Efficacy of chloroquine and sulfadoxine/pyrimethamine mono- and combined therapy against falciparum malaria in Sudan.

We assessed the efficacy of chloroquine and sulfadoxine/pyrimethamine monotherapy in several sentinel sites in northern Sudan and the efficacy of combined therapy in 2 sites. Chloroquine efficacy in children under 5 years was also assessed in 2 sites in southern Sudan. Patients with indications of uncomplicated falciparum malaria and sufficient parasite density were enrolled. The chloroquine failure rates in the northern and southern sites were 43.4% and 80.2% respectively. Treatment failure was significantly higher in children than adults, while there was no significant sex difference. Sulfadoxine/pyrimethamine had an overall failure rate of 4.4%. Combination of the 2 drugs had a failure rate of 14.5% and 5.9% in the 2 sites.

From chloroquine to artemisinin-based combination therapy: the Sudanese experience.

BACKGROUND: In Sudan, chloroquine (CQ) remains the most frequently used drug for falciparum malaria for more than 40 years. The change to artemisinin-based combination therapy (ACT) was initiated in 2004 using the co-blister of artesunate + sulfadoxine/pyrimethamine (AS+SP) and artemether + lumefantrine (ART+LUM), as first- and second-line, respectively. This article describes the evidence-base, the process for policy change and it reflects the experience of one year implementation. Relevant published and unpublished documents were reviewed. Data and information obtained were compiled into a structured format. CASE DESCRIPTION: Sudan has used evidence to update its malaria treatment to ACTs. The country moved without interim period and proceeded with country-wide implementation instead of a phased introduction of the new policy. The involvement of care providers and key stakeholders in a form of a technical advisory committee is considered the key issue in the process. Development and distribution of guidelines, training of care providers, communication to the public and provision of drugs were given great consideration. To ensure presence of high quality drugs, a system for post-marketing drugs surveillance was established. Currently, ACTs are chargeable and chiefly available in urban areas. With the input from the Global Fund to fight AIDs, Tuberculosis and Malaria, AS+SP is now available free of charge in 10 states. CONCLUSION: Implementation of the new policy is affected by the limited availability of the drugs, their high cost and limited pre-qualified manufacturers. Substantial funding needs to be mobilized by all partners to increase patients' access for this life-saving intervention.

The efficacies of artesunate-sulfadoxine-pyrimethamine and artemether-lumefantrine in the treatment of uncomplicated, Plasmodium falciparum malaria, in an area of low transmission in central Sudan.

In an efficacy trial of artemisinin-based combination treatments (ACT) in central Sudan, cases of uncomplicated, Plasmodium falciparum malaria were given artesunate-sulfadoxine-pyrimethamine (ASP) or artemether-lumefantrine (AL) as first-line treatment. On enrolment, the 71 patients given ASP were similar to the 72 given AL, apart from having generally lower parasitaemias (geometric mean counts of 4893 nu. 10,215 asexual parasites/microl) and having a lower mean age (15 nu. 23 years). Each patient was treated on days 0, 1 and 2, and all 137 who completed follow-up without further, unscheduled treatment were found aparasitaemic and afebrile from day 2 until the last follow-up, on day 28. No moderate or severe adverse side-effects, clinical failures or parasitological failures were observed among these 137 patients. ACT therefore appear both efficacious and safe for the treatment of uncomplicated malaria in central Sudan.

The Efficacy of Artemether/Lumefantrine for the Treatment of Uncomplicated Falciparum Malaria in Children in an Area of High Transmission in Southern Sudan

"Objectives: Sudanese health authority adopted a new antimalarial drug policy in response to the reported high level of chloroquine resistance. ""Artesunate+ sulfadoxine/pyrimethamine"" (ASP) and ""artemether/lumefantrine"" (A/L) are recommended as first and second lines for the treatment of uncomplicated falciparum malaria respectively. This study aims to evaluate the clinical and parasitological response to A/L and to report any side effects related to the drug in children living in high transmission areas. Methods: This evaluation of the clinical and parasitological response to directly observed treatment with 6 doses A/L following WHO protocol for monitoring antimalarial drugs efficacy. Giemsa-stained thick and thin blood smears were examined microscopically. Results: A total of 75 (40.8) patients met the inclusion criteria; of them 70 (97.2) patients showed adequate clinical and parasitological response (radical cure); 2 (2.8) patients were classified as early treatment failure and 3 (4) patients were lost to be followed-up by day 3. No progression to severe illness or danger signs occurred for any patient during the study. Conclusion: The main outcome of study was that A/L was found to be highly effective against Plasmodium falciparum uncomplicated malaria; well tolerated by children with no reported serious side effects. Dramatic decrease in parasites density and fever were observed in most of the cases by day 3 of treatment."