TY - JOUR
T1 - Prevalence of and Risk Factors Associated with Polymerase Chain Reaction-Determined Plasmodium falciparum Positivity on Day 3 after Initiation of Artemether–Lumefantrine Treatment for Uncomplicated Malaria in Bagamoyo District, Tanzania
AU - Mwaiswelo, Richard
AU - Ngasala, Billy
AU - Jovel, Irina
AU - Xu, Weiping
AU - Larsson, Erik
AU - Malmberg, Maja
AU - Gil, Jose Pedro
AU - Premji, Zul
AU - Mmbando, Bruno P.
AU - Mårtensson, Andreas
N1 - Publisher Copyright:
Copyright © 2019 by The American Society of Tropical Medicine and Hygiene
PY - 2019
Y1 - 2019
N2 - Prevalence of and risk factors associated with polymerase chain reaction (PCR)-determined Plasmodium falciparum positivity were assessed on day 3 after initiation of treatment, pre-implementation and up to 8 years post-deployment of artemether–lumefantrine as first-line treatment for uncomplicated malaria in Bagamoyo district, Tanzania. Samples originated from previously reported trials conducted between 2006 and 2014. Cytochrome b-nested PCR was used to detect malaria parasites from blood samples collected on a filter paper on day 3. Chi-square and McNemar chi-squared tests, logistic regression models, and analysis of variance were used as appropriate. Primary outcome was based on the proportion of patients with day 3 PCR-determined P. falciparum positivity. Overall, 256/584 (43.8%) of screened patients had day 3 PCR-determined positivity, whereas only 2/584 (0.3%) had microscopy-determined asexual parasitemia. Day 3 PCR-determined positivity increased from 28.0% (14/50) in 2006 to 74.2% (132/178) in 2007–2008 and declined, thereafter, to 36.0% (50/139) in 2012–2013 and 27.6% (60/217) in 2014. When data were pooled, pretreatment microscopy-determined asexual parasitemia 3 100,000/μL, hemoglobin < 10 g/dL, age < 5 years, temperature 3 37.5°C, and year of study 2007–2008 and 2012–2013 were significantly associated with PCR-determined positivity on day 3. Significant increases in P. falciparum multidrug resistance gene 1 N86 and P. falciparum chloroquine resistant transporter K76 across years were not associated with PCR-determined positivity on day 3. No statistically significant association was observed between day 3 PCR-determined positivity and PCR-adjusted recrudescence. Day 3 PCR-determined P. falciparum positivity remained common in patients treated before and after implementation of artemether–lumefantrine in Bagamoyo district, Tanzania. However, its presence was associated with pretreatment characteristics.
AB - Prevalence of and risk factors associated with polymerase chain reaction (PCR)-determined Plasmodium falciparum positivity were assessed on day 3 after initiation of treatment, pre-implementation and up to 8 years post-deployment of artemether–lumefantrine as first-line treatment for uncomplicated malaria in Bagamoyo district, Tanzania. Samples originated from previously reported trials conducted between 2006 and 2014. Cytochrome b-nested PCR was used to detect malaria parasites from blood samples collected on a filter paper on day 3. Chi-square and McNemar chi-squared tests, logistic regression models, and analysis of variance were used as appropriate. Primary outcome was based on the proportion of patients with day 3 PCR-determined P. falciparum positivity. Overall, 256/584 (43.8%) of screened patients had day 3 PCR-determined positivity, whereas only 2/584 (0.3%) had microscopy-determined asexual parasitemia. Day 3 PCR-determined positivity increased from 28.0% (14/50) in 2006 to 74.2% (132/178) in 2007–2008 and declined, thereafter, to 36.0% (50/139) in 2012–2013 and 27.6% (60/217) in 2014. When data were pooled, pretreatment microscopy-determined asexual parasitemia 3 100,000/μL, hemoglobin < 10 g/dL, age < 5 years, temperature 3 37.5°C, and year of study 2007–2008 and 2012–2013 were significantly associated with PCR-determined positivity on day 3. Significant increases in P. falciparum multidrug resistance gene 1 N86 and P. falciparum chloroquine resistant transporter K76 across years were not associated with PCR-determined positivity on day 3. No statistically significant association was observed between day 3 PCR-determined positivity and PCR-adjusted recrudescence. Day 3 PCR-determined P. falciparum positivity remained common in patients treated before and after implementation of artemether–lumefantrine in Bagamoyo district, Tanzania. However, its presence was associated with pretreatment characteristics.
UR - http://www.scopus.com/inward/record.url?scp=85065527621&partnerID=8YFLogxK
U2 - 10.4269/ajtmh.18-0729
DO - 10.4269/ajtmh.18-0729
M3 - Article
C2 - 30860013
AN - SCOPUS:85065527621
SN - 0002-9637
VL - 100
SP - 1179
EP - 1186
JO - American Journal of Tropical Medicine and Hygiene
JF - American Journal of Tropical Medicine and Hygiene
IS - 5
ER -