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Background:Dihydroartemisinin-piperaquine is a first line treatment for uncomplicated malaria in Ghana. A facility-based study was undertaken to examine the effectiveness of thetreatment in the routine health care system.Methods:The study was undertaken at the Navrongodemographic surveillance area. Patients presenting with acute febrile illness were enrolled after informed consented and confirmation by microscopy. Patients were randomized into supervised group who received treatment under direct observation and unsupervised group which had only the first treatment given under supervision. Treatment was according to bodyweight and 42 days follow-up was undertaken.Results:A total of 194 patients were enrolled; 54.1% were females and 51% had supervised treatment. The median age and weight were 6.7 years and 20.0kg respectively. Mean baseline temperature, haemoglobin concentration and parasite density were, 37.6oC, 11.1 g/dl and 11,098 parasites per microliter of blood respectively. Study completion rate was 93.3%, day 42 polymerase chain reaction-unadjusted adequate clinical and parasitological responses rate (ACPR) was 93.4% by evaluable and 87.1 % by intention-to-treat (ITT). The day 42 ACPR by evaluable was 92.3% in the supervised arm compared to 94.4% in the unsupervised arm. The day 42 ACPR by ITT was 85.7% in the supervised and 88.5% in the unsupervised arms. The fever resolution and haemoglobin concentration changes for the two arms were similar.Conclusions: The results show that dihydroartemisinin-piperaquine iseffective and good first-line antimalarial in the routine health delivery system
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Objectives: To develop and validate patients’ knowledge, attitudes, and practice instrument for uncomplicated malaria(PKAPIUM).Material and Methods: A draft PKAPIUM scale was developed after the review of relevant literature and malariatreatment guidelines, and six experts validated its content. Monte Carlo simulation principle was followed in arrivingat 300 patients populations whose data were used to reduce the items based on “Kaiser’s eigenevalue-greater-than-onerule.” This was followed by the test of validity and reliability to assess the psychometric properties of the instrument.Results: The items content validity indices (I-CVI) and the scale CVI (S-CVI) using universal agreement (UA) withinexperts (S-CVI/UA) and average CVI (S-CVI/Ave) approaches were good (0.8–1.00), with absence of items’ floor orceiling effects. Twenty-one items were retained in the new scale arranged under four factors with average varianceextracted (AVE) and square root AVE values of 0.58–0.70 and 0.76–0.84, respectively, suggesting convergent anddiscriminant validities. The goodness-of-fit results [Chi-square (CMIN/DF) = 3.07, p = 0.00], standardized root meansquare residual = 0.070, root mean square error approximation = 0.08 confirmed the hypothesized factor structuresof the scale whose internal consistency of Cronbach’s alpha and composite reliability values were 0.74 and 0.82,respectively, and stability of ICC = 0.92 [95% confidence interval : 0.87–0.95, F = 43 (p = 0.51)].Conclusion: The validity and reliability of the PKAPIUM were in acceptable ranges.
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Background:Three different artemisinin-based combination therapies (ACTs) namely; artesunate-amodiaquine, artemether-lumefantrine and dihydroartemisinin-piperaquine (being the latest to be introduced) are concurrently being used forthe treatment of falciparummalaria in Ghana. This study assessed patients’ experience, perceptions and willingness to use dihydroartemisinin-piperaquine, brand name duo-cotecxin as an alternative first line ACT for the treatment of falciparummalaria in Northern Ghana.Methods:This was a qualitative study using phenomenology approach where sixty in-depth interviews were conducted with two groups; thirty patients who were given duo-cotecxin, one group and thirty interviews with patients who were given other ACTs (artesunate-amodiaquine, artemether-lumefantrine) as another group. The interviews were conducted between August and November, 2015 Purposive sampling technique was used to select study participants. The interviews were transcribed andcoded into themes using QSR NVivo 11 software for thematic content analysis.Results:All patients who used duo-cotecxin reported that the drug was very good in treating uncomplicated malaria compared to other ACTs they had used in the past. Some of the patients who used other ACTs could not complete their doses because of the side effects. However, none of the patients who used duo-cotecxin reported side effects. The findings revealed high acceptance and preference to use duo-cotecxin to treat uncomplicated malaria compared with other ACTs. All the participants were also willing to recommend duo-cotexcin to their relatives and friends to use. Conclusions: Duo-cotecxin as an alternative first line ACT for treatment of uncomplicated malaria is highly accepted, preferred and there was willingness to use it compared with other first line recommended ACTs.
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Objectives:To explore whether individuals infected with Plasmodium falciparum (P.falciparum) develop antibodies directed against PfEMP1-DBLα,and to assess their IgG subclass distribution in severe and uncomplicated malaria.Methods:The anti-PfDBLα IgG and their IgG subclass distributions in plasma of severe (SM) and uncomplicated malaria (UCM) were assessed by enzyme-linked immunoabsorbent assay.The antibody profiles to P.falciparum blood stage antigens were evaluated.CD36 binding ability was determined by static receptor-binding assays.Rosette formation was performed by staining with acridine orange.Results:Significantly higher number of UCM (86.48％) than SM (57.78％) plasma contained total acquisition of specific IgG to P.falciparum antigens (P =0.000).Similar manners were seen in response to P.falciparum DBLα with significant difference (UCM,59.46％ vs SM,40.00％;P =0.014).Anti-PfDBLα-IgG1 and-IgG3 were the predominant subclasses.Similar percentage of UCM (31.82％) and SM (33.33％) plasma contained only IgG1,while 13.64％ of UCM and 27.78％ of SM plasma contained only IgG3.AntiPfTDBLα-IgG1 coexpressed with more than one subclass was noted (UCM,27.27％;SM,16.67％).Obviously,IgG1 coexpressed with IgG3 (9.09％) was observed in only UCM plasma.IgG1 was coexpressed with IgG2 in UCM (9.09％) and SM (11.11％) plasma,while IgG1 was coexpressed with IgG4 only in UCM plasma (4.55％).IgG subclasses to P.falciparum antigens were distributed in a similar manner.Only the levels of IgG1,but not IgG3 were significantly higher in UCM than in SM.Conclusions:These data suggest that individuals infected with P.falciparum can develop the anti-PfEMP1 antibodies with the major contribution of specific IgG subclasses.The balance and the levels of anti-PfDBLα IgG subclasses play a crucial role in antibody mediated protection against severe malaria.
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Objectives To explore whether individuals infected with Plasmodium falciparum (P. falciparum) develop antibodies directed against PfEMP1-DBLα and to assess their IgG subclass distribution in severe and uncomplicated malaria. Methods The anti-PfDBLα IgG and their IgG subclass distributions in plasma of severe (SM) and uncomplicated malaria (UCM) were assessed by enzyme-linked immunoabsorbent assay. The antibody profiles to P. falciparum blood stage antigens were evaluated. CD36 binding ability was determined by static receptor-binding assays. Rosette formation was performed by staining with acridine orange. Results Significantly higher number of UCM (86.48%) than SM (57.78%) plasma contained total acquisition of specific IgG to P. falciparum antigens (P = 0.000). Similar manners were seen in response to P. falciparum DBLα with significant difference (UCM, 59.46% vs SM, 40.00%; P = 0.014). Anti-PfDBLα-IgG1 and -IgG3 were the predominant subclasses. Similar percentage of UCM (31.82%) and SM (33.33%) plasma contained only IgG1, while 13.64% of UCM and 27.78% of SM plasma contained only IgG3. Anti-PfDBLα-IgG1 coexpressed with more than one subclass was noted (UCM, 27.27%; SM, 16.67%). Obviously, IgG1 coexpressed with IgG3 (9.09%) was observed in only UCM plasma. IgG1 was coexpressed with IgG2 in UCM (9.09%) and SM (11.11%) plasma, while IgG1 was coexpressed with IgG4 only in UCM plasma (4.55%). IgG subclasses to P. falciparum antigens were distributed in a similar manner. Only the levels of IgG1, but not IgG3 were significantly higher in UCM than in SM. Conclusions These data suggest that individuals infected with P. falciparum can develop the anti-PfEMP1 antibodies with the major contribution of specific IgG subclasses. The balance and the levels of anti-PfDBLα IgG subclasses play a crucial role in antibody mediated protection against severe malaria.
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Objective: To compare the level of glutathione (GSH) and oxidized glutathione (GSSG), the ratio of GSH/GSSG and the concentration of albumin in plasma of patients with complicated and un-complicated falciparum malaria. Methods: This research was a cross sectional study using comparison analysis with the plasma GSH and GSSG, the ratio of plasma GSH/GSSG and the concentration of plasma albumin as variables. The complicated malaria patients were obtained from Dr. Saiful Anwar Hospital Malang, whereas uncomplicated malaria patients were obtained from the Regency of Pleihari South Kalimantan. Plasma GSH and GSSG levels were determined by the spectrophotometer at the wave length of 412 nm, whereas the concentration of albumin was determined by bromocresol green method in the pH of 4.1. Results: There were no significant differences between the level of plasma GSH and GSSG in complicated and uncomplicated malaria patients, as well as the ratio of plasma GSH/GSSG in the two groups (P=0.373;P=0.538;and P=0.615, respectively, independent t-test). In contrast, the plasma albumin concentration in complicated malaria patients were significantly higher than uncomplicated malaria patients (P=0.000, Mann Whitney U test). Conclusions: It can be concluded that the average of plasma GSH and GSSG level, also plasma GSH/GSSG ratio in complicated malaria are not different from uncomplicated ma-laria. Although plasma concentration of albumin in both groups is below the normal range, there is an increase in complicated malaria that might be as compensation of oxidative stress.
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Objective To compare the level of glutathione (GSH) and oxidized glutathione (GSSG), the ratio of GSH/GSSG and the concentration of albumin in plasma of patients with complicated and un-complicated falciparum malaria. Methods This research was a cross sectional study using comparison analysis with the plasma GSH and GSSG, the ratio of plasma GSH/GSSG and the concentration of plasma albumin as variables. The complicated malaria patients were obtained from Dr. Saiful Anwar Hospital Malang, whereas uncomplicated malaria patients were obtained from the Regency of Pleihari South Kalimantan. Plasma GSH and GSSG levels were determined by the spectrophotometer at the wave length of 412 nm, whereas the concentration of albumin was determined by bromocresol green method in the pH of 4.1. Results There were no significant differences between the level of plasma GSH and GSSG in complicated and uncomplicated malaria patients, as well as the ratio of plasma GSH/GSSG in the two groups (P = 0.373; P = 0.538; and P = 0.615, respectively, independent t-test). In contrast, the plasma albumin concentration in complicated malaria patients were significantly higher than uncomplicated malaria patients (P = 0.000, Mann Whitney U test). Conclusions It can be concluded that the average of plasma GSH and GSSG level, also plasma GSH/GSSG ratio in complicated malaria are not different from uncomplicated malaria. Although plasma concentration of albumin in both groups is below the normal range, there is an increase in complicated malaria that might be as compensation of oxidative stress.
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Background: Morbidity and mortality resulting from malaria remains a serious obstacle for social and economic development. Accurate diagnosis and prompt treatment are therefore essential components of case management strategy. The aim of this study therefore was to examine the diagnostic procedure of uncomplicated malaria, and patients’ understanding and satisfaction of treatment in Community Health Care Facilities, three years after the deployment of Malaria Rapid Diagnostic Tests in Ghana. Methodology: A prospective and data collation was done randomly, by means of cluster and stratified multistage surveyat three government hospitals and three private pharmacies in Kumasi, Ghana, between July and September, 2013. Patients treated for uncomplicated malaria, while leaving the health facility, upon consent, were selected and requested to answer questionnaires which served as a source of data to address the objective of the study. Bivariate statistics from the SPSS v 19 was employed to predict the relationships between health institutions and mode of diagnosis, patients’ understanding and satisfaction of services. Results: Fifty-three (53) out of 65 patients responded. The study indicated presumptive diagnosis [44 (83.0%)] to be predominantly used over test-based diagnosis [9 (17.0%)]. The mean age of patients was 34.44±14.8 years (Range 17-66). Out of 52 patients who provided information on educational level, those with tertiary education were 24 (46.2%), secondary were 9 (17.3%), primary were 14 (26.9%) and no formal education were 14 (26.9%). Male patients were 25 (47.2%) and female 28 (52.8%). All 53 patients were given Artemisinin-based Combination Therapy at the various health facilities. Of 35 patients at hospitals/clinics, 15 (42.9%) rated “very good value” to explain their understanding and satisfaction of services provided, and of 18 patients from private pharmacies, 10 (55.6%) rated as “very good value”. Patients with tertiary education [14/25 (56.0%)] showed better understanding and satisfaction of services than those with no formal education [1/25 (4.0%)]. Not a single use of Malaria Rapid Diagnostic Tests for diagnosis was recorded. Conclusion: Diagnosis of malaria at the periphery of health systems is still mainly presumptive three years after deployment of the Malaria Rapid Diagnostic Test. Patients’ good rating on the diagnosis of uncomplicated malaria at private pharmacies, should be an advantage to introducing the Malaria Rapid Diagnostic Tests by healthcare practitioners.
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Artemisinin-based combination therapy (ACT) is currently promoted as a strategy for treating both uncomplicated and severe falciparum malaria, targeting asexual blood-stage Plasmodium falciparum parasites. However, the effect of ACT on sexual-stage parasites remains controversial. To determine the clearance of sexual-stage P. falciparum parasites from 342 uncomplicated, and 217 severe, adult malaria cases, we reviewed and followed peripheral blood sexualstage parasites for 4 wk after starting ACT. All patients presented with both asexual and sexual stage parasites on admission, and were treated with artesunate-mefloquine as the standard regimen. The results showed that all patients were asymptomatic and negative for asexual forms before discharge from hospital. The percentages of uncomplicated malaria patients positive for gametocytes on days 3, 7, 14, 21, and 28 were 41.5, 13.1, 3.8, 2.0, and 2.0%, while the percentages of gametocyte positive severe malaria patients on days 3, 7, 14, 21, and 28 were 33.6, 8.2, 2.7, 0.9, and 0.9%, respectively. Although all patients were negative for asexual parasites by day 7 after completion of the artesunate-mefloquine course, gametocytemia persisted in some patients. Thus, a gametocytocidal drug, e.g., primaquine, may be useful in combination with an artesunate-mefloquine regimen to clear gametocytes, so blocking transmission more effectively than artesunate alone, in malaria transmission areas.
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Adolescent , Adult , Animals , Female , Humans , Male , Antimalarials/pharmacology , Artemisinins/pharmacology , Drug Evaluation , Drug Therapy, Combination , Follow-Up Studies , Germ Cells/drug effects , Malaria, Falciparum/drug therapy , Mefloquine/pharmacology , Plasmodium falciparum/drug effects , Severity of Illness Index , Thailand , Treatment OutcomeABSTRACT
In acute uncomplicated falciparum malaria, there is a continuum from mild to severe malaria. However, no mathematical system is available to predict uncomplicated falciparum malaria patients turning to severe malaria. This study aimed to devise a simple and reliable model of Malaria Severity Prognostic Score (MSPS). The study was performed in adult patients with acute uncomplicated falciparum malaria admitted to the Bangkok Hospital for Tropical Diseases between 2000 and 2005. Total 38 initial clinical parameters were identified to predict the usual recovery or deterioration to severe malaria. The stepwise multiple discriminant analysis was performed to get a linear discriminant equation. The results showed that 4.3% of study patients turned to severe malaria. The MSPS = 4.38 (schizontemia) + 1.62 (gametocytemia) + 1.17 (dehydration) + 0.14 (overweight by body mass index; BMI) + 0.05 (initial pulse rate) + 0.04 (duration of fever before admission) - 0.50 (past history of malaria in last 1 year) - 0.48 (initial serum albumin) - 5.66. Based on the validation study in other malaria patients, the sensitivity and specificity were 88.8% and 88.4%, respectively. We conclude that the MSPS is a simple screening tool for predicting uncomplicated falciparum malaria patients turning to severe malaria. However, the MSPS may need revalidation in different geographical areas before utilized at specific places.