Artemisinin-based combination therapy in pregnant women in Zambia: efficacy, safety and risk of recurrent malaria
Abstract Background In Zambia, malaria is one of the leading causes of morbidity and mortality, especially among under five children and pregnant women. For the latter, the World Health Organization recommends the use of artemisinin-based combination therapy (ACT) in the second and third trimester o...
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ftdoajarticles:oai:doaj.org/article:75a41815a80b4393992337302cb33641 2023-05-15T15:18:39+02:00 Artemisinin-based combination therapy in pregnant women in Zambia: efficacy, safety and risk of recurrent malaria Michael Nambozi Jean-Bertin Bukasa Kabuya Sebastian Hachizovu David Mwakazanga Joyce Mulenga Webster Kasongo Jozefien Buyze Modest Mulenga Jean-Pierre Van Geertruyden Umberto D’Alessandro 2017-05-01T00:00:00Z https://doi.org/10.1186/s12936-017-1851-7 https://doaj.org/article/75a41815a80b4393992337302cb33641 EN eng BMC http://link.springer.com/article/10.1186/s12936-017-1851-7 https://doaj.org/toc/1475-2875 doi:10.1186/s12936-017-1851-7 1475-2875 https://doaj.org/article/75a41815a80b4393992337302cb33641 Malaria Journal, Vol 16, Iss 1, Pp 1-13 (2017) Zambia Sub-Saharan Africa Artemisinin-combination therapy Treatment failure Arctic medicine. Tropical medicine RC955-962 Infectious and parasitic diseases RC109-216 article 2017 ftdoajarticles https://doi.org/10.1186/s12936-017-1851-7 2022-12-31T10:50:42Z Abstract Background In Zambia, malaria is one of the leading causes of morbidity and mortality, especially among under five children and pregnant women. For the latter, the World Health Organization recommends the use of artemisinin-based combination therapy (ACT) in the second and third trimester of pregnancy. In a context of limited information on ACT, the safety and efficacy of three combinations, namely artemether–lumefantrine (AL), mefloquine–artesunate (MQAS) and dihydroartemisinin–piperaquine (DHAPQ) were assessed in pregnant women with malaria. Methods The trial was carried out between July 2010 and August 2013 in Nchelenge district, Luapula Province, an area of high transmission, as part of a multi-centre trial. Women in the second or third trimester of pregnancy and with malaria were recruited and randomized to one of the three study arms. Women were actively followed up for 63 days, and then at delivery and 1 year post-delivery. Results Nine hundred pregnant women were included, 300 per arm. PCR-adjusted treatment failure was 4.7% (12/258) (95% CI 2.7–8.0) for AL, 1.3% (3/235) (95% CI 0.4–3.7) for MQAS and 0.8% (2/236) (95% CI 0.2–3.0) for DHAPQ, with significant risk difference between AL and DHAPQ (p = 0.01) and between AL and MQAS (p = 0.03) treatments. Re-infections during follow up were more frequent in the AL (HR: 4.71; 95% CI 3.10–7.2; p < 0.01) and MQAS (HR: 1.59; 95% CI 1.02–2.46; p = 0.04) arms compared to the DHAPQ arm. PCR-adjusted treatment failure was significantly associated with women under 20 years [Hazard Ratio (HR) 5.35 (95% CI 1.07–26.73; p = 0.04)] and higher malaria parasite density [3.23 (95% CI 1.03–10.10; p = 0.04)], and still women under 20 years [1.78, (95% CI 1.26–2.52; p < 0.01)] had a significantly higher risk of re-infection. The three treatments were generally well tolerated. Dizziness, nausea, vomiting, headache and asthenia as adverse events (AEs) were more common in MQAS than in AL or DHAPQ (p < 0.001). Birth outcomes were not significantly different between ... Article in Journal/Newspaper Arctic Directory of Open Access Journals: DOAJ Articles Arctic Malaria Journal 16 1 |
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ftdoajarticles |
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topic |
Zambia Sub-Saharan Africa Artemisinin-combination therapy Treatment failure Arctic medicine. Tropical medicine RC955-962 Infectious and parasitic diseases RC109-216 |
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Zambia Sub-Saharan Africa Artemisinin-combination therapy Treatment failure Arctic medicine. Tropical medicine RC955-962 Infectious and parasitic diseases RC109-216 Michael Nambozi Jean-Bertin Bukasa Kabuya Sebastian Hachizovu David Mwakazanga Joyce Mulenga Webster Kasongo Jozefien Buyze Modest Mulenga Jean-Pierre Van Geertruyden Umberto D’Alessandro Artemisinin-based combination therapy in pregnant women in Zambia: efficacy, safety and risk of recurrent malaria |
topic_facet |
Zambia Sub-Saharan Africa Artemisinin-combination therapy Treatment failure Arctic medicine. Tropical medicine RC955-962 Infectious and parasitic diseases RC109-216 |
description |
Abstract Background In Zambia, malaria is one of the leading causes of morbidity and mortality, especially among under five children and pregnant women. For the latter, the World Health Organization recommends the use of artemisinin-based combination therapy (ACT) in the second and third trimester of pregnancy. In a context of limited information on ACT, the safety and efficacy of three combinations, namely artemether–lumefantrine (AL), mefloquine–artesunate (MQAS) and dihydroartemisinin–piperaquine (DHAPQ) were assessed in pregnant women with malaria. Methods The trial was carried out between July 2010 and August 2013 in Nchelenge district, Luapula Province, an area of high transmission, as part of a multi-centre trial. Women in the second or third trimester of pregnancy and with malaria were recruited and randomized to one of the three study arms. Women were actively followed up for 63 days, and then at delivery and 1 year post-delivery. Results Nine hundred pregnant women were included, 300 per arm. PCR-adjusted treatment failure was 4.7% (12/258) (95% CI 2.7–8.0) for AL, 1.3% (3/235) (95% CI 0.4–3.7) for MQAS and 0.8% (2/236) (95% CI 0.2–3.0) for DHAPQ, with significant risk difference between AL and DHAPQ (p = 0.01) and between AL and MQAS (p = 0.03) treatments. Re-infections during follow up were more frequent in the AL (HR: 4.71; 95% CI 3.10–7.2; p < 0.01) and MQAS (HR: 1.59; 95% CI 1.02–2.46; p = 0.04) arms compared to the DHAPQ arm. PCR-adjusted treatment failure was significantly associated with women under 20 years [Hazard Ratio (HR) 5.35 (95% CI 1.07–26.73; p = 0.04)] and higher malaria parasite density [3.23 (95% CI 1.03–10.10; p = 0.04)], and still women under 20 years [1.78, (95% CI 1.26–2.52; p < 0.01)] had a significantly higher risk of re-infection. The three treatments were generally well tolerated. Dizziness, nausea, vomiting, headache and asthenia as adverse events (AEs) were more common in MQAS than in AL or DHAPQ (p < 0.001). Birth outcomes were not significantly different between ... |
format |
Article in Journal/Newspaper |
author |
Michael Nambozi Jean-Bertin Bukasa Kabuya Sebastian Hachizovu David Mwakazanga Joyce Mulenga Webster Kasongo Jozefien Buyze Modest Mulenga Jean-Pierre Van Geertruyden Umberto D’Alessandro |
author_facet |
Michael Nambozi Jean-Bertin Bukasa Kabuya Sebastian Hachizovu David Mwakazanga Joyce Mulenga Webster Kasongo Jozefien Buyze Modest Mulenga Jean-Pierre Van Geertruyden Umberto D’Alessandro |
author_sort |
Michael Nambozi |
title |
Artemisinin-based combination therapy in pregnant women in Zambia: efficacy, safety and risk of recurrent malaria |
title_short |
Artemisinin-based combination therapy in pregnant women in Zambia: efficacy, safety and risk of recurrent malaria |
title_full |
Artemisinin-based combination therapy in pregnant women in Zambia: efficacy, safety and risk of recurrent malaria |
title_fullStr |
Artemisinin-based combination therapy in pregnant women in Zambia: efficacy, safety and risk of recurrent malaria |
title_full_unstemmed |
Artemisinin-based combination therapy in pregnant women in Zambia: efficacy, safety and risk of recurrent malaria |
title_sort |
artemisinin-based combination therapy in pregnant women in zambia: efficacy, safety and risk of recurrent malaria |
publisher |
BMC |
publishDate |
2017 |
url |
https://doi.org/10.1186/s12936-017-1851-7 https://doaj.org/article/75a41815a80b4393992337302cb33641 |
geographic |
Arctic |
geographic_facet |
Arctic |
genre |
Arctic |
genre_facet |
Arctic |
op_source |
Malaria Journal, Vol 16, Iss 1, Pp 1-13 (2017) |
op_relation |
http://link.springer.com/article/10.1186/s12936-017-1851-7 https://doaj.org/toc/1475-2875 doi:10.1186/s12936-017-1851-7 1475-2875 https://doaj.org/article/75a41815a80b4393992337302cb33641 |
op_doi |
https://doi.org/10.1186/s12936-017-1851-7 |
container_title |
Malaria Journal |
container_volume |
16 |
container_issue |
1 |
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1766348842015391744 |