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Adam M, Nahzat S, Kakar Q, Assada M, Witkowski B, Tag Eldin Elshafie A, Abuobaida D, Safi N, Khan MA, Nagi M, Mustafa SA, Kohestani K, Muhammad J, Khim N, Al-Hadi M, Elfaki TM, Habib MN, Khairy AKA, Hamid H, Uddin Z, Amer Y, Hassan AH, Elhag MS, Sediqi AW, Kakar I, Abdul-Ghani R, Amran JGH, Abdallrahim TA, Tamim MS, Aljasari A, Rasmussen C, Azkoul L, Warsame M. Antimalarial drug efficacy and resistance in malaria-endemic countries in HANMAT-PIAM_net countries of the Eastern Mediterranean Region 2016-2020: Clinical and genetic studies. Trop Med Int Health 2023; 28:817-829. [PMID: 37705047 DOI: 10.1111/tmi.13929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/15/2023]
Abstract
INTRODUCTION The World Health Organization recommends regular monitoring of the efficacy of nationally recommended antimalarial drugs. We present the results of studies on the efficacy of recommended antimalarials and molecular markers of artemisinin and partner resistance in Afghanistan, Pakistan, Somalia, Sudan and Yemen. METHODS Single-arm prospective studies were conducted to evaluate the efficacy of artesunate-sulfadoxine-pyrimethamine (ASSP) in Afghanistan and Pakistan, artemether-lumefantrine (AL) in all countries, or dihydroartemisinin-piperaquine (DP) in Sudan for the treatment of Plasmodium falciparum. The efficacy of chloroquine (CQ) and AL for the treatment of Plasmodium vivax was evaluated in Afghanistan and Somalia, respectively. Patients were treated and monitored for 28 (CQ, ASSP and AL) or 42 (DP) days. Polymerase chain reaction (PCR)-corrected cure rate and parasite positivity rate at Day 3 were estimated. Mutations in the P. falciparum kelch 13 (Pfk13) gene and amplifications of plasmepsin (Pfpm2) and multidrug resistance-1 (Pfmdr-1) genes were also studied. RESULTS A total of 1680 (249 for ASSP, 1079 for AL and 352 for DP) falciparum cases were successfully assessed. A PCR-adjusted ASSP cure rate of 100% was observed in Afghanistan and Pakistan. For AL, the cure rate was 100% in all but four sites in Sudan, where cure rates ranged from 92.1% to 98.8%. All but one patient were parasite-free at Day 3. For P. vivax, cure rates were 98.2% for CQ and 100% for AL. None of the samples from Afghanistan, Pakistan and Yemen had a Pfk13 mutation known to be associated with artemisinin resistance. In Sudan, the validated Pfk13 R622I mutation accounted for 53.8% (14/26) of the detected non-synonymous Pfk13 mutations, most of which were repeatedly detected in Gadaref. A prevalence of 2.7% and 9.3% of Pfmdr1 amplification was observed in Pakistan and Yemen, respectively. CONCLUSION High efficacy of ASSP, AL and DP in the treatment of uncomplicated falciparum infection and of CQ and AL in the treatment of P. vivax was observed in the respective countries. The repeated detection of a relatively high rate of Pfk13 R622I mutation in Sudan underscores the need for close monitoring of the efficacy of recommended ACTs, parasite clearance rates and Pfk13 mutations in Sudan and beyond. Registration numbers of the trials: ACTRN12622000944730 and ACTRN12622000873729 for Afghanistan, ACTRN12620000426987 and ACTRN12617001025325 for Pakistan, ACTRN12618001224213 for Somalia, ACTRN12617000276358, ACTRN12622000930785 and ACTRN12618001800213 for Sudan and ACTRN12617000283370 for Yemen.
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Affiliation(s)
| | - Sami Nahzat
- National Malaria and Leishmania Control Programme, Ministry of Public Health, Kabul, Afghanistan
| | | | - Methaq Assada
- National Malaria Control Programme, Ministry of Health, Sana'a, Yemen
| | - Benoit Witkowski
- Malaria Research Unit, Pasteur Institute of Cambodia, Phnom Penh, Cambodia
| | | | - Duha Abuobaida
- Communicable Diseases Control Directorate, Federal Ministry of Health, Khartoum, Sudan
| | | | - Munir Ahmed Khan
- Provincial Malaria and VBDs Control Programme, Quetta, Balochistan, Pakistan
| | - Mustafa Nagi
- National Malaria Control Programme, Ministry of Health, Sana'a, Yemen
| | - Sayed Ali Mustafa
- Communicable Diseases Control Directorate, Federal Ministry of Health, Khartoum, Sudan
| | - Khalilahmad Kohestani
- National Malaria and Leishmania Control Programme, Ministry of Public Health, Kabul, Afghanistan
| | - Jamil Muhammad
- Provincial Malaria and VBDs Control Programme, Khyber Pakhtunkhwa, Pakistan
| | - Nimol Khim
- Malaria Research Unit, Pasteur Institute of Cambodia, Phnom Penh, Cambodia
| | - Mohammed Al-Hadi
- National Malaria Control Programme, Ministry of Health, Sana'a, Yemen
| | - Tarig Mohamed Elfaki
- Communicable Diseases Control Directorate, Federal Ministry of Health, Khartoum, Sudan
| | - Muhammad Naeem Habib
- Malaria & Other Vector Borne Disease Program, Ministry of Public Health, Kabul, Afghanistan
| | | | - Hamida Hamid
- Malaria & Other Vector Borne Disease Program, Ministry of Public Health, Kabul, Afghanistan
| | - Zain Uddin
- District Headquarter Hospital, Zhob, Pakistan
| | - Yahya Amer
- Almarawiah Hospital Ministry of Health, Al Mahrah, Yemen
| | | | - Mousab Siddig Elhag
- Communicable Diseases Control Directorate, Federal Ministry of Health, Khartoum, Sudan
| | - Ahmad Walid Sediqi
- Global Fund Programme, United Nations Development Programme, Kabul, Afghanistan
| | - Inamullah Kakar
- Directorate of Malaria Control, Common Management Unit Global Fund grant for Malaria Control, Ministry of National Health Services Regulations and Coordination, Islamabad, Pakistan
| | - Rashad Abdul-Ghani
- Department of Medical Parasitology, Faculty of Medicine and Health Sciences, Sana'a University, Sana'a, Yemen
| | | | | | - Mohammad Shoaib Tamim
- Malaria & Other Vector Borne Disease Program, Ministry of Public Health, Kabul, Afghanistan
| | | | | | | | - Marian Warsame
- School of Public Health and Community Medicine, University of Gothenburg, Gothenburg, Sweden
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Mahmoodi SD, Atarud AA, Sediqi AW, Gallalee S, McFarland W, Aynie TB, Nahzat MS, Hamid H, Qader GQ, Tamim MS, Mirzazadeh A. Trends in malaria indicators after scale-up of community-based malaria management in Afghanistan. Malar J 2022; 21:165. [PMID: 35659291 PMCID: PMC9166477 DOI: 10.1186/s12936-022-04174-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 05/05/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The Community-Based Malaria Management (CBMM) strategy, introduced in 2013 and expanded to all health facilities and health posts in Afghanistan by 2016, aimed to deliver rapid diagnostic testing and more timely treatment to all communities nationwide. In this study, trends for several malaria outcome indicators were compared before and after the expansion of the CBMM strategy, using cross-sectional analysis of surveillance data. METHODS Generalized estimating equation (GEE) models with a Poisson distribution were used to assess trends of three key outcomes before (2012-2015) and after (2016-2019) CBMM expansion. These outcomes were annual malaria incidence rate (both all and confirmed malaria incidence), malaria death rate, and malaria test positivity rate. Additional variables assessed included annual blood examination rates (ABER) and malaria confirmation rate. RESULTS Average malaria incidence rates decreased from 13.1 before CBMM expansion to 10.0 per 1000 persons per year after CBMM expansion (P < 0.001). The time period after CBMM was expanded witnessed a 339% increase in confirmed malaria incidence as compared to the period before (IRR 3.39, 95% CI 2.18, 5.27; P < 0.001). In the period since the expansion of CBMM (2016-2019), overall malaria incidence rate declined by 19% each year (IRR 0.81, 95% CI 0.71,0.92; P = 0.001) and the malaria death rate declined by 85% each year (IRR 0.15, 95% CI 0.12, 0.20; P < 0.001). In comparing the before period to the after period, the ABER increased from 2.3 to 3.5 per 100 person/year, the malaria test positivity rate increased from 12.2 to 20.5%, and the confirmation rate increased from 21% before to 71% after CBMM. CONCLUSIONS Afghanistan's CBMM expansion to introduce rapid diagnostic tests and provide more timely treatment for malaria through all levels of care temporally correlates with significant improvement in multiple indicators of malaria control.
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Affiliation(s)
| | | | | | - Sarah Gallalee
- grid.266102.10000 0001 2297 6811Institute for Global Health Sciences, University of California San Francisco, San Francisco, CA USA
| | - Willi McFarland
- grid.266102.10000 0001 2297 6811Institute for Global Health Sciences, University of California San Francisco, San Francisco, CA USA ,grid.266102.10000 0001 2297 6811Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA USA
| | | | - Mohmmad Sami Nahzat
- grid.490670.cNational Malaria Leishmania Control Programme, Ministry of Public Health, Kabul, Afghanistan
| | - Hamida Hamid
- grid.490670.cNational Malaria Leishmania Control Programme, Ministry of Public Health, Kabul, Afghanistan
| | - Ghulam Qader Qader
- Sustaining Technical and Analytical Resources (STAR) project, Public Health Institute (PHI), Kabul, Afghanistan
| | - Mohammad Shoaib Tamim
- grid.490670.cNational Malaria Leishmania Control Programme, Ministry of Public Health, Kabul, Afghanistan
| | - Ali Mirzazadeh
- grid.266102.10000 0001 2297 6811Institute for Global Health Sciences, University of California San Francisco, San Francisco, CA USA ,grid.266102.10000 0001 2297 6811Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA USA
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