatrics, University of Maiduguri, Maiduguri, Nigeria
| | - Robinson Wammanda
- Antimalarial Therapeutic Efficacy Monitoring Group, National Malaria Elimination Programme, The Federal Ministry of Health, Abuja, Nigeria
- Department of Paediatrics, Ahmadu Bello University, Zaria, Nigeria
| | - George Emechebe
- Antimalarial Therapeutic Efficacy Monitoring Group, National Malaria Elimination Programme, The Federal Ministry of Health, Abuja, Nigeria
- Department of Paediatrics, Imo State University Teaching Hospital, Orlu, Nigeria
| | | | - Olubunmi A. Wewe
- Department of Pharmacology and Therapeutics, University of Ibadan, Ibadan, Nigeria
| | - Sikiru Amoo
- Department of Pharmacology and Therapeutics, University of Ibadan, Ibadan, Nigeria
| | - Nnenna Ezeigwe
- Antimalarial Therapeutic Efficacy Monitoring Group, National Malaria Elimination Programme, The Federal Ministry of Health, Abuja, Nigeria
| | - Stephen Oguche
- Antimalarial Therapeutic Efficacy Monitoring Group, National Malaria Elimination Programme, The Federal Ministry of Health, Abuja, Nigeria
- Department of Paediatrics, University of Jos, Jos, Nigeria
| | - Bayo Fatunmbi
- Antimalarial Therapeutic Efficacy Monitoring Group, National Malaria Elimination Programme, The Federal Ministry of Health, Abuja, Nigeria
- World Health Organization, Country Office, Kampala, Uganda
| | - Akintunde Sowunmi
- Department of Pharmacology and Therapeutics, University of Ibadan, Ibadan, Nigeria
- Antimalarial Therapeutic Efficacy Monitoring Group, National Malaria Elimination Programme, The Federal Ministry of Health, Abuja, Nigeria
- Institute for Medical Research and Training, University of Ibadan, Ibadan, Nigeria
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5
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Ebenebe JC, Ntadom G, Ambe J, Wammanda R, Jiya N, Finomo F, Emechebe G, Mokuolu O, Akano K, Agomo C, Folarin OA, Oguche S, Useh F, Oyibo W, Aderoyeje T, Abdulkadir M, Ezeigwe NM, Happi C, Sowunmi A. Efficacy of Artemisinin-Based Combination Treatments of Uncomplicated Falciparum Malaria in Under-Five-Year-Old Nigerian Children Ten Years Following Adoption as First-Line Antimalarials. Am J Trop Med Hyg 2018; 99:649-664. [PMID: 29943725 PMCID: PMC6169162 DOI: 10.4269/ajtmh.18-0115] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Accepted: 05/08/2018] [Indexed: 11/07/2022] Open
Abstract
The efficacies of 3-day regimens of artemether-lumefantrine (AL), artesunate-amodiaquine (AA), and dihydroartemisinin-piperaquine (DHP) were evaluated in 910 children < 5 years old with uncomplicated malaria from six geographical areas of Nigeria. Parasite positivity 1 day and Kaplan-Meier estimated risk of persistent parasitemia 3 days after therapy initiation were both significantly higher, and geometric mean parasite reduction ratio 1 day after treatment initiation (PRRD1) was significantly lower in AL-treated children than in AA- and DHP-treated children. No history of fever, temperature > 38°C, enrollment parasitemia > 75,000 μL-1, and PRRD1 < 5,000 independently predicted persistent parasitemia 1 day after treatment initiation. Parasite clearance was significantly faster and risk of reappearance of asexual parasitemia after initial clearance was significantly lower in DHP-treated children. Overall, day 42 polymerase chain reaction-corrected efficacy was 98.3% (95% confidence interval [CI]: 96.1-100) and was similar for all treatments. In a non-compartment model, declines of parasitemias were monoexponential with mean terminal elimination half-life of 1.3 hours and unimodal frequency distribution of half-lives. All treatments were well tolerated. In summary, all three treatments evaluated remain efficacious treatments of uncomplicated malaria in young Nigerian children, but DHP appears more efficacious than AL or AA.
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Affiliation(s)
- Joy C. Ebenebe
- Department of Paediatrics, Nnamdi Azikiwe University, Awka, Nigeria
| | - Godwin Ntadom
- National Malaria Elimination Programme, The Federal Ministry of Health, Abuja, Nigeria
| | - Jose Ambe
- Department of Paediatrics, University of Maiduguri, Maiduguri, Nigeria
| | | | - Nma Jiya
- Department of Paediatrics, Uthman Dan Fodio University, Sokoto, Nigeria
| | - Finomo Finomo
- Department of Paediatrics, Federal Medical Centre, Yenagoa, Nigeria
| | - George Emechebe
- Department of Paediatrics, Imo State University Teaching Hospital, Orlu, Nigeria
| | - Olugbenga Mokuolu
- Department of Paediatrics and Child Health, University of Ilorin, Ilorin, Nigeria
| | - Kazeem Akano
- Department of Pharmacology and Therapeutics, University of Ibadan, Ibadan, Nigeria
| | - Chimere Agomo
- Department of Medical Laboratory Science, University of Lagos, Lagos, Nigeria
| | - Onikepe A. Folarin
- Department of Biological Sciences and African Centre of Excellence for Genomics of Infectious Diseases (ACEGID), Redeemer University, Ede, Nigeria
| | - Stephen Oguche
- Department of Paediatrics, University of Jos, Jos, Nigeria
| | - Francis Useh
- Department of Medical Laboratory Science, University of Calabar, Calabar, Nigeria
| | - Wellington Oyibo
- Department of Medical Microbiology and Parasitology, University of Lagos, Lagos, Nigeria
| | - Temitope Aderoyeje
- Department of Clinical Pharmacology, University College Hospital, Ibadan, Nigeria
- Institute for Medical Research and Training, University of Ibadan, Ibadan, Nigeria
| | - Mohammed Abdulkadir
- Department of Paediatrics and Child Health, University of Ilorin, Ilorin, Nigeria
| | - Nnenna M. Ezeigwe
- National Malaria Elimination Programme, The Federal Ministry of Health, Abuja, Nigeria
| | - Christian Happi
- Department of Biological Sciences and African Centre of Excellence for Genomics of Infectious Diseases (ACEGID), Redeemer University, Ede, Nigeria
| | - Akintunde Sowunmi
- Department of Pharmacology and Therapeutics, University of Ibadan, Ibadan, Nigeria
- Department of Clinical Pharmacology, University College Hospital, Ibadan, Nigeria
- Institute for Medical Research and Training, University of Ibadan, Ibadan, Nigeria
| | - for the Antimalarial Therapeutic Efficacy Monitoring Group, National Malaria Elimination Programme, The Federal Ministry of Health, Abuja, Nigeria
- Department of Paediatrics, Nnamdi Azikiwe University, Awka, Nigeria
- National Malaria Elimination Programme, The Federal Ministry of Health, Abuja, Nigeria
- Department of Paediatrics, University of Maiduguri, Maiduguri, Nigeria
- Department of Paediatrics, Ahmadu Bello University, Zaria, Nigeria
- Department of Paediatrics, Uthman Dan Fodio University, Sokoto, Nigeria
- Department of Paediatrics, Federal Medical Centre, Yenagoa, Nigeria
- Department of Paediatrics, Imo State University Teaching Hospital, Orlu, Nigeria
- Department of Paediatrics and Child Health, University of Ilorin, Ilorin, Nigeria
- Department of Pharmacology and Therapeutics, University of Ibadan, Ibadan, Nigeria
- Department of Medical Laboratory Science, University of Lagos, Lagos, Nigeria
- Department of Biological Sciences and African Centre of Excellence for Genomics of Infectious Diseases (ACEGID), Redeemer University, Ede, Nigeria
- Department of Paediatrics, University of Jos, Jos, Nigeria
- Department of Medical Laboratory Science, University of Calabar, Calabar, Nigeria
- Department of Medical Microbiology and Parasitology, University of Lagos, Lagos, Nigeria
- Department of Clinical Pharmacology, University College Hospital, Ibadan, Nigeria
- Institute for Medical Research and Training, University of Ibadan, Ibadan, Nigeria
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Sowunmi A, Fatunmbi B, Akano K, Wewe OA, Agomo C, Finomo F, Ebenebe J, Jiya N, Ambe J, Wammanda R, Ntadom G, Mokuolu O, Emechebe G, Ezeigwe N, Ayede AI, Adewoye EO, Gbotosho GO, Folarin OA, Happi CT, Oguche S, Oyibo WA, Useh F. Factors contributing to anaemia after uncomplicated falciparum malaria in under five year-old Nigerian children ten years following adoption of artemisinin-based combination therapies as first-line antimalarials. BMC Infect Dis 2017; 17:781. [PMID: 29258448 PMCID: PMC5738206 DOI: 10.1186/s12879-017-2876-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Accepted: 11/30/2017] [Indexed: 11/23/2022] Open
Abstract
Background Artemisinin-based combination therapies (ACTs) have remained efficacious treatments of acute falciparum malaria in many endemic areas but there is little evaluation of factors contributing to the anaemia of acute falciparum malaria following long term adoption of ACTs as first-line antimalarials in African children. Methods Malarious <5 year-olds randomized to artemether-lumefantrine, artesunate-amodiaquine or dihydroartemisinin-piperaquine treatments were followed up clinically for 6 weeks. Anaemia was defined as haematocrit <30%; Malaria-attributable fall in haematocrit (MAFH) as the difference between haematocrit 28–42 days post- and pre-treatment; Total MAFH (TMAFH) as the difference between days 28–42 haematocrit and the lowest haematocrit recorded in the first week post-treatment initiation; Drug-attributable fall in haematocrit (DAFH) as the difference between MAFH and TMAFH; Early appearing anaemia (EAA) as haematocrit <30% occurring within 1 week in children with normal haematocrit pre-treatment. Predictors of anaemia pre-treatment, EAA, MAFH or DAFH >4% were evaluated by stepwise multiple logistic regression models. Survival analysis and kinetics of DAFH were evaluated by Kaplan-Meier estimator and non-compartment model, respectively. Results Pre-treatment, 355 of 959 children were anaemic. Duration of illness >2 days and parasitaemia ≤10,000 μL−1 were independent predictors of anaemia pre-treatment. EAA occurred in 301 of 604 children. Predictors of EAA were age ≤ 15 months, history of fever pre-treatment and enrolment haematocrit ≤35%. The probabilities of progression from normal haematocrit to EAA were similar for all treatments. MAFH >4% occurred in 446 of 694 children; its predictors were anaemia pre-treatment, enrolment parasitaemia ≤50,000 μL−1, parasitaemia one day post-treatment initiation and gametocytaemia. DAFH >4% occurred in 334 of 719 children; its predictors were history of fever pre-and fever 1 day post-treatment initiation, haematocrit ≥37%, and parasitaemia >100,000 μL−1. In 432 children, declines in DAFH deficits were monoexponential with overall estimated half-time of 2.2d (95% CI 1.9–2.6). Area under curve of deficits in DAFH versus time and estimated half-time were significantly higher in non-anaemic children indicating greater loss of haematocrit in these children. Conclusion After ten years of adoption of ACTs, anaemia is common pre-and early post-treatment, falls in haematocrit attributable to a single infection is high, and DAFH >4% is common and significantly lower in anaemic compared to non-anaemic Nigerian children. Trial registration Pan African Clinical Trial Registry (PACTR) [PACTR201709002064150, 1 March 2017].
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Affiliation(s)
- Akintunde Sowunmi
- Antimalarial Therapeutic Efficacy Monitoring Group, National Malaria Elimination Programme, The Federal Ministry of Health, Abuja, Nigeria. .,Department of Pharmacology and Therapeutics, University of Ibadan, Ibadan, Nigeria. .,Institute for Medical Research and Training, University of Ibadan, Ibadan, Nigeria. .,Department of Clinical Pharmacology, University College Hospital, Ibadan, Nigeria.
| | - Bayo Fatunmbi
- Antimalarial Therapeutic Efficacy Monitoring Group, National Malaria Elimination Programme, The Federal Ministry of Health, Abuja, Nigeria.,World Health Organization, Country Office, Kampala, Uganda
| | - Kazeem Akano
- Department of Pharmacology and Therapeutics, University of Ibadan, Ibadan, Nigeria
| | - Olubunmi A Wewe
- Department of Pharmacology and Therapeutics, University of Ibadan, Ibadan, Nigeria
| | - Chimere Agomo
- Antimalarial Therapeutic Efficacy Monitoring Group, National Malaria Elimination Programme, The Federal Ministry of Health, Abuja, Nigeria.,Department of Medical Laboratory Science, University of Lagos, Lagos, Nigeria
| | - Finomo Finomo
- Antimalarial Therapeutic Efficacy Monitoring Group, National Malaria Elimination Programme, The Federal Ministry of Health, Abuja, Nigeria.,Department of Paediatrics, Federal Medical Centre, Yenagoa, Nigeria
| | - Joy Ebenebe
- Antimalarial Therapeutic Efficacy Monitoring Group, National Malaria Elimination Programme, The Federal Ministry of Health, Abuja, Nigeria.,Department of Paediatrics, Nnamdi Azikiwe University, Awka, Nigeria
| | - Nma Jiya
- Antimalarial Therapeutic Efficacy Monitoring Group, National Malaria Elimination Programme, The Federal Ministry of Health, Abuja, Nigeria.,Department of Paediatrics, Uthman Dan Fodio University, Sokoto, Nigeria
| | - Jose Ambe
- Antimalarial Therapeutic Efficacy Monitoring Group, National Malaria Elimination Programme, The Federal Ministry of Health, Abuja, Nigeria.,Department of Paediatrics, University of Maiduguri, Maiduguri, Nigeria
| | - Robinson Wammanda
- Antimalarial Therapeutic Efficacy Monitoring Group, National Malaria Elimination Programme, The Federal Ministry of Health, Abuja, Nigeria.,Department of Paediatrics, Ahmadu Bello University, Zaria, Nigeria
| | - Godwin Ntadom
- Antimalarial Therapeutic Efficacy Monitoring Group, National Malaria Elimination Programme, The Federal Ministry of Health, Abuja, Nigeria.,Department of Pharmacology and Therapeutics, University of Ibadan, Ibadan, Nigeria
| | - Olugbenga Mokuolu
- Antimalarial Therapeutic Efficacy Monitoring Group, National Malaria Elimination Programme, The Federal Ministry of Health, Abuja, Nigeria.,Department of Paediatrics, University of Ilorin, Ilorin, Nigeria
| | - George Emechebe
- Antimalarial Therapeutic Efficacy Monitoring Group, National Malaria Elimination Programme, The Federal Ministry of Health, Abuja, Nigeria.,Department of Paediatrics, Imo State University Teaching Hospital, Orlu, Nigeria
| | - Nnenna Ezeigwe
- Antimalarial Therapeutic Efficacy Monitoring Group, National Malaria Elimination Programme, The Federal Ministry of Health, Abuja, Nigeria
| | | | - Elsie O Adewoye
- Department of Physiology, University of Ibadan, Ibadan, Nigeria
| | - Grace O Gbotosho
- Department of Pharmacology and Therapeutics, University of Ibadan, Ibadan, Nigeria.,Institute for Medical Research and Training, University of Ibadan, Ibadan, Nigeria.,Department of Pharmacology and Toxicology, University of Ibadan, Ibadan, Nigeria
| | - Onikepe A Folarin
- Department of Biological Sciences and African Centre of Excellence for Genomics of Infectious Diseases (ACEGID), Redeemer University, Ede, Nigeria
| | - Christian T Happi
- Antimalarial Therapeutic Efficacy Monitoring Group, National Malaria Elimination Programme, The Federal Ministry of Health, Abuja, Nigeria.,Department of Biological Sciences and African Centre of Excellence for Genomics of Infectious Diseases (ACEGID), Redeemer University, Ede, Nigeria
| | - Stephen Oguche
- Antimalarial Therapeutic Efficacy Monitoring Group, National Malaria Elimination Programme, The Federal Ministry of Health, Abuja, Nigeria.,Department of Paediatrics, University of Jos, Jos, Nigeria
| | - Wellington A Oyibo
- Antimalarial Therapeutic Efficacy Monitoring Group, National Malaria Elimination Programme, The Federal Ministry of Health, Abuja, Nigeria.,Department of Medical Microbiology and Parasitology, University of Lagos, Lagos, Nigeria
| | - Francis Useh
- Antimalarial Therapeutic Efficacy Monitoring Group, National Malaria Elimination Programme, The Federal Ministry of Health, Abuja, Nigeria.,Department of Medical Laboratory Science, University of Calabar, Calabar, Nigeria
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