Trends and predictive factors for treatment failure following artemisinin-based combination therapy among children with uncomplicated malaria in Ghana: 2005-2018

Since the introduction of artemisinin-based combination therapy (ACT) in Ghana in 2005 there has been a surveillance system by the National Malaria Control Programme (NMCP) and the University of Ghana Noguchi Memorial Institute for Medical Research (UG-NMIMR) to monitor the therapeutic efficacy of A...

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Bibliographic Details
Published in:BMC infectious diseases 2021-12, Vol.21 (1), p.1255-13, Article 1255
Main Authors: Abuaku, Benjamin, Duah-Quashie, Nancy Odurowah, Quashie, Neils, Gyasi, Akosua, Afriyie, Patricia Opoku, Owusu-Antwi, Felicia, Ghansah, Anita, Malm, Keziah Laurencia, Bart-Plange, Constance, Koram, Kwadwo Ansah
Format: Article
Language:English
Subjects:
ACTs
Amodiaquine
Amodiaquine - therapeutic use
Analysis
Antimalarials - therapeutic use
Artemether
Artemether - therapeutic use
Artemether, Lumefantrine Drug Combination - therapeutic use
Artemisinin
Artemisinins - therapeutic use
Artesunate
Asexuality
Care and treatment
Child
Children
Combination therapy
Diagnosis
Drug Combinations
Failure analysis
Ghana
Ghana - epidemiology
Health aspects
Hospitals
Humans
Infant
Infections
Infectious diseases
Laboratories
Malaria
Malaria - drug therapy
Malaria - epidemiology
Malaria, Falciparum - drug therapy
Malaria, Falciparum - epidemiology
Medical research
Microscopy
Parasites
Predictive factors
Regression analysis
Risk factors
Statistical analysis
Surveillance
Treatment Failure
Treatment outcome
Trends
Vector-borne diseases
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Summary:Since the introduction of artemisinin-based combination therapy (ACT) in Ghana in 2005 there has been a surveillance system by the National Malaria Control Programme (NMCP) and the University of Ghana Noguchi Memorial Institute for Medical Research (UG-NMIMR) to monitor the therapeutic efficacy of ACTs for the treatment of uncomplicated malaria in the country. We report trends and determinants of failure following treatment of Ghanaian children with artesunate-amodiaquine (ASAQ) and artemether-lumefantrine (AL) combinations. Per protocol analyses as well as cumulative incidence of day 28 treatment failure from Kaplan Meier survival analyses were used to describe trends of failure over the surveillance period of 2005-2018. Univariable and multivariable cox regression analyses were used to assess the determinants of treatment failure over the period. Day 28 PCR-corrected failure, following treatment with ASAQ, significantly increased from 0.0% in 2005 to 2.0% (95% CI: 1.1-3.6) in 2015 (p = 0.013) but significantly decreased to 0.4% (95% CI: 0.1-1.6) in 2018 (p = 0.039). Failure, following treatment with AL, decreased from 4.5% (95% CI: 2.0-9.4) in 2010 to 2.7% (95% CI: 1.4-5.1) in 2018, though not statistically significant (p = 0.426). Risk of treatment failure, from multivariable cox regression analyses, was significantly lower among children receiving ASAQ compared with those receiving AL (HR = 0.24; 95% CI: 0.11-0.53; p 
ISSN:1471-2334
1471-2334
DOI:10.1186/s12879-021-06961-4