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

Sowunmi, Akintunde and Adewoye, Elsie O. and Gbotsho, Grace O and Happi, Christian T. and Sijuade, Abayomi and Folarin, Onikepe A and Okuboyejo, Titilope M and Michael, Obaro S (2010) Factors contributing to delay in parasite clearance in uncomplicated falciparum malaria in children. Malaria Journal.

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Background: Drug 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. Methods: The 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. Results: 1,237 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). Conclusion: Delay 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.

Item Type: Article
Subjects: Q Science > QR Microbiology
Divisions: Faculty of Medicine, Health and Life Sciences > School of Biological Sciences
Depositing User: Mrs Patricia Nwokealisi
Date Deposited: 24 Sep 2014 08:42
Last Modified: 19 Dec 2014 20:14

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