Efficacy of Artesunate/Amodiaquine in the Treatment of Uncomplicated Malaria among Children in Ghana

Benjamin K. Abuaku Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Accra, Ghana;

Search for other papers by Benjamin K. Abuaku in
Current site
Google Scholar
PubMed
Close
,
Benedicta A. Mensah Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Accra, Ghana;

Search for other papers by Benedicta A. Mensah in
Current site
Google Scholar
PubMed
Close
,
Michael F. Ofori Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Accra, Ghana;

Search for other papers by Michael F. Ofori in
Current site
Google Scholar
PubMed
Close
,
James Myers-Hansen Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Accra, Ghana;

Search for other papers by James Myers-Hansen in
Current site
Google Scholar
PubMed
Close
,
Abigail N. Derkyi-Kwarteng Ewim Polyclinic, Ghana Health Service, Cape-Coast, Ghana;

Search for other papers by Abigail N. Derkyi-Kwarteng in
Current site
Google Scholar
PubMed
Close
,
Felicia Essilfie Ewim Polyclinic, Ghana Health Service, Cape-Coast, Ghana;

Search for other papers by Felicia Essilfie in
Current site
Google Scholar
PubMed
Close
,
Moses Dokurugu Begoro District Hospital, Ghana Health Service, Begoro, Ghana

Search for other papers by Moses Dokurugu in
Current site
Google Scholar
PubMed
Close
,
Emmanuel Amoakoh Begoro District Hospital, Ghana Health Service, Begoro, Ghana

Search for other papers by Emmanuel Amoakoh in
Current site
Google Scholar
PubMed
Close
,
Kwadwo A. Koram Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Accra, Ghana;

Search for other papers by Kwadwo A. Koram in
Current site
Google Scholar
PubMed
Close
, and
Anita Ghansah Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Accra, Ghana;

Search for other papers by Anita Ghansah in
Current site
Google Scholar
PubMed
Close
Restricted access

The declining efficacy of chloroquine in the early 2000s in Ghana led to its replacement with artesunate/amodiaquine (AS/AQ) combination as first-line drug for treating uncomplicated malaria in 2005. Since then efficacy studies have been ongoing in the country to provide continuous data on the efficacy of AS/AQ and other alternative antimalarials (artemether/lumefantrine and dihyroartemisinin/piperaquine combinations) introduced in 2008. In vivo AS/AQ efficacy studies were conducted between June and October 2014 among children aged 6 months to 14 years, in two sentinel sites representing the forest and coastal zones of the country. The 2009 World Health Organization protocol for monitoring antimalarial drug efficacy was used in these studies. The studies showed an overall cumulative polymerase chain reaction-corrected day 28 cure rate of 97.2% (95% confidence interval [CI]: 93.6–99.1): 97.7% (95% CI: 92.0–99.7) within the forest zone and 96.7% (95% CI: 90.7–99.3) within the coastal zone (P = 0.686). Prevalence of fever declined from 100% to < 4% after first day of treatment in both ecological zones. All children in the coastal zone had cleared parasites by day 2. Three children (3.2%) in the forest zone were parasitemic on day 2, whereas one child was parasitemic on day 3. Gametocytemia was absent in both zones after day 14, and mean hemoglobin concentration significantly increased from 10.3 g/dL (95% CI: 10.1–10.5) on day 0 to 11.8 g/dL (95% CI: 11.6–12.0) on day 28. We conclude that AS/AQ combination remains efficacious in the treatment of uncomplicated malaria in Ghana.

Author Notes

Address correspondence to Benjamin K. Abuaku, Noguchi Memorial Institute for Medical Research, University of Ghana, P.O. Box LG581, Legon, Accra, Ghana. E-mail: babuaku@noguchi.ug.edu.gh

Financial support: This study was sponsored by the National Institute of Allergy and Infectious Diseases (NIAID) under NIH Grant No. 5R01AI099527-02.

Authors’ addresses: Benjamin K. Abuaku, Benedicta A. Mensah, Michael F. Ofori, James Myers-Hansen, Kwadwo A. Koram, and Anita Ghansah, Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Accra, Ghana, E-mails: babuaku@noguchi.ug.edu.gh, bmensah@noguchi.ug.edu.gh, mofori@noguchi.ug.edu.gh, jmyers-hansen@noguchi.ug.edu.gh, kkoram@noguchi.ug.edu.gh and aghansah@noguchi.ug.edu.gh. Abigail N. Derkyi-Kwarteng and Felicia Essilfie, Ewim Polyclinic, Ghana Health Service, Cape-Coast, Ghana, E-mails: nyarkocodjoe@yahoo.co.uk and e.felicia@gmail.com. Moses Dokurugu and Emmanuel Amoakoh, Begoro District Hospital, Ghana Health Service, Begoro, Ghana, E-mails: doksdam@yahoo.com and paamoakoh@gmail.com.

  • 1.

    World Health Organization, 2015. World Malaria Report 2015. Geneva, Switzerland: WHO.

  • 2.

    Ministry of Health, 2015. National Malaria Control Programme, 2014 Annual Report. Accra, Ghana: Ministry of Health.

  • 3.

    Ghana Statistical Service (GSS), Ghana Health Service (GHS), and ICF International, 2015. 2014 Ghana Demographic and Health Survey (GDHS) Key Findings. Rockville, MD: GSS, GHS, and ICF International.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 4.

    Ministry of Health, 2014. Guidelines for Case Management of Malaria in Ghana, 3rd edition. Accra, Ghana: Ministry of Health.

  • 5.

    Koram KA, 2003. Mapping Response of Plasmodium falciparum to Chloroquine and Other Antimalarial Drugs in Ghana. Project ID 980034. Final report submitted to MIM/TDR. Accra, Ghana: Noguchi Memorial Institute for Medical Research.

    • PubMed
    • Export Citation
  • 6.

    Abuaku B, Duah N, Quaye L, Quashie N, Koram KA, 2012. Therapeutic efficacy of artemether-lumefantrine combination in the treatment of uncomplicated malaria among children under five years of age in three ecological zones in Ghana. Malar J 11: 388.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 7.

    Koram KA, Abuaku B, Duah N, Quashie N, 2005. Comparative efficacy of antimalarial drugs including ACTs in the treatment of uncomplicated malaria among children under 5 years in Ghana. Acta Trop 95: 194203.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 8.

    Duah NO, Wilson MD, Ghansah A, Abuaku B, Edoh D, Quashie NB, Koram KA, 2007. Mutations in Plasmodium falciparum chloroquine resistance transporter and multidrug resistance genes, and treatment outcomes in Ghanaian children with uncomplicated malaria. J Trop Pediatr 53: 2731.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 9.

    Quashie NB, Duah NO, Abuaku B, Koram KA, 2007. The in-vitro susceptibilities of Ghanaian Plasmodium falciparum to antimalarial drugs. Ann Trop Med Parasitol 101: 391398.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 10.

    Koram KA, Quaye L, Abuaku B, 2008. Efficacy of amodiaquine/artesunate combination therapy for uncomplicated malaria in children under five years in Ghana. Ghana Med J 42: 5560.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 11.

    Duah NO, Abuaku B, Quashie N, Kronmann K, Koram K, 2012. Surveillance of molecular markers of Plasmodium falciparum resistance to sulphadoxine-pyrimethamine resistance 5 years after the change of malaria treatment policy in Ghana. Am J Trop Med Hyg 87: 9961003.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 12.

    Duah NO et al., 2013. Increased pfmdr1 gene copy number and the decline in pfcrt and pfmdr1 resistance alleles in Ghanaian Plasmodium falciparum isolates after change of anti-malarial drug treatment policy. Malar J 12: 377.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 13.

    Quashie NB et al., 2013. A SYBR Green 1-based in-vitro test of susceptibility of Ghanaian Plasmodium falciparum clinical isolates to a panel of antimalarial drugs. Malar J 12: 450.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 14.

    Abuaku B, Quaye L, Quashie N, Quashie N, Koram KA, 2014. Managing antimalarial drug resistance in Ghana: the importance of surveillance. Koram KA, Ahorlu CSK, Wilson MD, Yeboah-Manu D, and Bosompem KM, eds. Towards Effective Disease Control in Ghana: Research and Policy Implications, Vol. 1. Accra, Ghana: University of Ghana Reader Series.

    • PubMed
    • Export Citation
  • 15.

    Ghana Statistical Service, 2012. 2010 Population and Housing Census. Summary Report of Final Results. Accra, Ghana: Ghana Statistical Service.

  • 16.

    Ministry of Food and Agriculture, 2012. Fanteakwa District. Available at: http//www.mofa.gov.gh/site/?page_id=1512. Accessed August 30, 2015.

  • 17.

    World Health Organization, 2008. Methods and Techniques for Clinical Ttrials on Antimalarial Drug Efficacy: Genotyping to Identify Parasite Populations. Geneva, Switzerland: WHO.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 18.

    Wooden J, Kyes S, Sibley CH, 1993. PCR and strain identification in Plasmodium falciparum. Parasitol Today 9: 303305.

  • 19.

    World Health Organization, 2009. Methods for Surveillance of Antimalarial Drug Efficacy. Geneva, Switzerland: WHO.

  • 20.

    Adjei GO, Kurtzhals JA, Rodrigues OP, Alifrangis M, Hoegberg LC, Kitcher ED, Badoe EV, Lamptey R, Goka BQ, 2008. Amodiaquine-artesunate vs artemether-lumefantrine for uncomplicated malaria in Ghanaian children: a randomized efficacy and safety trial with one year follow-up. Malar J 7: 127.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 21.

    Owusu-Agyei S, Asante KP, Owusu R, Adjuik M, Amenga-Etego S, Dosoo DK, Gyapong J, Greenwood B, Chandramohan D, 2008. An open label, randomized trial of artesunate+amodiaquine, artesunate+chlorproguanil-dapsone and artemether-lumefantrine for the treatment of uncomplicated malaria. PLoS One 3: e2530.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 22.

    Yavo W, Konaté A, Kassi FK, Djohan V, Angora EK, Kiki-Barro PC, Vanga-Bosson H, Menan EIH, 2015. Efficacy and safety of artesunate-amodiaquine versus artemether-lumefantrine in the treatment of uncomplicated Plasmodium falciparum malaria in sentinel sites across Côte d’Ivoire. Malar Res Treat 2015: 878132.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 23.

    Paczkowski M, Mwandama D, Marthey D, Luka M, Makuta G, Sande J, Ali D, Troell P, Mathanga DP, Gutman J, 2016. In vivo efficacy of artemether-lumefantrine and artesunate-amodiaquine for uncomplicated Plasmodium falciparum malaria in Malawi, 2014. Malar J 15: 236.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 24.

    Ndounga M, Mayengue PI, Casimiro PN, Koukouikila-Koussounda F, Bitemo M, Matondo BD, Diakou LAN, Basco LK, Ntoumi F, 2015. Artesunate-amodiaquine versus artemether-lumefantrine for the treatment of acute uncomplicated malaria in Congolese children under 10 years old living in a suburban area: a randomized study. Malar J 14: 423.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 25.

    Nji AM et al., 2015. Randomized non-inferiority and safety trial of dihydroartemisinin-piperaquine and artesunate-amodiaquine versus artemether-lumefantrine in the treatment of uncomplicated Plasmodium falciparum malaria in Cameroonian children. Malar J 14: 27.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 26.

    Schramm B et al., 2013. Efficacy of artesunate-amodiaquine and artemether-lumefantrine fixed-dose combinations for the treatment of uncomplicated Plasmodium falciparum malaria among children aged six to 59 months in Nimba County, Liberia: an open-label randomized non-inferiority trial. Malar J 12: 251.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 27.

    Yeka A, Lameyre V, Afizi K, Frederick M, Lukwago R, Kamya MR, Talisuna AO, 2014. Efficacy and safety of fixed-dose artesunate-amodiaquine vs. artemether-lumefantirne for repeated treatment of uncomplicated malaria in Ugandan children. PLoS One 9: e113311.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 28.

    World Health Organization, 2001. Antimalarial Drug Combination Therapy. Report of a WHO Technical Consultation, 4–5 April 2001. Geneva, Switzerland: WHO.

  • 29.

    Mutabingwa TK, 2005. Artemisinin-based combination therapies (ACTs): best hope for malaria treatment but inaccessible to the needy! Acta Trop 95: 305315.

  • 30.

    Nosten F, van Vugt M, Price R, Luxemburger C, Thway KL, Brockman A, McGready R, ter Kuile F, Looareesuwan S, White NJ, 2000. Effects of artesunate-mefloquine combination on incidence of Plasmodium falciparum malaria and mefloquine resistance in western Thailand: a prospective study. Lancet 356: 297302.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 31.

    Adjuik M et al., 2004. Artesunate combinations for treatment of malaria: meta-analysis. Lancet 363: 917.

  • 32.

    Mårtensson A, Strömberg J, Sisowath C, Msellem MI, Gil JP, Montgomery SM, Olliaro P, Ali AS, Björkman A, 2005. Efficacy of artesunate plus amodiaquine versus that of artemether-lumefantrine for the treatment of uncomplicated childhood Plasmodium falciparum malaria in Zanzibar, Tanzania. Clin Infect Dis 41: 10791086.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 33.

    Sagara I, Piarroux R, Djimde A, Giorgi R, Kayentao K, Doumbo OK, Gaudart J, 2014. Delayed anemia assessment in patients treated with oral artemisinin derivatives for uncomplicated malaria: a pooled analysis of clinical trials data from Mali. Malar J 13: 358.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 34.

    Oguche S et al., 2014. Efficacy of artemisinin-based combination treatments of uncomplicated falciparum malaria in under-five-year-old Nigerian children. Am J Trop Med Hyg 91: 925935.

    • PubMed
    • Search Google Scholar
    • Export Citation
Past two years Past Year Past 30 Days
Abstract Views 687 536 80
Full Text Views 582 20 0
PDF Downloads 223 13 0
 
 
 
 
Affiliate Membership Banner
 
 
Research for Health Information Banner
 
 
CLOCKSS
 
 
 
Society Publishers Coalition Banner
Save