Trends and predictive factors for treatment failure following artemisinin-based combination therapy among children with uncomplicated malaria in Ghana: 2005–2018

Abuaku, Benjamin; Duah-Quashie, Nancy Odurowah; Quashie, Neils B; Gyasi, Akosua; Afriyie, Patricia Opoku; Owusu-Antwi, Felicia; Ghansah, Anita; Malm, Keziah; Bart-Plange, Constance; Koram, Kwadwo A.

doi:10.1186/s12879-021-06961-4

Cited by 9 publications

(10 citation statements)

References 29 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Also, mean hemoglobin levels significantly increased in all three sites after treatment with DHAP. These observations compare well with findings from previous Ghanaian studies (Abuaku et al, 2019;Abuaku et al, 2021) and studies from other African countries (Dama et al, 2018;Davlantes et al, 2018;Mandara et al, 2018;Raobela et al, 2018;Roth et al, 2018) demonstrating the effectiveness of ACTs in parasite and fever clearance as well as improving hemoglobin levels of uncomplicated malaria patients.…”

Section: Discussionsupporting

confidence: 91%

See 1 more Smart Citation

Therapeutic efficacy of dihydroartemisinin-piperaquine combination for the treatment of uncomplicated malaria in Ghana

Abuaku

Boateng

Peprah

et al. 2023

Front. Cell. Infect. Microbiol.

Self Cite

View full text Add to dashboard Cite

In 2020, Dihydroartemisinin-Piperaquine (DHAP) was adopted as a second-line antimalarial for treatment of uncomplicated malaria in Ghana following a review of the country’s antimalarial medicines policy. Available data obtained in 2007 had shown PCR-uncorrected therapeutic efficacy of 93.3% using a 28-day follow-up schedule. In 2020, the standard 42-day follow-up schedule for DHAP was used to estimate efficacy levels among febrile children aged 6 months to 9 years in three malaria sentinel sites representing the three main ecological zones of the country- savannah, forest, and coastal. PCR genotyping distinguished between recrudescence and re-infection using merozoite surface protein 2 (MSP2)-specific primers for FC27 and 3D7 strains. Per protocol analyses showed day 28 efficacy of 100% in all three sentinel sites with day 42 PCR-corrected efficacy ranging between 90.3% (95% CI: 80.1 – 96.4%) in the savannah zone and 100% in the forest and coastal zones, yielding a national average of 97.0% (95% CI: 93.4 – 98.8). No day 3 parasitemia was observed in all three sites. Prevalence of measured fever (axillary temperature ≥ 37.5°C) declined from 50.0 - 98.8% on day 0 to 7.1-11.5% on day 1 whilst parasitemia declined from 100% on day 0 to 1.2 - 2.3% on day 1. Mean haemoglobin levels on days 28 and 42 were significantly higher than pre-treatment levels in all three sites. We conclude that DHAP is highly efficacious in the treatment of uncomplicated malaria in Ghana. This data will serve as baseline for subsequent DHAP efficacy studies in the country.

show abstract

Section: Discussionsupporting

confidence: 91%

“…All children examined on day 3, the day used to assess artemisinin partial resistance (WHO, 2020), were aparasitemic suggesting an adequate response of parasites to dihydroartemisinin, and supporting the observation that artemisinin resistance is currently not a problem in Ghana (Abuaku et al, 2021).…”

Section: Discussionmentioning

confidence: 72%

Therapeutic efficacy of dihydroartemisinin-piperaquine combination for the treatment of uncomplicated malaria in Ghana

Abuaku

Boateng

Peprah

et al. 2023

Front. Cell. Infect. Microbiol.

Self Cite

View full text Add to dashboard Cite

show abstract

“…Ghana adopted ACTs as the frontline treatment of uncomplicated falciparum malaria in 2005. Subsequent efficacy studies conducted in many sentinel sites of Ghana showed high efficacies of AL and AS-AQ with 28-day PCR-corrected cure rates above 90% (Abuaku et al, 2012;Abuaku et al, 2016;Abuaku et al, 2017;Abuaku et al, 2019;Abuaku et al, 2021). In addition, the imported falciparum cases among the Chinese workers returning from Ghana also responded well to the DHA-PPQ treatment with a 100% 28-day cure rate (not shown).…”

Section: Discussionmentioning

confidence: 95%

In vitro susceptibility profile of Plasmodium falciparum clinical isolates from Ghana to antimalarial drugs and polymorphisms in resistance markers

Zhao

Li²,

Yang³

et al. 2022

Front. Cell. Infect. Microbiol.

View full text Add to dashboard Cite

Drug resistance in Plasmodium falciparum compromises the effectiveness of antimalarial therapy. This study aimed to evaluate the extent of drug resistance in parasites obtained from international travelers returning from Ghana to guide the management of malaria cases. Eighty-two clinical parasite isolates were obtained from patients returning from Ghana in 2016–2018, of which 29 were adapted to continuous in vitro culture. Their geometric mean IC50 values to a panel of 11 antimalarial drugs, assessed using the standard SYBR Green-I drug sensitivity assay, were 2.1, 3.8, 1.0, 2.7, 17.2, 4.6, 8.3, 8.3, 19.6, 55.1, and 11,555 nM for artemether, artesunate, dihydroartemisinin, lumefantrine, mefloquine, piperaquine, naphthoquine, pyronaridine, chloroquine, quinine, and pyrimethamine, respectively. Except for chloroquine and pyrimethamine, the IC50 values for other tested drugs were below the resistance threshold. The mean ring-stage survival assay value was 0.8%, with four isolates exceeding 1%. The mean piperaquine survival assay value was 2.1%, all below 10%. Mutations associated with chloroquine resistance (pfcrt K76T and pfmdr1 N86Y) were scarce, consistent with the discontinuation of chloroquine a decade ago. Instead, the pfmdr1 86N-184F-1246D haplotype was predominant, suggesting selection by the extensive use of artemether-lumefantrine. No mutations in the pfk13 propeller domain were detected. The pfdhfr/pfdhps quadruple mutant IRNGK associated with resistance to sulfadoxine-pyrimethamine reached an 82% prevalence. In addition, five isolates had pfgch1 gene amplification but, intriguingly, increased susceptibilities to pyrimethamine. This study showed that parasites originating from Ghana were susceptible to artemisinins and the partner drugs of artemisinin-based combination therapies. Genotyping drug resistance genes identified the signature of selection by artemether-lumefantrine. Parasites showed substantial levels of resistance to the antifolate drugs. Continuous resistance surveillance is necessary to guide timely changes in drug policy.

show abstract

“…Drug-resistant malaria and bacterial pathogens have already been identified in Ghana [28][29][30][31][32][33][34] and the distribution of antimicrobials has yet to be comprehensively studied.…”

Section: Introductionmentioning

confidence: 99%

Challenges in the distribution of antimicrobial medications in community dispensaries in Accra, Ghana

Greene

Makovi

Abdul-Mumin³

et al. 2023

Preprint

View full text Add to dashboard Cite

Introduction Community distribution of medications in low- and middle-income countries has been shown to accelerate the emergence of antimicrobial resistance. The distribution of medications is often carried out by private vendors operating under constrained conditions. Yet patterns in medicine distribution—and their consequences—are not well understood. The aim of this study was to illuminate the challenges reported by employees of chemical shops and pharmacies throughout Accra. Our objectives are twofold: to 1) assess obstacles and challenges faced by medicine vendors during their sales of antibiotic and antimalarial medications, and 2) identify opportunities for improving community-level stewardship of antimicrobials. Methods Responses to open-ended questions from a survey of 80 shopkeepers in pharmacies and chemical shops throughout Accra were analyzed using the socioecological model of public health. Results Overall, shopkeepers most often reported constraints at the interpersonal and community levels of the socioecological model of public health. These included the prohibitive costs of medicines, customer attitudes, and customers’ attempts at self-medication and uninformed antimicrobial use. Other challenges included a lack of diagnostic testing, supply chain issues, and the larger economic and healthcare situation of the community. Discussion The safe and effective distribution of medications was truncated by three main sources of obstacles: financial insecurity among customers, challenges directly in the treatment of illnesses, and broader issues with the fragmented healthcare infrastructure affecting shopkeepers’ roles as health educators and gatekeepers of medicines. Conclusion These context-specific findings identify tractable challenges faced by medicine vendors in Ghana, with relevance to antimicrobial stewardship across resource-poor settings globally. Addressing barriers faced by shopkeepers would provide an opportunity for significantly improving the provision of medications, and ultimately healthcare, at the community level. Such efforts will likely expand access to populations who may otherwise be unable to access services in formal institutions of care.

show abstract

Trends and predictive factors for treatment failure following artemisinin-based combination therapy among children with uncomplicated malaria in Ghana: 2005–2018

Cited by 9 publications

References 29 publications

Therapeutic efficacy of dihydroartemisinin-piperaquine combination for the treatment of uncomplicated malaria in Ghana

Therapeutic efficacy of dihydroartemisinin-piperaquine combination for the treatment of uncomplicated malaria in Ghana

In vitro susceptibility profile of Plasmodium falciparum clinical isolates from Ghana to antimalarial drugs and polymorphisms in resistance markers

Challenges in the distribution of antimicrobial medications in community dispensaries in Accra, Ghana

Contact Info

Product

Resources

About