Occurrence of day 3 submicroscopic plasmodium falciparum parasitaemia before and after implementation of artemether-lumefantrine treatment policy in Tanzania.
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Date
2017
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BMJ Global Health
Abstract
Background Emergence ofPlasmodium falciparumresistanceagainst artemisinin in Southeast Asia raises a serious concernabout the long-term efficacy of artemisinin-based combinationtherapy (ACT) globally. In Africa, ACT has remained highlyefficacious with a microscopy determined asexual parasites clear-ance occurring within 48 hours post-treatment in most patients.However, submicroscopic parasitaemia has been reported onDay 3 after ACT treatment. We assessed the prevalence ofpatients with submicroscopic parasitaemia on Day 3 and its asso-ciated factors following treatment with artemether-lumefantrine(AL) from 2006 to 2014 in Bagamoyo district, Tanzania.MethodsCytochrome b-nested polymerase chain reaction(PCR) was used for screening of submicroscopic parasitaemiafrom blood samples collected onfilter paper on Day 3 post-ALtreatment for acute uncomplicatedP. falciparummalaria.Primary outcome was proportion of patients with submicro-scopic parasitaemia on Day 3 from 2006 to 2014. Secondaryoutcomes included proportional difference in submicroscopicparasitaemia across years, association of pre-treatment character-istics with submicroscopic parasitaemia, and association of sub-microscopic parasitaemia with recurrent infection ResultsOnly 2/584 (0.34%) of the screened patients hadmicroscopy determined parasitaemia on Day 3, whereas, 256/584 (43.8%) had submicroscopic parasitaemia. Submicroscopicparasitaemia prevalence increased from 28% (14/50) in 2006 to74.2% (132/178) in 2007–8, and thereafter declined to 36%(50/139) in 2012–13 and 27.6% (60/217) in 2014, with thelikelihood of being positive for submicroscopic parasitaemiadecreasing by 14.7% (95% CI: 9.5–19.7%, p<0.001) for anincrease in year by one. Pre-treatment parasitaemia >100,000/mL, haemoglobin <10 g/dL, fever, being aged <5 years andyear of study 2007–8 and 2012–13 were associated with thepresence of submicroscopic parasitaemia. There was no associ-ation between submicroscopic parasitaemia and recurrentinfection.ConclusionsDay 3 submicroscopic parasitaemia was commonin patients treated with AL before and after implementation ofthe policy, and changed considerably across years from 2006 to2014, however, its presence was associated with pre-treatmentcharacteristics.
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Keywords
Submicroscopic plasmodium falciparum parasitaemia, Artemether-lumefantrine, Treatment policy in Tanzania
Citation
Ngasala, B., Jovel, I., Malmberg, M., Mmbando, B., Björkman, A., Premji, Z., Mårtensson, A. and Mwaiswelo, R., 2017. Ngasala, B., Jovel, I., Malmberg, M., Mmbando, B., Björkman, A., Premji, Z., Mårtensson, A. and Mwaiswelo, R., 2017.Occurrence of day 3 submicroscopic plasmodium falciparum parasitaemia before and after implementation of artemether-lumefantrine treatment policy in Tanzania . BMJ Global Health, 2(Suppl 2).. BMJ Global Health, 2(Suppl 2).