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Abstract
Aim The aim of this study is to determine the effects of artemisinin-based Combination therapy on the haemoglobin levels of preschool Nigerian children with uncomplicated falciparum malaria.
Methods Selection of study participants: Children attending two primary health centres in Southeast Nigeria were consecutively screened for inclusion if they fulfilled the following criteria of age 6–59 months; Weight >5 kg; Mono-infection with P. falciparum with parasite density of 2,000–200,000 a sexual parasites per µl; Axillary temperature 37.5°C and signed informed consent by the parents or guardian. Children were excluded if they had signs of severe illness or concurrent infections or chronic illnesses. Each eligible child was randomised to receive one of three ACT regimens namely: Artesunate amodiaquine (AS+AQ), dihydroartemisinin piperaquine (DHAPQ) or Artemether lumefantrine (AL) and follow-up for 28 days based on standard antimalarial therapeutic efficacy test protocol. The haematological test was carried out using the HemoCue® Hb 201 DM System at baseline and then on 3rd, 7th, 14th and 28th days of follow-up. The mean values were compared across the types of ACTs with analysis of variance (ANOVA) using SPSS version 23.
Results A total of 493 eligible children participated in this study. The Baseline characteristics of these subjects are represented in Table 1.
Characteristics of preschool children with uncomplicated malaria
The haemoglobin levels was measured in children who were treated with Artemether Lumefantrine, Artesunate Amodiaquine and Dihydroartemisinin Piperaquine on days 0, 3, 7, 14 and 28. This is represented in Figure 1.
Effects of three ACTs on haemoglobin levels of pre-school children with uncomplicated malaria
Therapeutic efficacy of all three treatment regimen were high (D28 PCR-confirmed cure rate > 95%). There was an initial decrease in the haemoglobin followed by steady increase till D28. Patients in the DHAQ group had a slightly but consistently higher haemoglobin concentration than those found in AL and AQ+AS but the difference by ANOVA was only statistically significant on Day 28 (see Table 2).
Comparison of mean haemoglobin of children with malaria treated with three common ACTs
Conclusion This shows that effective treatment of malaria improves haemoglobin status of affected children. Mean HB was marginally better in DHAPQ than AL and AS+AQ on day 28; otherwise there were no significant differences in the effects.