Efficacy and effectiveness of the combination of sulfadoxine/pyrimethamine and a 3-day course of artesunate for the treatment of uncomplicated falciparum malaria in a refugee settlement in Zambia.

Hdl Handle:
http://hdl.handle.net/10144/17251
Title:
Efficacy and effectiveness of the combination of sulfadoxine/pyrimethamine and a 3-day course of artesunate for the treatment of uncomplicated falciparum malaria in a refugee settlement in Zambia.
Authors:
Depoortere, E; Guthmann, J P; Pressé, J; Sipilanyambe, N; Nkandu, E; Balkan, S; de Pécoulas, P E; Legros, D
Journal:
Tropical Medicine & International Health
Abstract:
In the Maheba Refugee Settlement, in the clinics supported by Medecins Sans Frontieres, all children aged up to 5 years with a confirmed diagnosis of uncomplicated falciparum malaria are treated with the combination of sulfadoxine/pyrimethamine (SP) and artesunate (AS). We compared the treatment's efficacy and effectiveness. Patients were randomized in order to receive the treatment supervised (efficacy) or unsupervised (effectiveness). Therapeutic response was determined after 28 days of follow up. The difference between recrudescence and re-infection was ascertained by polymerase chain reaction (PCR). We also assessed genetic markers associated to SP resistance (dhfr and dhps). Eighty-five patients received treatment under supervision and 84 received it unsupervised. On day 28, and after PCR adjustment, efficacy was found to be 83.5% (95% CI: 74.1-90.5), and effectiveness 63.4% (95% CI: 52.6-73.3) (P < 0.01). Point mutations on dhfr (108) and dhps (437) were found for 92.0% and 44.2% respectively of the PCR samples analysed. The significant difference in therapeutic response after supervised and unsupervised treatment intake can only be explained by insufficient patient adherence. When implementing new malaria treatment policies, serious investment in ensuring patient adherence is essential to ascertain the effectiveness of the new treatment schedules.
Affiliation:
Epicentre, 8 rue Saint Sabin, 75011 Paris, France. evelyn.depootere@brussels.msf.org
Publisher:
Wiley-Blackwell
Issue Date:
Feb-2005
URI:
http://hdl.handle.net/10144/17251
DOI:
10.1111/j.1365-3156.2004.01363.x
PubMed ID:
15679556
Additional Links:
http://www.blackwell-synergy.com/loi/tmi
Language:
en
ISSN:
1360-2276
Appears in Collections:
Malaria

Full metadata record

DC FieldValue Language
dc.contributor.authorDepoortere, E-
dc.contributor.authorGuthmann, J P-
dc.contributor.authorPressé, J-
dc.contributor.authorSipilanyambe, N-
dc.contributor.authorNkandu, E-
dc.contributor.authorBalkan, S-
dc.contributor.authorde Pécoulas, P E-
dc.contributor.authorLegros, D-
dc.date.accessioned2008-01-31T15:57:20Z-
dc.date.available2008-01-31T15:57:20Z-
dc.date.issued2005-02-
dc.identifier.citationEfficacy and effectiveness of the combination of sulfadoxine/pyrimethamine and a 3-day course of artesunate for the treatment of uncomplicated falciparum malaria in a refugee settlement in Zambia. 2005, 10 (2):139-45 Trop. Med. Int. Healthen
dc.identifier.issn1360-2276-
dc.identifier.pmid15679556-
dc.identifier.doi10.1111/j.1365-3156.2004.01363.x-
dc.identifier.urihttp://hdl.handle.net/10144/17251-
dc.description.abstractIn the Maheba Refugee Settlement, in the clinics supported by Medecins Sans Frontieres, all children aged up to 5 years with a confirmed diagnosis of uncomplicated falciparum malaria are treated with the combination of sulfadoxine/pyrimethamine (SP) and artesunate (AS). We compared the treatment's efficacy and effectiveness. Patients were randomized in order to receive the treatment supervised (efficacy) or unsupervised (effectiveness). Therapeutic response was determined after 28 days of follow up. The difference between recrudescence and re-infection was ascertained by polymerase chain reaction (PCR). We also assessed genetic markers associated to SP resistance (dhfr and dhps). Eighty-five patients received treatment under supervision and 84 received it unsupervised. On day 28, and after PCR adjustment, efficacy was found to be 83.5% (95% CI: 74.1-90.5), and effectiveness 63.4% (95% CI: 52.6-73.3) (P < 0.01). Point mutations on dhfr (108) and dhps (437) were found for 92.0% and 44.2% respectively of the PCR samples analysed. The significant difference in therapeutic response after supervised and unsupervised treatment intake can only be explained by insufficient patient adherence. When implementing new malaria treatment policies, serious investment in ensuring patient adherence is essential to ascertain the effectiveness of the new treatment schedules.en
dc.language.isoenen
dc.publisherWiley-Blackwell-
dc.relation.urlhttp://www.blackwell-synergy.com/loi/tmi-
dc.rightsArchived on this site with the kind permission of Wiley-Blackwellen
dc.subject.meshAntimalarialsen
dc.subject.meshArtemisininsen
dc.subject.meshChild, Preschoolen
dc.subject.meshDeveloping Countriesen
dc.subject.meshDrug Administration Scheduleen
dc.subject.meshDrug Combinationsen
dc.subject.meshDrug Resistanceen
dc.subject.meshDrug Therapy, Combinationen
dc.subject.meshFemaleen
dc.subject.meshGenetic Markersen
dc.subject.meshGenomicsen
dc.subject.meshHumansen
dc.subject.meshInfanten
dc.subject.meshMalaria, Falciparumen
dc.subject.meshMaleen
dc.subject.meshPatient Complianceen
dc.subject.meshPyrimethamineen
dc.subject.meshRefugeesen
dc.subject.meshSesquiterpenesen
dc.subject.meshSulfadoxineen
dc.subject.meshTreatment Outcomeen
dc.subject.meshZambiaen
dc.titleEfficacy and effectiveness of the combination of sulfadoxine/pyrimethamine and a 3-day course of artesunate for the treatment of uncomplicated falciparum malaria in a refugee settlement in Zambia.en
dc.contributor.departmentEpicentre, 8 rue Saint Sabin, 75011 Paris, France. evelyn.depootere@brussels.msf.orgen
dc.identifier.journalTropical Medicine & International Healthen
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