Incidence of malaria and efficacy of combination antimalarial therapies over 4 years in an urban cohort of Ugandan children.
Combination therapies are now recommended to treat uncomplicated malaria. We used a longitudinal design to assess the incidence of malaria and compare the efficacies of 3 combination regimens in Kampala, Uganda.Children aged 1-10 years were enrolled from randomly selected households in 2004-05 and 2...
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Public Library of Science (PLoS)
2010-07-01
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| Series: | PLoS ONE |
| Online Access: | http://europepmc.org/articles/PMC2912768?pdf=render |
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| author | Tamara D Clark Denise Njama-Meya Bridget Nzarubara Catherine Maiteki-Sebuguzi Bryan Greenhouse Sarah G Staedke Moses R Kamya Grant Dorsey Philip J Rosenthal |
| author_facet | Tamara D Clark Denise Njama-Meya Bridget Nzarubara Catherine Maiteki-Sebuguzi Bryan Greenhouse Sarah G Staedke Moses R Kamya Grant Dorsey Philip J Rosenthal |
| author_sort | Tamara D Clark |
| collection | DOAJ |
| description | Combination therapies are now recommended to treat uncomplicated malaria. We used a longitudinal design to assess the incidence of malaria and compare the efficacies of 3 combination regimens in Kampala, Uganda.Children aged 1-10 years were enrolled from randomly selected households in 2004-05 and 2007, and were followed at least monthly through 2008. Insecticide-treated bednets (ITNs) were provided in 2006. Children were randomized upon their first episode, and then treated for all episodes of uncomplicated malaria with amodiaquine/sulfadoxine-pyrimethamine (AQ/SP), artesunate/amodiaquine (AS/AQ), or artemether/lumefantrine (AL). Risks of parasitological failure were determined for each episode of uncomplicated malaria and clinical parameters were followed. A total of 690 children experienced 1464 episodes of malaria. 96% of these episodes were uncomplicated malaria and treated with study drugs; 94% were due to Plasmodium falciparum. The rank order of treatment efficacy was AL > AS/AQ > AQ/SP. Failure rates increased over time for AQ/SP, but not the artemisinin-based regimens. Over the 4-year course of the study the prevalence of asymptomatic parasitemia decreased from 11.8% to 1.4%, the incidence of malaria decreased from 1.55 to 0.32 per person year, and the prevalence of anemia (hemoglobin <10 gm/dL) decreased from 5.9% to 1.0%. No episodes of severe malaria (based on WHO criteria) and no deaths were seen.With ready access to combination therapies and distribution of ITNs, responses were excellent for artemisinin-containing regimens, severe malaria was not seen, and the incidence of malaria and prevalence of parasitemia and anemia decreased steadily over time.isrctn.org ISRCTN37517549. |
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| id | doaj.art-37869334a38d4af5a9ab6aa1b813acc1 |
| institution | Directory Open Access Journal |
| issn | 1932-6203 |
| language | English |
| last_indexed | 2024-04-12T23:30:14Z |
| publishDate | 2010-07-01 |
| publisher | Public Library of Science (PLoS) |
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| series | PLoS ONE |
| spelling | doaj.art-37869334a38d4af5a9ab6aa1b813acc12022-12-22T03:12:17ZengPublic Library of Science (PLoS)PLoS ONE1932-62032010-07-0157e1175910.1371/journal.pone.0011759Incidence of malaria and efficacy of combination antimalarial therapies over 4 years in an urban cohort of Ugandan children.Tamara D ClarkDenise Njama-MeyaBridget NzarubaraCatherine Maiteki-SebuguziBryan GreenhouseSarah G StaedkeMoses R KamyaGrant DorseyPhilip J RosenthalCombination therapies are now recommended to treat uncomplicated malaria. We used a longitudinal design to assess the incidence of malaria and compare the efficacies of 3 combination regimens in Kampala, Uganda.Children aged 1-10 years were enrolled from randomly selected households in 2004-05 and 2007, and were followed at least monthly through 2008. Insecticide-treated bednets (ITNs) were provided in 2006. Children were randomized upon their first episode, and then treated for all episodes of uncomplicated malaria with amodiaquine/sulfadoxine-pyrimethamine (AQ/SP), artesunate/amodiaquine (AS/AQ), or artemether/lumefantrine (AL). Risks of parasitological failure were determined for each episode of uncomplicated malaria and clinical parameters were followed. A total of 690 children experienced 1464 episodes of malaria. 96% of these episodes were uncomplicated malaria and treated with study drugs; 94% were due to Plasmodium falciparum. The rank order of treatment efficacy was AL > AS/AQ > AQ/SP. Failure rates increased over time for AQ/SP, but not the artemisinin-based regimens. Over the 4-year course of the study the prevalence of asymptomatic parasitemia decreased from 11.8% to 1.4%, the incidence of malaria decreased from 1.55 to 0.32 per person year, and the prevalence of anemia (hemoglobin <10 gm/dL) decreased from 5.9% to 1.0%. No episodes of severe malaria (based on WHO criteria) and no deaths were seen.With ready access to combination therapies and distribution of ITNs, responses were excellent for artemisinin-containing regimens, severe malaria was not seen, and the incidence of malaria and prevalence of parasitemia and anemia decreased steadily over time.isrctn.org ISRCTN37517549.http://europepmc.org/articles/PMC2912768?pdf=render |
| spellingShingle | Tamara D Clark Denise Njama-Meya Bridget Nzarubara Catherine Maiteki-Sebuguzi Bryan Greenhouse Sarah G Staedke Moses R Kamya Grant Dorsey Philip J Rosenthal Incidence of malaria and efficacy of combination antimalarial therapies over 4 years in an urban cohort of Ugandan children. PLoS ONE |
| title | Incidence of malaria and efficacy of combination antimalarial therapies over 4 years in an urban cohort of Ugandan children. |
| title_full | Incidence of malaria and efficacy of combination antimalarial therapies over 4 years in an urban cohort of Ugandan children. |
| title_fullStr | Incidence of malaria and efficacy of combination antimalarial therapies over 4 years in an urban cohort of Ugandan children. |
| title_full_unstemmed | Incidence of malaria and efficacy of combination antimalarial therapies over 4 years in an urban cohort of Ugandan children. |
| title_short | Incidence of malaria and efficacy of combination antimalarial therapies over 4 years in an urban cohort of Ugandan children. |
| title_sort | incidence of malaria and efficacy of combination antimalarial therapies over 4 years in an urban cohort of ugandan children |
| url | http://europepmc.org/articles/PMC2912768?pdf=render |
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