Anti-malarial treatment outcomes in Ethiopia: a systematic review and meta-analysis

Abstract

BackgroundEthiopia is among countries with a high malaria burden. There are several studies that assessed the efficacy of anti-malarial agents in the country and this systematic review and meta-analysis was performed to obtain stronger evidence on treatment outcomes of malaria from the existing literature in Ethiopia.MethodsA systematic literature search using the preferred reporting items for systematic review and meta-analysis (PRISMA) statement was conducted on studies from Pubmed, Google Scholar, and ScienceDirect databases to identify published and unpublished literature. Comprehensive meta-analysis software was used to perform all meta-analyses. The Cochrane Q and the I 2 were used to evaluate heterogeneity of studies. Random effects model was used to combine studies showing heterogeneity of Cochrane Q p < 0.10 and I 2 > 50.ResultsTwenty-one studies were included in the final analysis with a total number of 3123 study participants. Treatment outcomes were assessed clinically and parasitologically using World Health Organization guidelines. Adequate clinical and parasitological response was used to assess treatment success at the 28th day. Overall, a significant high treatment success of 92.9% (95% CI 89.1–96.6), p < 0.001, I 2 = 98.39% was noticed. However, treatment success was higher in falciparum malaria patients treated with artemether–lumefantrine than chloroquine for Plasmodium vivax patients [98.1% (97.0–99.2), p < 0.001, I 2 = 72.55 vs 94.7% (92.6–96.2), p < 0.001, I 2 = 53.62%]. Seven studies reported the adverse drug reactions to anti-malarial treatment; of 822 participants, 344 of them were exposed to adverse drug reactions with a pooled event rate of 39.8% (14.1–65.5), p = 0.002.ConclusionsOn the basis of this review, anti-malarial treatment success was high (92.9%) and standard regimens showed good efficacy against Plasmodium falciparum (98.1%) and P. vivax (94.7%) infections in Ethiopia, but associated with high rates of adverse drug reactions (ADRs). However, these ADRs were not serious enough to discontinue anti-malarial treatment. The results of this study suggest that the current anti-malarial medications are effective and safe; however, greater priority should be placed on the discovery of new anti-malarial drugs to achieve successful outcomes as resistance seems inevitable since cases of anti-malarial drug resistance have been reported from other areas of the world.Electronic supplementary materialThe online version of this article (doi:10.1186/s12936-017-1922-9) contains supplementary material, which is available to authorized users.

Use of primaquine and glucose-6-phosphate dehydrogenase deficiency testing: Divergent policies and practices in malaria endemic countries

“…All malaria-endemic countries in Africa have high estimated G6PD deficiency prevalences, including 7 with >13%–17% and 8 with >20%–23% ( Table 4 ) [ 29 ].…”

Efficacy and safety of artemisinin-based combination therapy for uncomplicated Plasmodium falciparum malaria in Sudan: a systematic review and meta-analysis

“…In neighbouring Ethiopia a high treatment success rate (92.9%) of malaria treatment was recently reported in a meta-analysis which included 21 studies with a total of 3123 patients. Furthermore, the treatment success was higher in falciparum malaria patients treated with AL compared to patients who received chloroquine for vivax malaria (98.1 vs 94.7%) [ 36 ]. In another recent meta-analyses in Ethiopia a high cure rate (98.2%) for AL was reported in 10 studies involving 1179 patients with uncomplicated falciparum malaria [ 37 ].…”

Treatments used for malaria in young Ethiopian children: a retrospective study

“…Although there are a few reports of CQ resistant P. vivax in Ethiopia [ 19 – 22 ], CQ is still recommended for the treatment of P. vivax malaria in Ethiopia [ 23 ] and is still effective in 94.7% of cases [ 4 ]. The lower reported “cure” rate in this study (reported by parents) could imply that chloroquine was being used for cases of falciparum malaria (some of which are resistant to chloroquine), and that some of the children may have had a disease other than malaria.…”

“…It is only used under the supervision of healthcare providers for patients with limited risk of malaria infection in the future, such as those who are not living in malaria endemic areas. A recent review showed that in Ethiopia, 98.1% of patients with P. falciparum were successfully treated with AL and 94.7% of patients with P. vivax were successfully treated with CQ [ 4 ]. However, AL is only effective in 75.1% of patients with P. vivax [ 4 ].…”

“…A recent review showed that in Ethiopia, 98.1% of patients with P. falciparum were successfully treated with AL and 94.7% of patients with P. vivax were successfully treated with CQ [ 4 ]. However, AL is only effective in 75.1% of patients with P. vivax [ 4 ]. Although prevalence of P. falciparum has reduced rapidly since the introduction of AL, prevalence of P. vivax has risen slightly [ 5 ].…”