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High therapeutic efficacy of artemether-lumefantrine and dihydroartemisinin-piperaquine for the treatment of uncomplicated falciparum malaria in Somalia

Journal article
Authors Marian Warsame
A. M. Hassan
A. H. Hassan
A. M. Jibril
N. Khim
A. M. Arale
A. H. Gomey
Z. S. Nur
S. M. Osman
M. S. Mohamed
A. Abdulrahman
F. E. Yusuf
J. G. H. Amran
B. Witkowski
P. Ringwald
Published in Malaria Journal
Volume 18
ISSN 1475-2875
Publication year 2019
Published at Institute of Medicine
Language en
Keywords Artemether-lumefantrine, Dihydroartemisinin-piperaquine, Plasmodium falciparum, Artemisinin resistance, Piperaquine resistance, Somalia, resistant plasmodium-falciparum, sulfadoxine-pyrimethamine, artesunate-amodiaquine, artemisinin resistance, sentinel sites, cambodia, combination, failure, spread, tolerability, Infectious Diseases, Parasitology, Tropical Medicine
Subject categories Infectious Medicine


Background: Artemether-lumefantrine (AL) and dihydroartemisinin-piperaquine (DHA/PPQ) are the recommended first- and second-line treatments, respectively, for uncomplicated falciparum malaria in Somalia. The studies reported here were conducted to assess the efficacy of these artemisinin-based combinations and the mutations in Plasmodium falciparum K13-propeller (Pfk13) domain and amplification in Pfplasmepsin 2 (Pfpm2) gene in Somalia. Methods: One-arm prospective studies were conducted to assess the clinical and parasitological responses to DHA/PPQ and AL at two sites in 2016 and 2017, respectively, using the standard WHO protocol. The patterns of molecular markers associated with artemisinin and PPQ resistance were investigated for the first time in Somalia. Results: A total of 339 patients were enrolled with 139 for AL and 200 for DHA/PPQ. With AL, no parasite recurrence was observed among patients treated at either site, corresponding to 100% clinical and parasitological responses. For DHA-PPQ, an adequate clinical and parasitological response rate > 97% was observed. All study patients on both treatments at both sites were parasite-free on day 3. Of the 138 samples with interpretable results for the polymorphism in Pfk13, only one (0.7%), from Bosaso, contained a non-synonymous mutation (R622I), which is not one of the known markers of artemisinin resistance. No Pfpm2 amplification was observed among the 135 samples with interpretable results. Conclusions: AL and DHA/PPQ were highly effective in the treatment of uncomplicated falciparum malaria, and there was no evidence of resistance to artemisinin or PPQ. These two combinations are thus relevant in the chemotherapeutic strategy for malaria control in Somalia.

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