World Health Organization, 2015. World Malaria Report 2015. Geneva, Switzerland: WHO.
Ministry of Health, 2015. National Malaria Control Programme, 2014 Annual Report. Accra, Ghana: Ministry of Health.
Ghana Statistical Service (GSS), Ghana Health Service (GHS), and ICF International, 2015. 2014 Ghana Demographic and Health Survey (GDHS) Key Findings. Rockville, MD: GSS, GHS, and ICF International.
Ministry of Health, 2014. Guidelines for Case Management of Malaria in Ghana, 3rd edition. Accra, Ghana: Ministry of Health.
Koram KA, 2003. Mapping Response of Plasmodium falciparum to Chloroquine and Other Antimalarial Drugs in Ghana. Project ID 980034. Final report submitted to MIM/TDR. Accra, Ghana: Noguchi Memorial Institute for Medical Research.
Abuaku B, Duah N, Quaye L, Quashie N, Koram KA, 2012. Therapeutic efficacy of artemether-lumefantrine combination in the treatment of uncomplicated malaria among children under five years of age in three ecological zones in Ghana. Malar J 11: 388.
Koram KA, Abuaku B, Duah N, Quashie N, 2005. Comparative efficacy of antimalarial drugs including ACTs in the treatment of uncomplicated malaria among children under 5 years in Ghana. Acta Trop 95: 194–203.
Duah NO, Wilson MD, Ghansah A, Abuaku B, Edoh D, Quashie NB, Koram KA, 2007. Mutations in Plasmodium falciparum chloroquine resistance transporter and multidrug resistance genes, and treatment outcomes in Ghanaian children with uncomplicated malaria. J Trop Pediatr 53: 27–31.
Quashie NB, Duah NO, Abuaku B, Koram KA, 2007. The in-vitro susceptibilities of Ghanaian Plasmodium falciparum to antimalarial drugs. Ann Trop Med Parasitol 101: 391–398.
Koram KA, Quaye L, Abuaku B, 2008. Efficacy of amodiaquine/artesunate combination therapy for uncomplicated malaria in children under five years in Ghana. Ghana Med J 42: 55–60.
Duah NO, Abuaku B, Quashie N, Kronmann K, Koram K, 2012. Surveillance of molecular markers of Plasmodium falciparum resistance to sulphadoxine-pyrimethamine resistance 5 years after the change of malaria treatment policy in Ghana. Am J Trop Med Hyg 87: 996–1003.
Duah NO et al., 2013. Increased pfmdr1 gene copy number and the decline in pfcrt and pfmdr1 resistance alleles in Ghanaian Plasmodium falciparum isolates after change of anti-malarial drug treatment policy. Malar J 12: 377.
Quashie NB et al., 2013. A SYBR Green 1-based in-vitro test of susceptibility of Ghanaian Plasmodium falciparum clinical isolates to a panel of antimalarial drugs. Malar J 12: 450.
Abuaku B, Quaye L, Quashie N, Quashie N, Koram KA, 2014. Managing antimalarial drug resistance in Ghana: the importance of surveillance. Koram KA, Ahorlu CSK, Wilson MD, Yeboah-Manu D, and Bosompem KM, eds. Towards Effective Disease Control in Ghana: Research and Policy Implications, Vol. 1. Accra, Ghana: University of Ghana Reader Series.
Ghana Statistical Service, 2012. 2010 Population and Housing Census. Summary Report of Final Results. Accra, Ghana: Ghana Statistical Service.
Ministry of Food and Agriculture, 2012. Fanteakwa District. Available at: http//www.mofa.gov.gh/site/?page_id=1512. Accessed August 30, 2015.
World Health Organization, 2008. Methods and Techniques for Clinical Ttrials on Antimalarial Drug Efficacy: Genotyping to Identify Parasite Populations. Geneva, Switzerland: WHO.
Wooden J, Kyes S, Sibley CH, 1993. PCR and strain identification in Plasmodium falciparum. Parasitol Today 9: 303–305.
World Health Organization, 2009. Methods for Surveillance of Antimalarial Drug Efficacy. Geneva, Switzerland: WHO.
Adjei GO, Kurtzhals JA, Rodrigues OP, Alifrangis M, Hoegberg LC, Kitcher ED, Badoe EV, Lamptey R, Goka BQ, 2008. Amodiaquine-artesunate vs artemether-lumefantrine for uncomplicated malaria in Ghanaian children: a randomized efficacy and safety trial with one year follow-up. Malar J 7: 127.
Owusu-Agyei S, Asante KP, Owusu R, Adjuik M, Amenga-Etego S, Dosoo DK, Gyapong J, Greenwood B, Chandramohan D, 2008. An open label, randomized trial of artesunate+amodiaquine, artesunate+chlorproguanil-dapsone and artemether-lumefantrine for the treatment of uncomplicated malaria. PLoS One 3: e2530.
Yavo W, Konaté A, Kassi FK, Djohan V, Angora EK, Kiki-Barro PC, Vanga-Bosson H, Menan EIH, 2015. Efficacy and safety of artesunate-amodiaquine versus artemether-lumefantrine in the treatment of uncomplicated Plasmodium falciparum malaria in sentinel sites across Côte d’Ivoire. Malar Res Treat 2015: 878132.
Paczkowski M, Mwandama D, Marthey D, Luka M, Makuta G, Sande J, Ali D, Troell P, Mathanga DP, Gutman J, 2016. In vivo efficacy of artemether-lumefantrine and artesunate-amodiaquine for uncomplicated Plasmodium falciparum malaria in Malawi, 2014. Malar J 15: 236.
Ndounga M, Mayengue PI, Casimiro PN, Koukouikila-Koussounda F, Bitemo M, Matondo BD, Diakou LAN, Basco LK, Ntoumi F, 2015. Artesunate-amodiaquine versus artemether-lumefantrine for the treatment of acute uncomplicated malaria in Congolese children under 10 years old living in a suburban area: a randomized study. Malar J 14: 423.
Nji AM et al., 2015. Randomized non-inferiority and safety trial of dihydroartemisinin-piperaquine and artesunate-amodiaquine versus artemether-lumefantrine in the treatment of uncomplicated Plasmodium falciparum malaria in Cameroonian children. Malar J 14: 27.
Schramm B et al., 2013. Efficacy of artesunate-amodiaquine and artemether-lumefantrine fixed-dose combinations for the treatment of uncomplicated Plasmodium falciparum malaria among children aged six to 59 months in Nimba County, Liberia: an open-label randomized non-inferiority trial. Malar J 12: 251.
Yeka A, Lameyre V, Afizi K, Frederick M, Lukwago R, Kamya MR, Talisuna AO, 2014. Efficacy and safety of fixed-dose artesunate-amodiaquine vs. artemether-lumefantirne for repeated treatment of uncomplicated malaria in Ugandan children. PLoS One 9: e113311.
World Health Organization, 2001. Antimalarial Drug Combination Therapy. Report of a WHO Technical Consultation, 4–5 April 2001. Geneva, Switzerland: WHO.
Mutabingwa TK, 2005. Artemisinin-based combination therapies (ACTs): best hope for malaria treatment but inaccessible to the needy! Acta Trop 95: 305–315.
Nosten F, van Vugt M, Price R, Luxemburger C, Thway KL, Brockman A, McGready R, ter Kuile F, Looareesuwan S, White NJ, 2000. Effects of artesunate-mefloquine combination on incidence of Plasmodium falciparum malaria and mefloquine resistance in western Thailand: a prospective study. Lancet 356: 297–302.
Adjuik M et al., 2004. Artesunate combinations for treatment of malaria: meta-analysis. Lancet 363: 9–17.
Mårtensson A, Strömberg J, Sisowath C, Msellem MI, Gil JP, Montgomery SM, Olliaro P, Ali AS, Björkman A, 2005. Efficacy of artesunate plus amodiaquine versus that of artemether-lumefantrine for the treatment of uncomplicated childhood Plasmodium falciparum malaria in Zanzibar, Tanzania. Clin Infect Dis 41: 1079–1086.
Sagara I, Piarroux R, Djimde A, Giorgi R, Kayentao K, Doumbo OK, Gaudart J, 2014. Delayed anemia assessment in patients treated with oral artemisinin derivatives for uncomplicated malaria: a pooled analysis of clinical trials data from Mali. Malar J 13: 358.
Oguche S et al., 2014. Efficacy of artemisinin-based combination treatments of uncomplicated falciparum malaria in under-five-year-old Nigerian children. Am J Trop Med Hyg 91: 925–935.
|Past two years||Past Year||Past 30 Days|
|Full Text Views||560||169||11|
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.
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: firstname.lastname@example.org, email@example.com, firstname.lastname@example.org, email@example.com, firstname.lastname@example.org and email@example.com. Abigail N. Derkyi-Kwarteng and Felicia Essilfie, Ewim Polyclinic, Ghana Health Service, Cape-Coast, Ghana, E-mails: firstname.lastname@example.org and email@example.com. Moses Dokurugu and Emmanuel Amoakoh, Begoro District Hospital, Ghana Health Service, Begoro, Ghana, E-mails: firstname.lastname@example.org and email@example.com.