Therapeutic efficacy of Coartem (R) for the treatment of uncomplicated malaria in Maputo, Mozambique

INTRODUCTION In Mozambique, malaria is a major public health problem, accounting for about 48% of outpatient visits, 63% of pediatric admissions and 26.7% mortality. Since 2009, uncomplicated malaria is being treated with Coartem as first line andASAQ (aretesunate + amodiaquine) as second line. In this country there are few data on therapeutic efficacy and the prevalence of molecular markers associated with resistance to components of the ACTs. The objective of the present work was to assess the efficacy of Coartem in Maputo, Mozambique.
METHODS AND MATERIALS Patients aged over 1 year with symptoms suggestive of malaria illness (elevated axillary temperature 37.5C or a history of fever within the previous 48 h, attending two health facilities in Maputo area were screened for P. falciparum monoinfection using thick blood film. Patients were recruited at Centro de Saúde de Boane (rural area) and 1 de Maio (city). Recruiting occurred between March 2009 and March 2011. Clinical outcome was assessed on day 7 and 14. The prevalence of the pfmdr1 SNPs, N86Y and F184Y associated to drug response were determined by PCR-RFLP.
RESULTS Two hundred and eleven patients were included in the study, 109 females and 102 males. Population was divided in three age groups <5 years of age (n = 74), 5 and <15 (n = 86) and ‡15 (n = 51). Most of the patients (60%) went to the health centre after 1 day of developing symptoms, but the time ranged from 1 to 5 days. Most of the patients (71%) referred to having treated the last malaria episode with Coartem notably 19.4% treated the last malaria, with Fansidar plus artesunate. The prevalence of pfmdr1 SNPs was 22.6% and 60% for 86Y and 184Y respectively. There were no therapeutic failures with Coartem in the 14 days of follow-up.