Global estimation of anti-malarial drug effectiveness for the treatment of uncomplicated Plasmodium falciparum malaria 1991–2019

• Published in: Malaria Journal
• Main Authors: Giulia Rathmes, Susan F. Rumisha, Tim C. D. Lucas, Katherine A. Twohig, Andre Python, Michele Nguyen, Anita K. Nandi, Suzanne H. Keddie, Emma L. Collins, Jennifer A. Rozier, Harry S. Gibson, Elisabeth G. Chestnutt, Katherine E. Battle, Georgina S. Humphreys, Punam Amratia, Rohan Arambepola, Amelia Bertozzi-Villa, Penelope Hancock, Justin J. Millar, Tasmin L. Symons, Samir Bhatt, Ewan Cameron, Philippe J. Guerin, Peter W. Gething, Daniel J. Weiss
• Format: Article in Journal/Newspaper
• Language: English
• Published: BMC 2020
• Subjects: Falciparum malaria; Anti-malarial drug effectiveness; Drug quality; Global; Arctic medicine. Tropical medicine; RC955-962; Infectious and parasitic diseases; RC109-216; Arctic
• Online Access: https://doi.org/10.1186/s12936-020-03446-8; https://doaj.org/article/75741e781dc14dad9f176c6bd4bd7be9

Abstract Background Anti-malarial drugs play a critical role in reducing malaria morbidity and mortality, but their role is mediated by their effectiveness. Effectiveness is defined as the probability that an anti-malarial drug will successfully treat an individual infected with malaria parasites under routine health care delivery system. Anti-malarial drug effectiveness (AmE) is influenced by drug resistance, drug quality, health system quality, and patient adherence to drug use; its influence on malaria burden varies through space and time. Methods This study uses data from 232 efficacy trials comprised of 86,776 infected individuals to estimate the artemisinin-based and non-artemisinin-based AmE for treating falciparum malaria between 1991 and 2019. Bayesian spatiotemporal models were fitted and used to predict effectiveness at the pixel-level (5 km × 5 km). The median and interquartile ranges (IQR) of AmE are presented for all malaria-endemic countries. Results The global effectiveness of artemisinin-based drugs was 67.4% (IQR: 33.3–75.8), 70.1% (43.6–76.0) and 71.8% (46.9–76.4) for the 1991–2000, 2006–2010, and 2016–2019 periods, respectively. Countries in central Africa, a few in South America, and in the Asian region faced the challenge of lower effectiveness of artemisinin-based anti-malarials. However, improvements were seen after 2016, leaving only a few hotspots in Southeast Asia where resistance to artemisinin and partner drugs is currently problematic and in the central Africa where socio-demographic challenges limit effectiveness. The use of artemisinin-based combination therapy (ACT) with a competent partner drug and having multiple ACT as first-line treatment choice sustained high levels of effectiveness. High levels of access to healthcare, human resource capacity, education, and proximity to cities were associated with increased effectiveness. Effectiveness of non-artemisinin-based drugs was much lower than that of artemisinin-based with no improvement over time: 52.3% (17.9–74.9) for 1991–2000 ...