title: Therapeutic efficacy of artesunate-amodiaquine and artemether-lumefantrine combinations in the treatment of uncomplicated malaria in two ecological zones in Ghana.
abstract: BACKGROUND
  Case management based on prompt diagnosis and adequate treatment using artemisinin-based combination therapy (ACT) remains the main focus of malaria control in Ghana. As part of routine surveillance on the therapeutic efficacy of ACT in Ghana, the efficacy of amodiaquine-artesunate (AS-AQ) and artemether-lumefantrine (AL) were studied in six sentinel sites representing the forest and savannah zones of the country.
  
  
  METHODS
  Three sites representing the two ecological zones studied AS-AQ whilst the other three sites studied AL. In each site, the study was a one-arm prospective evaluation of the clinical, parasitological, and haematological responses to directly observed therapy for uncomplicated malaria with either AS-AQ or AL among children aged 6 months and 9 years. The WHO 2009 protocol for monitoring anti-malarial drug efficacy was used for the study between July 2013 and March 2014.
  
  
  RESULTS
  Per-protocol analyses on day 28 showed an overall PCR-corrected cure rate of 100% for AS-AQ and 97.6% (95% CI 93.1, 99.5) for AL: 97.2% (95% CI 92.0, 99.4) in the forest zone and 100% in the savannah zone. Kaplan-Meier survival analysis showed similar outcomes. Prevalence of fever decreased by about 75% after the first day of treatment with each ACT in the two ecological zones. No child studied was parasitaemic on day 3, and gametocytaemia was generally maintained at low levels (<5%). Post-treatment mean haemoglobin concentrations significantly increased in the two ecological zones.
  
  
  CONCLUSIONS
  Therapeutic efficacy of AS-AQ and AL remains over 90% in the forest and savannah zones of Ghana. Additionally, post-treatment parasitaemia on day 3 is rare suggesting that artemisinin is still efficacious in Ghana.
authors.affiliation: Epidemiology Department, Noguchi Memorial Institute for Medical Research, College of Health Sciences, University of Ghana, P. O. Box LG581, Legon, Ghana. babuaku@noguchi.ug.edu.gh.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Abuaku
authors.affiliation: Epidemiology Department, Noguchi Memorial Institute for Medical Research, College of Health Sciences, University of Ghana, P. O. Box LG581, Legon, Ghana. nduah@noguchi.ug.edu.gh.
authors.forename: Nancy
authors.initials: N
authors.lastname: Duah
authors.affiliation: Epidemiology Department, Noguchi Memorial Institute for Medical Research, College of Health Sciences, University of Ghana, P. O. Box LG581, Legon, Ghana. lquaye@noguchi.ug.edu.gh.
authors.forename: Lydia
authors.initials: L
authors.lastname: Quaye
authors.affiliation: Epidemiology Department, Noguchi Memorial Institute for Medical Research, College of Health Sciences, University of Ghana, P. O. Box LG581, Legon, Ghana. nquashie@hotmail.com.|Centre for Tropical Clinical Pharmacology and Therapeutics, University of Ghana Medical School, P. O. Box GP4236, Accra, Ghana. nquashie@hotmail.com.
authors.forename: Neils
authors.initials: N
authors.lastname: Quashie
authors.affiliation: National Malaria Control Programme, Public Health Division, Ghana Health Service, Accra, Ghana. kezmalm@yahoo.com.
authors.forename: Keziah
authors.initials: K
authors.lastname: Malm
authors.affiliation: National Malaria Control Programme, Public Health Division, Ghana Health Service, Accra, Ghana. constance.bartplange@ghsmail.org.
authors.forename: Constance
authors.initials: C
authors.lastname: Bart-Plange
authors.affiliation: Epidemiology Department, Noguchi Memorial Institute for Medical Research, College of Health Sciences, University of Ghana, P. O. Box LG581, Legon, Ghana. kkoram@noguchi.ug.edu.gh.
authors.forename: Kwadwo
authors.initials: K
authors.lastname: Koram
mesh_terms: D000655:Amodiaquine / Q000627:therapeutic use*; D000962:Antimalarials / Q000627:therapeutic use*; D037621:Artemisinins / Q000627:therapeutic use*; D000077332:Artesunate; D002648:Child; D002675:Child, Preschool; D004338:Drug Combinations; D004463:Ecology; D005260:Female; D005869:Ghana; D006801:Humans; D007223:Infant; D008288:Malaria / Q000188:drug therapy*; D008297:Male; D010963:Plasmodium falciparum / Q000187:drug effects / Q000472:pathogenicity; D011446:Prospective Studies
chemical_list: D000962:Antimalarials; D037621:Artemisinins; D004338:Drug Combinations; C515299:amodiaquine, artesunate drug combination; D000655:Amodiaquine; D000077332:Artesunate