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

Richard Mwaiswelo, Billy Ngasala, Irina Jovel, Weiping Xu, Erik Larsson, Maja Malmberg, Jose Pedro Gil, Zul Premji, Bruno P. Mmbando, Andreas Mårtensson

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9 Citations (Scopus)

Abstract

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.

Original languageEnglish
Pages (from-to)1179-1186
Number of pages8
JournalAmerican Journal of Tropical Medicine and Hygiene
Volume100
Issue number5
DOIs
Publication statusPublished - 2019
Externally publishedYes

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