1921
Volume 97, Issue 2
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645
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Abstract

Abstract.

We assessed the temporal trend of artemether–lumefantrine (AL) cure rate after 8 years of its wide-scale use for treatment of uncomplicated malaria from 2006 to 2014 in Bagamoyo district, Tanzania. Trend analysis was performed for four studies conducted in 2006, 2007–2008, 2012–2013, and 2014. Patients with acute uncomplicated malaria were enrolled, treated with standard AL regimen and followed-up for 3 (2006), 28 (2014), 42 (2012–2013), or 56 (2007–2008) days for clinical and laboratory evaluation. Primary outcome was day 28 polymerase chain reaction (PCR)-adjusted cure rate across years from 2007 to 2014. Parasite clearance was slower for the 2006 and 2007–2008 cohorts with less than 50% of patients cleared of parasitemia on day 1, but was rapid for the 2012–2013 and 2014 cohorts. Day 28 PCR-adjusted cure rate was 168/170 (98.8%) (95% confidence interval [CI], 97.2–100), 122/127 (96.1%) (95% CI, 92.6–99.5), and 206/207 (99.5%) (95% CI, 98.6–100) in 2007–2008, 2012–2013, and 2014, respectively. There was no significant change in the trend of cure rate between 2007 and 2014 (χ test = 0.06, = 0.90). Pretreatment multidrug-resistant gene 1 () N86 prevalence increased significantly across years from 13/48 (27.1%) in 2006 to 183/213 (85.9%) in 2014 ( < 0.001), and chloroquine resistance transporter gene () K76 prevalence increased significantly from 24/47 (51.1%) in 2006 to 198/205 (96.6%) in 2014 ( < 0.001). The AL cure rate remained high after 8 years of its wide-scale use in Bagamoyo district for the treatment of uncomplicated malaria despite an increase in prevalence of pretreatment N86 and K76 between 2006 and 2014.

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/content/journals/10.4269/ajtmh.16-0780
2017-08-02
2017-11-23
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  • Received : 02 Oct 2016
  • Accepted : 16 Mar 2017

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