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Evidence basis for antimalarial policy change in Sierra Leone: five in vivo efficacy studies of chloroquine, sulphadoxine-pyrimethamine and amodiaquine.

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dc.contributor Epicentre, 8 rue Saint-Sabin, 75011 Paris, France. francesco.checchi@lshtm.ac.uk
dc.creator Checchi, F
dc.creator Roddy, P
dc.creator Kamara, S
dc.creator Williams, A
dc.creator Morineau, G
dc.creator Wurie, A R
dc.creator Hora, B
dc.creator Lamotte, N
dc.creator Baerwaldt, T
dc.creator Heinzelmann, A
dc.creator Danks, A
dc.creator Pinoges, L
dc.creator Oloo, A
dc.creator Durand, R
dc.creator Ranford-Cartwright, L
dc.creator Smet, M
dc.date 2005-02
dc.date.accessioned 2017-01-31T07:10:05Z
dc.date.available 2017-01-31T07:10:05Z
dc.identifier Evidence basis for antimalarial policy change in Sierra Leone: five in vivo efficacy studies of chloroquine, sulphadoxine-pyrimethamine and amodiaquine. 2005, 10 (2):146-53 Trop. Med. Int. Health
dc.identifier 1360-2276
dc.identifier 15679557
dc.identifier 10.1111/j.1365-3156.2004.01367.x
dc.identifier http://hdl.handle.net/10144/18366
dc.identifier http://fieldresearch.msf.org/msf/handle/10144/18366
dc.identifier Tropical Medicine & International Health
dc.identifier.uri http://dspace.mediu.edu.my:8181/xmlui/handle/10144/18366
dc.description OBJECTIVES: To provide nationally relevant information on the antimalarial efficacy of chloroquine (CQ), sulphadoxine-pyrimethamine (SP) and amodiaquine (AQ) in Sierra Leone, with a view to updating antimalarial policy in the country. METHODS: Between October 2002 and May 2003, standard WHO methodology for in vivo efficacy assessment was used in five sites to study the therapeutic response of 6-59 months old uncomplicated Plasmodium falciparum malaria cases treated with CQ (n = 247), SP (n = 353) or AQ (n = 434). Follow-up was of 28 days, with polymerase chain reaction genotyping to distinguish late recrudescences from re-infections. RESULTS: Overall 85.3% of patients reached an analysable endpoint. CQ failure proportions were very high, ranging from 39.5% (95% CI: 25.0-55.6) in Kabala to 78.8% (65.3-88.9) in Kailahun. Early failures under CQ were frequent. SP efficacy was also disappointing, with failure from 23.2% (13.9-34.9) in Kabala to 46.1% (35.4-57.0) in Kailahun. AQ resistance was more moderate, ranging from 5.4% (1.8-12.1) in Makeni to 29.8% (20.3-40.8) in Kailahun, with almost no early failures. AQ also provided more rapid fever and parasite clearance. CONCLUSION: In a consensus meeting organized by the Ministry of Health and Sanitation, and based on these findings, artesunate (AS) + AQ and artemether-lumefantrine (Coartemtrade mark) were identified as the only options to rapidly replace CQ. The choice fell on AS + AQ because of expected high efficacy, lower cost in a blister presentation, and the absence of safety data on artemether-lumefantrine in pregnancy. Donor support is required to support this policy change. Throughout Africa, as SP resistance increases, these two regimens are probably the only options available while newer combinations are developed. Efficacy studies should focus on testing AQ and AS + AQ.
dc.language en
dc.publisher Wiley-Blackwell
dc.relation http://www.blackwell-synergy.com/loi/tmi
dc.rights Archived on this site with the kind permission of Wiley-Blackwell
dc.title Evidence basis for antimalarial policy change in Sierra Leone: five in vivo efficacy studies of chloroquine, sulphadoxine-pyrimethamine and amodiaquine.


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