Declining responsiveness of childhood Plasmodium falciparum infections to artemisinin-based combination treatments ten years following deployment as first-line antimalarials in Nigeria

作     者：Akintunde Sowunmi Godwin Ntadom Kazeem Akano Folasade O.Ibironke Adejumoke I.Ayede Chimere Agomo Onikepe A.Folarin Grace O.Gbotosho Christian Happi Stephen Oguche Henrietta U.Okafor Martin Meremikwu Philip Agomo William Ogala Ismaila Watila Olugbenga Mokuolu Finomo Finomo Joy C.Ebenebe Nma Jiya Jose Ambe Robinson Wammanda George Emechebe Wellington Oyibo Francis Useh Temitope Aderoyeje Titilope M.Dokunmu Omobolaji T.Alebiosu Sikiru Amoo Oluwabunmi K.Basorun Olubunmi A.Wewe Chukwuebuka Okafor Odafe Akpoborie Bayo Fatunmbi Elsie O.Adewoye Nnenna M.Ezeigwe Ayoade Oduola 

作者机构：Antimalarial Therapeutic Efficacy Monitoring GroupNational Malaria Elimination ProgrammeThe Federal Ministry of HealthAbujaNigeria Department of Pharmacology and TherapeuticsUniversity of IbadanIbadanNigeria 不详 

出 版 物：《Infectious Diseases of Poverty》 (贫困所致传染病（英文）)

年 卷 期：2019年第8卷第4期

页      面：96-97页

核心收录：

学科分类：1004[医学-公共卫生与预防医学(可授医学、理学学位)] 1002[医学-临床医学] 1001[医学-基础医学(可授医学、理学学位)] 10[医学] 

基　　金：Malaria Consortium United States President’s Malaria Initiative National Institutes of Health, NIH U.S. Department of Health and Human Services, HHS, (U01HG007480, U54HG007480) National Human Genome Research Institute, NHGRI Henry M. Jackson Foundation, HJF Global Fund to Fight AIDS, Tuberculosis and Malaria World Bank Group, WBG, (ACE019) Bundesministerium für Gesundheit, BMG 

主　　题：Declining responsiveness Falciparum malaria Children Artemisinin-based combination treatment Nigeria 

摘      要：Background:The development and spread of artemisinin-resistant Plasmodium falciparum malaria in Greater Mekong Subregion has created impetus for continuing global monitoring of efficacy of artemisinin-based combination therapies(ACTs). This post analyses is aimed to evaluate changes in early treatment response markers 10 years after the adoption of ACTs as first-line treatments of uncomplicated falciparum malaria in Nigeria.Methods: At 14 sentinel sites in six geographical areas of Nigeria, we evaluated treatment responses in 1341 children under 5 years and in additional 360 children under 16 years with uncomplicated malaria enrolled in randomized trials of artemether-lumefantrine versus artesunate-amodiaquine at 5-year interval in 2009-2010 and 2014-2015 and at 2-year interval in 2009-2010 and 2012-2015, respectively after deployment in 2005.Results: Asexual parasite positivity 1 day after treatment initiation (APPD1) rose from 54 to 62% and 2 days after treatment initiation from 5 to 26% in 2009-2010 to 2014-2015(P=0.002 and P 75 000 μl^-1, haematocrit 27% 1 day post-treatment initiatiortreatment with artemether-lumefantrine and enrolment in 2014-2015 independently predicted APPD1. In paralle , Kaplan-Meier estimated risk of recurrent infections by day 28 rose from 8 to 14% (P=0005) and from 9 to 15%(P=0.02) with artemether-lumefantrine and artesunate-amodiaquine, respectively. Mean asexual parasitaemia half-life increased significantly from 1.1 h to 1.3h within 2 years (P0.0001).Conclusions:These data indicate declining parasitological responses through time to the two ACTs may be due to emergence of parasites with reduced susceptibility or decrease in immunity to the infections in these children.