title: Monitoring the efficacy of artemether-lumefantrine for the treatment of uncomplicated malaria in Malawian children.
abstract: BACKGROUND
  The resistance of malaria parasites to sulphadoxine-pyrimethamine (SP) in 2007 led to the Malawi Ministry of Health changing to artemether-lumefantrine (AL) as first-line for uncomplicated malaria treatment. This study determined the efficacy and safety of AL for the treatment of uncomplicated Plasmodium falciparum malaria among six to 59 months old Malawian children.
  
  
  METHODS
  This was a prospective study of children six to 59 months old treated with AL after presenting with uncomplicated malaria in the six health facilities in Malawi. The children were followed up on days 1, 2, 3, 7, 14, 21 and 28 days post-treatment and assessed for clinical and parasitological responses. The Kaplan Meier survival estimate was used to measure the efficacy of AL by calculating the cumulative risk of failure at day 28.
  
  
  RESULTS
  A total of 322 children were recruited into the study across the six sites. The overall intention-to-treat (ITT) polymerase chain reaction (PCR)-corrected cure rate was 93.4%. Per protocol overall PCR-corrected cure rates for the study sites were; Karonga 98.0%, Kawale 97.4%, Machinga 90.2%, Mangochi 95.4% and Rumphi 91.3%. Nkhotakota study site had the lowest cure rate of 78.0%.
  
  
  CONCLUSIONS
  There is evidence of good efficacy of AL in Malawi notwithstanding geographical contrasts and this supports the continued use of AL as the first-line treatment for uncomplicated malaria. However there may be need to further investigate the comparatively low efficacy rate found in Nkhotakota district in order to identify possible determinants of treatment failure.
authors.affiliation: Department of Public Health, School of Medicine, University of Zambia, P.O Box 50110, Lusaka, Zambia. saly.dambe@gmail.com.
authors.forename: Rosalia
authors.initials: R
authors.lastname: Dambe
authors.affiliation: National Malaria Control Programme, Ministry of Health, Private Bag 65, Lilongwe, Malawi. jhsande@yahoo.co.uk.
authors.forename: John
authors.initials: J
authors.lastname: Sande
authors.affiliation: National Malaria Control Programme, Ministry of Health, Private Bag 65, Lilongwe, Malawi. alidoreen@yahoo.com.
authors.forename: Doreen
authors.initials: D
authors.lastname: Ali
authors.affiliation: National Public Health Reference Laboratory Ministry of Health, Private Bag 65, Lilongwe, Malawi. bchilima2@yahoo.com.
authors.forename: Ben
authors.initials: B
authors.lastname: Chilima
authors.affiliation: World Health Organization, P.O. Box 30390, Lilongwe, Malawi. dodoliw@who.int.
authors.forename: Wilfred
authors.initials: W
authors.lastname: Dodoli
authors.affiliation: Department of Public Health, School of Medicine, University of Zambia, P.O Box 50110, Lusaka, Zambia. ccmichelo@yahoo.com.
authors.forename: Charles
authors.initials: C
authors.lastname: Michelo
authors.affiliation: National Malaria Control Programme, Ministry of Health, Private Bag 65, Lilongwe, Malawi. gjmalenga@gmail.com.
authors.forename: Grace
authors.initials: G
authors.lastname: Malenga
authors.affiliation: Department of Public Health, College of Medicine, University of Malawi, Private Bag 360, Blantyre, Malawi. kamijaphiri@gmail.com.
authors.forename: Kamija S
authors.initials: KS
authors.lastname: Phiri
mesh_terms: D000962:Antimalarials / Q000009:adverse effects / Q000627:therapeutic use*; D000077611:Artemether, Lumefantrine Drug Combination; D037621:Artemisinins / Q000009:adverse effects / Q000627:therapeutic use*; D002675:Child, Preschool; D004338:Drug Combinations; D004983:Ethanolamines / Q000009:adverse effects / Q000627:therapeutic use*; D005260:Female; D005449:Fluorenes / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D007223:Infant; D053208:Kaplan-Meier Estimate; D016778:Malaria, Falciparum / Q000188:drug therapy* / Q000453:epidemiology; D008295:Malawi / Q000453:epidemiology; D008297:Male; D011446:Prospective Studies; D017211:Treatment Failure
chemical_list: D000962:Antimalarials; D000077611:Artemether, Lumefantrine Drug Combination; D037621:Artemisinins; D004338:Drug Combinations; D004983:Ethanolamines; D005449:Fluorenes