Factors contributing to delay in parasite clearance in uncomplicated falciparum malaria in children

Malaria Journal

Research

Abayomi Sijuade¹  Titilope M Okuboyejo¹  Obaro S Michael²  Akintunde Sowunmi²  Grace O Gbotsho²  Elsie O Adewoye³  Onikepe A Folarin⁴  Christian T Happi⁴ 

[1] Department of Pharmacology & Therapeutics, University of Ibadan, Ibadan, Nigeria;Department of Pharmacology & Therapeutics, University of Ibadan, Ibadan, Nigeria;Malaria Research Laboratories, Institute for Medical Research and Training, University of Ibadan, Ibadan, Nigeria;Department of Physiology, University of Ibadan, Ibadan, Nigeria;Malaria Research Laboratories, Institute for Medical Research and Training, University of Ibadan, Ibadan, Nigeria;

关键词: Malaria;    Treatment Failure;    Falciparum Malaria;    Artesunate;    Parasite Clearance;   

DOI  :  10.1186/1475-2875-9-53

 received in 2009-08-26, accepted in 2010-02-15,  发布年份 2010

来源: Springer

【 摘 要 】

BackgroundDrug resistance in Plasmodium falciparum is common in many endemic and other settings but there is no clear recommendation on when to change therapy when there is delay in parasite clearance after initiation of therapy in African children.MethodsThe factors contributing to delay in parasite clearance, defined as a clearance time > 2 d, in falciparum malaria were characterized in 2,752 prospectively studied children treated with anti-malarial drugs between 1996 and 2008.Results1,237 of 2,752 children (45%) had delay in parasite clearance. Overall 211 children (17%) with delay in clearance subsequently failed therapy and they constituted 72% of those who had drug failure, i.e., 211 of 291 children. The following were independent risk factors for delay in parasite clearance at enrolment: age less than or equal to 2 years (Adjusted odds ratio [AOR] = 2.13, 95% confidence interval [CI]1.44-3.15, P < 0.0001), presence of fever (AOR = 1.33, 95% CI = 1.04-1.69, P = 0.019), parasitaemia >50,000/ul (AOR = 2.21, 95% CI = 1.77-2.75, P < 0.0001), and enrolment before year 2000 (AOR= 1.55, 95% CI = 1.22-1.96, P < 0.0001). Following treatment, a body temperature ≥ 38°C and parasitaemia > 20000/μl a day after treatment began, were independent risk factors for delay in clearance. Non-artemisinin monotherapies were associated with delay in clearance and treatment failures, and in those treated with chloroquine or amodiaquine, with pfmdr 1/pfcrt mutants. Delay in clearance significantly increased gametocyte carriage (P < 0.0001).ConclusionDelay in parasite clearance is multifactorial, is related to drug resistance and treatment failure in uncomplicated malaria and has implications for malaria control efforts in sub-Saharan Africa.

【 授权许可】

CC BY   
© Sowunmi et al; licensee BioMed Central Ltd. 2010