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Surveillance of the efficacy of artemether-lumefantrine and artesunate-amodiaquine for the treatment of uncomplicated Plasmodium falciparum among children under five in Togo, 2005-2009

Monique A Dorkenoo16*, Amy Barrette2, Yao M Agbo16, Hervé Bogreau3, Séenam Kutoati4, Yao K Sodahlon5 and Kodjo Morgah6

Author Affiliations

1 Faculté Mixte de Médecine et de Pharmacie, Université de Lomé, Lomé, BP1515, Togo

2 Global Malaria Programme, World Health Organization, 20 Avenue Appia, Geneva 27, 1211, Switzerland

3 Unité de Recherche en Biologie et Epidémiologie Parasitaires, Institut de Médecine Tropicale des Services de Santé de l’Armée, Allée du Médecin, colonnel Jamot, Parc du PHARO, Marseille cedex 07, BP 60109, 13262, France

4 Service de Médecine Polyvalente-Urgences Médicales du CHU Amiens Picardie, Faculté de Médecine de l’Université Jules Vernes de Picardie, 37 Rue Alfred Lemaire, Amiens, 80000, France

5 Mectizan Donation Programme, 325, Swaton way, Decatur, GA, 30030, USA

6 Ministère de la Santé, Angle avenue, Sarakawa et avenue 24 janvier, Lomé, BP 336, Togo

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Malaria Journal 2012, 11:338  doi:10.1186/1475-2875-11-338

Published: 8 October 2012

Abstract

Background

Malaria remains a major public health problem in Togo. The national malaria control programme in Togo changed the anti-malarial treatment policy from monotherapy to artemisinin combination therapy in 2004. This study reports the results of therapeutic efficacy studies conducted on artemether-lumefantrine and artesunate-amodiaquine for the treatment of uncomplicated Plasmodium falciparum malaria in Togo, between 2005 and 2009.

Methods

Children between 6 and 59 months of age, who were symptomatically infected with P. falciparum, were treated with either artemether-lumefantrine or artesunate-amodiaquine. The primary end-point was the 28-day cure rate, PCR-corrected for reinfection and recrudescence. Studies were conducted according to the standardized WHO protocol for the assessment of the efficacy of anti-malarial treatment. Differences between categorical data were compared using the chi-square test or the Fisher’s exact test where cell counts were ≤ 5. Differences in continuous data were compared using a t-test.

Results

A total of 16 studies were conducted in five sentinel sites, with 459, 505 and 332 children included in 2005, 2007 and 2009, respectively. The PCR-corrected 28-day cure rates using the per-protocol analysis were between 96%-100% for artemether-lumefantrine and 94%-100% for artesunate-amodiaquine.

Conclusions

Both formulations of artemisinin-based combination therapy were effective over time and no severe adverse events related to the treatment were reported during the studies.

Keywords:
Malaria; Plasmodium falciparum; Therapeutic efficacy; Artemisinin-based combination; Togo