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Low efficacy of the combination artesunate plus amodiaquine for uncomplicated falciparum malaria among children under 5 years in Kailahun, Sierra Leone.
Tropical Medicine and International Health. 2006 Jul; 11(7):1017-1021.In 2004, Sierra Leone adopted artesunate plus amodiaquine as first-line antimalarial treatment. We evaluated the efficacy of this combination in Kailahun, where a previous study had shown 70.2% efficacy of amodiaquine in monotherapy. Method and outcome classification of the study complied with WHO guidelines. Children 6--59 months with uncomplicated malaria were followed-up for 28 days. PCR genotyping was used to distinguish recrudescence from reinfection. Reinfections were reclassified as cured. Of 172 children who were referred to the study clinic, 126 satisfied inclusion criteria and were enrolled. No early treatment failures were reported. The day 14, efficacy was 98.2% (95% CI: 93.8--99.8). Of 65 recurrent parasitaemias analysed by PCR, 17 were recrudescences. The PCR-adjusted day 28 efficacy was 84.5% (95% CI: 76.4--90.7). All true failures occurred in the last 8 days of follow-up. Of 110 children who completed the 28-day follow-up, 54 (49.1%) experienced a novel infection. The efficacy of this combination was disappointing. The high reinfection rate suggested little prophylactic effect. In Kailahun a more efficacious combination might be necessary in the future. The efficacy of AS + AQ needs to be monitored in Kailahun and in the other regions of Sierra Leone. (author's)
Science. 2005 Jan 7; 307:33.It seemed like a classic case of bait and switch. In 2004, the World Health Organization (WHO) and the Global Fund for AIDS, Tuberculosis, and Malaria threw their weight behind a radical change in the fight against malaria in Africa. Old, ineffective drugs were to be abandoned in favor of new formulations based on a compound called artemisinin that could finally reduce the staggering death toll. More than 20 African countries have signed on. But the catch is there aren’t nearly enough of the new drugs to go around. Just before Christmas, WHO—which buys the tablets from Novartis for use in African countries—announced that it would deliver only half of the 60 million doses anticipated in 2005, leaving many countries in the cold. “It’s a very cruel irony,” concedes Allan Schapira of WHO’s Roll Back Malaria effort. (excerpt)