The purpose of this study was to describe the characteristics and findings of antimalarial
drug efficacy studies conducted in Ethiopia and to use the findings to formulate
recommendations for antimalarial drug efficacy monitoring and use of evidence to
inform antimalarial treatment policy for the Ethiopian setting.
This study reviewed 44 antimalarial efficacy studies conducted in Ethiopia from 1974 to
2011. The analysis of results indicated that chloroquine as the first-line antimalarial drug
for the treatment of malaria due to Plasmodium falciparum had a 22% therapeutic
failure in 1985. Chloroquine was replaced with sulfadoxine-pyrimethamine in 1998,
more than 12 years later, when its therapeutic failure had reached 65%. Sulfadoxinepyrimethamine
at the time of its introduction had a treatment failure of 7.7%; it was
replaced after seven years in 2004 by artemether-lumefantrine; by then its treatment
failure had reached 36%.
The WHO recommends the replacement of a first-line antimalarial drug when more than
10% of treatment failure is reported. The replacement drug should have a therapeutic
efficacy of more than 95%; while the change itself should be completed within two years.
The prolonged delay to replace failing antimalarial drugs in Ethiopia seems to have
been influenced mainly by the lack of systematic antimalarial drug efficacy data
collection and pragmatic use of the data and evidence gathered.Almost eight years after its introduction, isolated studies show that the efficacy of
artemether-lumefantrine has decreased from 99% in 2003 to around 96.3% in 2008.
Though this decrease is not statistically significant (chi-square 1.5; P=0.22) and has not
reached the threshold of 10%, it is plausible that its efficacy may drop further. This is
mainly due to regulatory provisions in the country that allow marketing of oral
artemisinin mono-therapies that are not recommended for malaria treatment, use of less
effective antimalarial combination drugs in the neighboring countries and widespread
drug quality problems.
The situation calls for and this study recommends the establishment of stringent drug
efficacy monitoring and early warning system and alignment of the antimalarial drug
regulatory practices with recommendations of the WHO. / Health Studies / D. Litt. et Phil. (Health Studies)
| Identifer | oai:union.ndltd.org:netd.ac.za/oai:union.ndltd.org:unisa/oai:umkn-dsp01.int.unisa.ac.za:10500/8668 |
| Date | 12 September 2013 |
| Creators | Ambachew Medhin Yohannes |
| Contributors | Zungu, L I, Malangu, N |
| Source Sets | South African National ETD Portal |
| Language | English |
| Detected Language | English |
| Type | Thesis |
| Rights | University of South Africa |
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