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;

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Benedicta A. Mensah Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Accra, Ghana;

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Michael F. Ofori Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Accra, Ghana;

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James Myers-Hansen Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Accra, Ghana;

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Abigail N. Derkyi-Kwarteng Ewim Polyclinic, Ghana Health Service, Cape-Coast, Ghana;

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Felicia Essilfie Ewim Polyclinic, Ghana Health Service, Cape-Coast, Ghana;

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Moses Dokurugu Begoro District Hospital, Ghana Health Service, Begoro, Ghana

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Emmanuel Amoakoh Begoro District Hospital, Ghana Health Service, Begoro, Ghana

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Kwadwo A. Koram Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Accra, Ghana;

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Anita Ghansah Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Accra, Ghana;

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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.

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