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| 1 | Therapeutic efficacy and effects of artemisinin-based combination treatments on uncomplicated Plasmodium falciparum malaria-associated anaemia in Nigerian children during seven years of adoption as first-line treatments显示文摘Background:Artemisinin-based combination treatments(ACTs)are the first-line treatments of uncomplicated Plasmodium falciparum malaria in many endemic areas but there are few evaluation of their efficacy in anaemic malarious children.Methods:Therapeutic efficacy of 3-day regimens of artesunate-amodiaquine and artemether-lumefantrine was evaluated in 437 anaemic and 909 non-anaemic malarious children following treatment during a seven-year period(2008-2014).Patterns of temporal changes in haematocrit were classified based on haematocrit values<30%and≥30%.Kinetics of the disposition of the deficit in haematocrit from 30%following treatment were evaluated using a non-compartment model.Results:PCR-corrected parasitological efficacy 28 days after start of treatment was significantly higher in artesunateamodiaquine-compared to artemether-lumefantrine-treated children[97%(95%CI:92.8-100)versus 96.4%(95%CI:91.3-99.4),P=0.02],but it was similar in non-anaemic and anaemic children.Fall in haematocrit/1000 asexual parasites cleared from peripheral blood was significantly greater at lower compared to higher parasitaemias(P<0.0001),and in non-anaemic compared to anaemic children(P=0.007).In anaemic children at presentation,mean anaemia recovery time(AnRT)was 15.4 days(95%CI:13.3-17.4)and it did not change over the years.Declines in haematocrit deficits from 30%were monoexponential with mean estimated half-time of 1.4 days(95%CI:1.2-1.6).Anaemia half-time(t_(1/2anaemia))correlated positively with AnRT in the same patients(r=0.69,P<0.0001).Bland-Altman analysis of 10 multiples of t_(1/2anaemia) and AnRT showed narrow limit of agreement with insignificant bias(P=0.07)suggesting both can be used interchangeably in the same patients.Conclusions:Artesunate-amodiaquine and artemether-lumefantrine remain efficacious treatments of uncomplicated P.falciparum infections in non-anaemic and anaemic Nigerian children in the last 7 years of adoption as first-line treatments.These ACTs may also conserve haematocrit at high parasitaemias and in anaemic children.Trials registration:Pan African Clinical Trial Registry PACTR201508001188143,3 July 2015;PACTR201510001189370,3 July 2015;PACTR201508001191898,7 July 2015 and PACTR201508001193368,8 July 2015. | Akintunde Sowunmi Kazeem Akano Godwin Ntadom Adejumoke I.Ayede Folasade O.Ibironke Temitope Aderoyeje Elsie O.Adewoye Bayo Fatunmbi Stephen Oguche Henrietta U.Okafor Ismaila Watila Martin Meremikwu Philip Agomo William Ogala Chimere Agomo Onikepe A.Folarin Grace O.Gbotosho Christian T.Happi | 2017 | Infectious Diseases of Poverty2017，6，1： | 2 |
| 2 | Declining responsiveness of childhood Plasmodium falciparum infections to artemisinin-based combination treatments ten years following deployment as first-line antimalarials in Nigeria显示文摘Background:The development and spread of artemisinin-resistant Plasmodium falciparum malaria in Greater Mekong Subregion has created impetus for continuing global monitoring of efficacy of artemisinin-based combination therapies(ACTs). This post analyses is aimed to evaluate changes in early treatment response markers 10 years after the adoption of ACTs as first-line treatments of uncomplicated falciparum malaria in Nigeria.Methods: At 14 sentinel sites in six geographical areas of Nigeria, we evaluated treatment responses in 1341 children under 5 years and in additional 360 children under 16 years with uncomplicated malaria enrolled in randomized trials of artemether-lumefantrine versus artesunate-amodiaquine at 5-year interval in 2009-2010 and 2014-2015 and at 2-year interval in 2009-2010 and 2012-2015, respectively after deployment in 2005.Results: Asexual parasite positivity 1 day after treatment initiation (APPD1) rose from 54 to 62% and 2 days after treatment initiation from 5 to 26% in 2009-2010 to 2014-2015(P=0.002 and P<0.0001, respectively).Parasite clearance time increased significantly from 1.6 days (95% confidence interval [CI]: 1.55-1.64) to 1.9 days (95% C,1.9-2.0) and geometric mean parasite reduction ratio 2 days after treatment initiation decreased significantly from 11 000 to 4700 within the same time period (P< 00001 for each). Enrolment parasitaemia > 75 000 μl^-1, haematocrit > 27% 1 day post-treatment initiatiortreatment with artemether-lumefantrine and enrolment in 2014-2015 independently predicted APPD1. In paralle , Kaplan-Meier estimated risk of recurrent infections by day 28 rose from 8 to 14% (P=0005) and from 9 to 15%(P=0.02) with artemether-lumefantrine and artesunate-amodiaquine, respectively. Mean asexual parasitaemia half-life increased significantly from 1.1 h to 1.3h within 2 years (P<0.0001).Conclusions:These data indicate declining parasitological responses through time to the two ACTs may be due to emergence of parasites with reduced susceptibility or decrease in immunity to the infections in these children. | Akintunde Sowunmi Godwin Ntadom Kazeem Akano Folasade O.Ibironke Adejumoke I.Ayede Chimere Agomo Onikepe A.Folarin Grace O.Gbotosho Christian Happi Stephen Oguche Henrietta U.Okafor Martin Meremikwu Philip Agomo William Ogala Ismaila Watila Olugbenga Mokuolu Finomo Finomo Joy C.Ebenebe Nma Jiya Jose Ambe Robinson Wammanda George Emechebe Wellington Oyibo Francis Useh Temitope Aderoyeje Titilope M.Dokunmu Omobolaji T.Alebiosu Sikiru Amoo Oluwabunmi K.Basorun Olubunmi A.Wewe Chukwuebuka Okafor Odafe Akpoborie Bayo Fatunmbi Elsie O.Adewoye Nnenna M.Ezeigwe Ayoade Oduola | 2019 | Infectious Diseases of Poverty2019，8，4： | 0 |
| 3 | Increased uptake of intermittent preventive treatment for malaria in pregnant women in Zambia(2006–2012):Potential determinants and highlight of lessons learnt显示文摘Objective:To assess potential determinants of uptake and highlight lessons learnt from the implementation of intermittent preventive treatment(IPTp), given to pregnant women as early as possible during the second trimester in Zambia.Methods: Data from four national malaria surveys(2006, 2008, 2010, 2012) were reviewed, and proportions of pregnant women attending antenatal clinics(ANCs) who received two or more doses of sulfadoxine–pyrimethamine(IPTp2) were compared by place of residence, education level, and wealth status. Malaria cases and deaths in pregnant women, from Health Information Management System 2011–2013, were analyzed to determine malaria burden in pregnancy in Zambia. A multiple logistic regression model was applied to identify potential determinants of IPTp uptake.Results: The proportion of pregnant women who took IPTp at ANCs increased from near zero at inception in 2001 to 61.9% in 2006; and to 72% by 2012(P < 0.001), and overall the uptake was 1.41 times higher in 2012 compared to 2006. From 2006 to 2012,IPTp2 uptake among women with no formal education increased from 51% to 68%(P < 0.1). Likewise, uptake among pregnant women with the lowest wealth index increased from 58.2% to 61.2%. By 2012, IPTp uptake among pregnant women within the lowest wealth index increased to a similar level as the women with high wealth index(P = 0.05). Incidence of malaria cases, hospital admissions and mortality during pregnancy decreased between 2011 and 2013. Overall, increased IPTp uptake was associated with being in urban areas(OR = 1.56, 95% CI: 1.39–1.74), having college(OR = 1.83,95% CI: 1.25–2.75) or secondary education(OR = 1.68, 95% CI: 1.44–1.96) or of being of higher wealth status(OR = 1.86, 95% CI: 1.60–2.17).Conclusions: Zambia has increased IPTp uptake through ANC for all women. The malaria control program has contributed to increasing access to health services and reducing demographic and socioeconomic disparities. | Freddie Masaninga Mary Katepa Bwalya Sarai Malumo Busiku Hamainza Peter Songolo Mulakwa Kamuliwo Martin Meremikwu Lawrence Kazembe Jacob Mufunda Olusegun Ayorinde Babaniyi | 2016 | Asian Pacific Journal of Tropical Biomedicine2016，6，7： | 0 |
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