Delayed Parasite Clearance Rates and Low Clinical and Parasitological Responses Following Treatment of Uncomplicated Falciparum Malaria With Artemether-lumefantrine in Ethiopian- Sudan Border, Western Ethiopia

2021 ◽  
Author(s):  
geletta Tadele Leta ◽  
Fatou Kene Jaiteh ◽  
Mary oboh mary ◽  
Sisay dhugassa Lemma ◽  
Alfred Amambua Ngwa ◽  
...  
Keyword(s):  
Treatment Failure ◽  
Falciparum Malaria ◽  
Parasite Clearance ◽  
Dried Blood Spots ◽  
Uncomplicated Falciparum Malaria ◽  
P Value ◽  
The Status ◽  
Lost To Follow Up ◽  
Al Treatment

Abstract BackgroundThe appearance of artemisinin-resistant parasites in Africa is catastrophic as many cases and deaths from malaria are usually reported in the continent. This study was the first to evaluate the status of artemether-lumefantrine (AL) efficacy, seventeen years after the introduction of this drug in the study area. This study aimed to assess PCR- corrected clinical and parasitological responses at 28 days following AL treatment.MethodsSixty uncomplicated falciparum malaria patients were enrolled, treated with standard doses of AL, and monitored for 28 days with clinical and parasitological assessments from September 15 to December 15, 2020. Molecular analysis was done on dried blood spots collected from each patient from day 0 and on follow-up days 1, 2, 3, 7, 14, 21, and 28. Descriptive statistics and binary logistic regressions were done using SPSS 20.0 statistical software. A p-value of less or equal to 0.05 was considered significant.ResultsSixty patients enrolled in the study, ten were lost to follow-up; and the results were analyzed for 50 patients. All of the patients were fever-free on day 3. But, two patients febrile on day 1 became febrile on day 7 of the follow-up period. Day 3 parasites positivity rate was zero and 60 % using microscopy and PCR, respectively. Parasite clearance on day 3 was more among patients ≥ 15 years as compared with < 15 years (AOR= 6.71, P=0.021). 14 of 50 patients tested were parasite positive on day 7 by PCR. In addition, 7 patients had persisted parasitemia by PCR from day 0 to day 28 of the follow-up. The PCR-corrected adequate clinical and parasitological response (ACPR) rate was 59.2 %. PCR adjusted AL treatment failures was 40.8% and it was noted as 0 early treatment failure, 10.2% late clinical failures, and 30.6% late parasitological failures. Recrudescence and new infection rate within 28 days was7/50(14%) and1/50 (2%) respectively.Conclusionartemisinin resistance is suspected in the study area as parasite positivity rate on day 3 was greater than 10%. A slow parasitological clearance was followed by low-density parasitemia persistence and recrudescences. AL treatment failure was greater than the 10% threshold for treatments in use as per WHO. These findings suggest probably a decreased sensitivity of the parasite for the artemisinin component and the partner drug and highlight the need for prompt reassessment of the efficacy of AL and other factors that may contribute to low parasite susceptibility to the drug.

scholarly journals Efficacy of artemether-lumefantrine and artesunate-amodiaquine for treating uncomplicated falciparum malaria in children

2012 ◽  
Vol 52 (5) ◽  
pp. 260
Author(s):  
Tri Faranita ◽  
Ayodhia Pitaloka Pasaribu ◽  
Muhammad Ali ◽  
Munar Lubis ◽  
Syahril Pasaribu
Keyword(s):  
Treatment Failure ◽  
Falciparum Malaria ◽  
Controlled Trial ◽  
Parasite Clearance ◽  
Uncomplicated Falciparum Malaria ◽  
Clearance Time ◽  
Parasite Clearance Time ◽  
Fever Clearance Time ◽  
Late Treatment ◽  
Cure Rates

Background Artesunate-amodiaquine (ASAQ) has been usedas a firsdine treatment for uncomplicated faldparum malariain Indonesia since 2004. Its efficacy depends on amodiaquineresistance of the infecting parasites. Artemether-lumefantrine(AL) has been shown to be highly efficacious in treatinguncomplicated faldparum malaria in several countries. However,there have been few studies on these anti-malarial medicationsin Indonesia.Objective To compare the efficacy of AL to ASAQ for treatinguncomplicated faldparum malaria in children.Methods An open, randomized, controlled trial wasconducted in school-aged children in the Mandailing NatalRegency, North Sumatera Province, Indonesia, from Octoberto December 2010. A total of 280 pediatric, uncomplicatedfalciparum malaria patients were randomly assigned to receiveeither AL or ASAQ for 3 days. Participants were followed-up ondays 1,2,3,7, 14, 28 and 42 following the first medication dose.The outcomes noted were adequate clinical and parasitologicalresponse (ACPR), parasite reduction, parasite clearance time,fever clearance time and adverse events. Analysis was basedon intention-to-treat.Results In this study, ACPRs on day 42 were 86.4% and 90.7%for the ASAQ and AL groups, respectively (p=0.260). On days 7and 14, the AL group had higher cure rates than that of the ASAQgroup (P<0.05). Early treatment failure, late treatment failure andparasitological failure for both groups were similar. We also foundfaster parasite clearance time and higher parasite reduction in theAL group than in the ASAQ group. However, fever clearancetime was shorter in the ASAQ group. The incidence of adverseevents such as nausea, vomiting, malaise, and pruritus were similarbetween the two groups (P=0.441).Conclusion AL had higher efficacy than ASAQ for the treatment of uncomplicated falciparum malaria in children.[Paediatr rndones. 2012;52:260-6].

scholarly journals Baseline predictors of antiretroviral treatment failure and lost to follow up in a multicenter countrywide HIV-1 cohort study in Ethiopia

PLoS ONE ◽  
2018 ◽  
Vol 13 (7) ◽  
pp. e0200505 ◽  
Author(s):  
Nigus Fikrie Telele ◽  
Amare Worku Kalu ◽  
Gaetano Marrone ◽  
Solomon Gebre-Selassie ◽  
Daniel Fekade ◽  
...  
Keyword(s):  
Cohort Study ◽  
Treatment Failure ◽  
Antiretroviral Treatment ◽  
Lost To Follow Up ◽  
Hiv 1 ◽  
Antiretroviral Treatment Failure

Treatment Outcomes of Childhood Tuberculosis in Three Districts of Balochistan, Pakistan: Findings from a Retrospective Cohort Study

2020 ◽  
Author(s):  
Abid Abdullah ◽  
Nafees Ahmad ◽  
Muhammad Atif ◽  
Shereen Khan ◽  
Abdul Wahid ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cohort Study ◽  
Treatment Outcomes ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
P Value ◽  
Childhood Tb ◽  
Study Sites ◽  
Lost To Follow Up

Abstract Background This study aimed to evaluate treatment outcomes and factors associated unsuccessful outcomes among pediatric tuberculosis (TB) patients (age ≤14 years). Methods This was a retrospective cohort study conducted at three districts (Quetta, Zhob and Killa Abdullah) of Balochistan, Pakistan. All childhood TB patients enrolled for treatment at Bolan Medical Complex Hospital (BMCH) Quetta and District Headquarter Hospitals of Zhob and Killa Abdullah from 1 January 2016 to 31 December 2018 were included in the study and followed until their treatment outcomes were reported. Data were collected through a purpose developed standardized data collection form and analyzed by using SPSS 20. A p-value &lt;0.05 was considered statistically significant. Results Out of 5152 TB patients enrolled at the study sites, 2184 (42.4%) were children. Among them, 1941 childhood TB patients had complete medical record were included in the study. Majority of the study participants were &lt;5 years old (66.6%) and had pulmonary TB (PTB; 65%). A total of 45 (2.3%) patients were cured, 1680 (86.6%) completed treatment, 195 (10%) lost to follow-up, 15 (0.8%) died, 5 (0.3%) failed treatment and 1 (0.1%) was not evaluated for outcomes. In multivariate binary logistic regression analysis, treatment at BMCH Quetta (OR = 25.671, p-value &lt; 0.001), rural residence (OR = 3.126, p-value &lt; 0.001) and extra-PTB (OR = 1.619, p-value = 0.004) emerged as risk factors for unsuccessful outcomes. Conclusion The study sites collectively reached the World Health Organization’s target of treatment success (&gt;85%). Lost to follow-up was the major reason for unsuccessful outcomes. Special attention to patients with identified risk factors for unsuccessful outcomes may improve outcomes further.

scholarly journals Role of Close Endocervical Margin in Treatment Failure After Cervical Excision for Cervical Intraepithelial Neoplasia: A Retrospective Study

2019 ◽  
Vol 143 (8) ◽  
pp. 1006-1011
Author(s):  
Francesco Sopracordevole ◽  
Giovanni Delli Carpini ◽  
Anna Del Fabro ◽  
Matteo Serri ◽  
Lara Alessandrini ◽  
...  
Keyword(s):  
Treatment Failure ◽  
Cervical Intraepithelial Neoplasia ◽  
Carbon Dioxide Laser ◽  
Positive Margin ◽  
Intraepithelial Neoplasia ◽  
Close Margin ◽  
Increased Risk ◽  
The Status ◽  
Disease Persistence

Context.— A significant negative trend in length of cone excision has been observed in recent years, leading to a higher percentage of positive endocervical excision margin and close (&lt;1 mm) negative endocervical margin cases. Objective.— To evaluate the rate of disease persistence and recurrence after cervical excision for cervical intraepithelial neoplasia in relation to a close (&lt;1 mm), negative, or positive endocervical margin. Design.— We retrospectively analyzed a cohort of patients with cervical intraepithelial neoplasia having a carbon dioxide laser cervical excision performed by the same operator. We evaluated the rate of positive follow-up in relation to the status of endocervical margin. Results.— We found a higher percentage of positivity at follow-up and recurrence rate between 13 and 24 months in patients with positive margin than for patients with negative or close endocervical margin (P = .005 and P = .006, respectively), with no difference between negative and close margin (7.0% versus 8.3%, P = .89, and 1.2% versus 0%, P = .83, respectively). Conclusions.— Women with close and negative endocervical margin presented similar risk of positivity at long-term follow-up, disease persistence, and recurrence between 13 and 24 months, so the histopathologic report of a free endocervical margin less than 1 mm should not categorize the patient as being at increased risk of treatment failure. Therefore, the only information that the pathologist should report is the state of the margin (positive or negative), regardless of the negative endocervical margin length.

scholarly journals Combinations of Artemisinin and Quinine for Uncomplicated Falciparum Malaria: Efficacy and Pharmacodynamics

2000 ◽  
Vol 44 (5) ◽  
pp. 1302-1308 ◽  
Author(s):  
Peter J. de Vries ◽  
Nguyen Ngoc Bich ◽  
Huynh Van Thien ◽  
Le Ngoc Hung ◽  
Trinh Kim Anh ◽  
...  
Keyword(s):  
Body Weight ◽  
Falciparum Malaria ◽  
Parasite Clearance ◽  
Uncomplicated Falciparum Malaria ◽  
Initial Increase ◽  
Radical Cure ◽  
Mixed Effect ◽  
Nonlinear Mixed Effect ◽  
Elimination Half

ABSTRACT Combinations of artemisinin and quinine for uncomplicated falciparum malaria were studied. A total of 268 patients were randomized to 7 days of quinine at 10 mg/kg of body weight three times a day (Q) or to artemisinin at 20 mg/kg of body weight followed by 3 (AQ3) or 5 (AQ5) days of quinine. Recrudescence rates were 16, 38, and 15% for the Q, AQ3, and AQ5 groups, respectively (P< 0.001). Recrudescence was associated with shorter parasite clearance time (PCT) and longer treatment after the blood smear had become negative (eradication time). However, classification of patients to outcome—recrudescence or radical cure—was correct in only 77% of patients. The population kinetics of the parasitemia was estimated with nonlinear mixed-effect models. Several models were tested, but the best model was a monoexponential decline of the parasitemia in which the mean parasite elimination half-life was shorter after artemisinin (5.1 h; 95% confidence interval [CI], 4.9 to 5.2 h) than after quinine (8.0 h [95% CI, 7.5 to 8.3 h]). Attempts to simulate the initial increase of the parasitemia did not result in better models with a biologically plausible interpretation. Recrudescence was associated with slower parasite clearance and a higher simulated terminal parasitemia (P term). The classification of patients to outcome groups based onP term was correct in 78% of patients. The data suggest that parasite strains with reduced sensitivity to quinine are prevalent in Vietnam, with slower parasite clearance and consequent recrudescence. A single dose of artemisinin induces rapid parasite reduction and lowers the value of P term, but to prevent recrudescence, this should be followed by quinine for at least 3 days after parasite clearance, or 5 days in total.

scholarly journals The cost and effect of expanding a Patient Tracer programme to identify and return patients loss to follow up at a large HIV Clinic in Trinidad

2020 ◽  
Author(s):  
R. Jeffrey Edwards ◽  
Nyla Lyons ◽  
Wendy Samaroo-Francis ◽  
Leon-Omari Lavia ◽  
Isshad John ◽  
...  
Keyword(s):  
Viral Suppression ◽  
Hiv Care ◽  
Loss To Follow Up ◽  
Treatment Clinic ◽  
The Status ◽  
Clinic Medical ◽  
The Cost ◽  
Lost To Follow Up ◽  
Over Time

Abstract Background: Patients who default from HIV care are usually poorly adherent to antiretroviral treatment which results in suboptimal viral suppression. The study evaluated the effect and cost of expanding an intervention using two Patient Tracers to track and return to care patients lost to follow up at a large HIV Clinic in Trinidad.Methods: Two Social Workers were trained as Patient Tracers and hired initially for 6 months (April –September 2017), then extended to 15 months (April 2017 – June 2018) to call patients who were lost to follow up for 30 days or more during the period July 2016 – May 2018 at the HIV Clinic Medical Research Foundation of Trinidad and Tobago. Both the outcomes of the intervention, and costs were assessed over time. Results: Over the 15 month period, of the of 2,473 patients who missed their scheduled visits for one month or more, 261 (10.6%) patients were no longer in active care - 89 patients dead, 65 migrated, 55 hospitalized, 33 transferred to another treatment clinic and 19 incarcerated. Of the remaining 2,212 patients eligible for tracing, 1,794 (81.1%) patients were returned to care at an average cost of $38.09 USD per patient returned to care as compared to 589 of 866 (68%) patients returned to care over the 6 month period (p < 0.001) at an estimated cost of $47.72 USD per patient returned to care (p<0.001). Of the 1,794 patients returned to care, 1,686 (94%) were re-initiated/started on anti-retroviral therapy and 72.7% of these were virally suppressed (viral load <1,000 copies/ml) as of December 2018.Conclusions: Patient Tracing is a feasible and effective intervention to identify and resolve the status of patients who are loss to follow up to bring these patients back into care with the aim of achieving viral suppression on antiretroviral therapy. Over time the effect of costs of patients returned to care demonstrated greater yields making patient tracing a sustainable intervention for programmes to identify and return patients to care.

scholarly journals Adherence patterns among patients receiving  healthcare services in the Muhimbili Sickle Cell Cohort, Tanzania

2020 ◽  
Author(s):  
Upendo Masamu ◽  
Raphael Zozimus Sangeda ◽  
Daniel Kandoga ◽  
Jesca Ondego ◽  
Florah Ndobho ◽  
...  
Keyword(s):  
Survival Analysis ◽  
Sickle Cell ◽  
Parametric Method ◽  
Healthcare Services ◽  
Rank Test ◽  
P Value ◽  
Mean Cell Volume ◽  
Loss To Follow Up ◽  
Lost To Follow Up

Abstract Background: Monitoring of patient’s clinical attendance is one of the crucial means that is used to improve adherence to care and treatment among the Sickle Cell Disease (SCD) patients. Adherence to care has been shown to improve health outcomes in SCD patients. However, these benefits cannot be achieved when patients are lost to follow-up to care. Method : We analyzed data on loss to follow up to determine the patterns among sickle cell patients registered at Muhimbili Sickle Cell Cohort (MSC), in Dar es Salaam, Tanzania. Data was aggregated and analysed using R software and Microsoft Excel Spreadsheet. Survival analysis techniques, both non-parametric methods (Kaplan-Meier estimator and Log-rank test) and semi-parametric method (Cox’s proportional hazard model), were used. A p-value of 0.05 was considered significant to make a strong inference of the analysis. Results: 5476 SCD patients were registered at MSC from 2004 to 2016, 3350 (58.13%) were actively participating in clinics while, 2126 (41.87%) were inactive, out of which 35.19% were lost to follow-up. From the survival analysis results, patients who were between 5 to 17 years were more likely to be lost to follow-up than the rest with a hazard ratio of 2.65 times more than those who were above 18 years. Patients with mean cell volume above 77.73 fL and white blood cell above 15.73(10ˆ3/uL) were more likely to be loss to follow-up than those below average. Conclusion: Loss to follow-up is evident in a cohort of patients in long term comprehensive care follow-up. It is, therefore, necessary to design interventions that minimize its impacts. Suggested solutions might include training of the health care workers, more emphasis on newborn screening and advocacy to patients regarding the effect of loss to follow-up.

Analysis of robustness of the landmark Cardiovascular outcome trials of antidiabetic drugs – A systematic review

2021 ◽  
Vol 17 ◽  
Author(s):  
Debdipta Bose ◽  
Mahanjit Konwar
Keyword(s):  
Statistical Significance ◽  
Rank Correlation ◽  
Primary Objective ◽  
Antidiabetic Drugs ◽  
Cardiovascular Outcome ◽  
P Value ◽  
Fragility Index ◽  
Cardiovascular Outcome Trials ◽  
Lost To Follow Up

Background: It is essential for Randomized controlled trials [RCTs] to report its results in a comprehensive manner. Hence, it is necessary to assess the robustness of the trials with statistically significant and as well as non-significant results. Robustness can be evaluated using fragility index (FI) and reverse fragility index [RFI] is for trials with statistically significant and as well as non-significant results. The primary aim of this study was to calculate FI and RFI for cardiovascular outcome trials [CVOT]. Materials & Methods: PubMed/MEDLINE was searched to identify all RCTs of antidiabetic drugs where the primary objective was to evaluate the cardiovascular outcomes. We recorded the trial characteristics of each CVOT trial. The FI, RFI, Fragility quotient [FQ] and reverse fragility quotient [FQ] was calculated to evaluate the robustness of the trials. Spearman rank correlation test was used for correlation. Findings: A total of 889 studies were identified and 24 RCTs was included. Among the 24 trials, 12 [50%] trials achieved statistical significance. The median FI and RFI were 29 [4-12] and 22.5 [1-37] for trials with statistically significant and non-significant results. The median FQ and RFQ were 0.0075 [0.002-0.013] and 0.0003 [0.0001-0.004] for trials with statistically significant and non-significant results. The hazard ratio, p value and NNT-B had strong negative relation with FI. Interpretation: Our study showed that half of the trials showing superiority of cardioprotective benefits have favourable FI. The trials failed to show superiority also have a reasonable RFI indicating the robustness of these trials. But the results pf the trials where patients lost to follow-up exceed the FI of that trial demands caution during interpretation.

scholarly journals No Evidence of Delayed Parasite Clearance after Oral Artesunate Treatment of Uncomplicated Falciparum Malaria in Mali

2012 ◽  
Vol 87 (1) ◽  
pp. 23-28 ◽  
Author(s):  
Amelia W. Maiga ◽  
Kassim Sanogo ◽  
Christopher V. Plowe ◽  
Sekou Toure ◽  
Abdoulaye A. Djimde ◽  
...  
Keyword(s):  
Falciparum Malaria ◽  
Parasite Clearance ◽  
Uncomplicated Falciparum Malaria

scholarly journals The expansion of a patient tracer programme to identify and return patients loss to follow up at a large HIV clinic in Trinidad

2021 ◽  
Vol 18 (1) ◽  
Author(s):  
R. Jeffrey Edwards ◽  
Nyla Lyons ◽  
Wendy Samaroo-Francis ◽  
Leon-Omari Lavia ◽  
Isshad John ◽  
...  
Keyword(s):  
Viral Suppression ◽  
Retention In Care ◽  
Hiv Care ◽  
Loss To Follow Up ◽  
Targeted Interventions ◽  
The Status ◽  
Care Models ◽  
Clinic Medical ◽  
Lost To Follow Up

Abstract Background Patients who default from HIV care are usually poorly adherent to antiretroviral treatment which results in suboptimal viral suppression. The study assessed the outcomes of retention in care and viral suppression by expansion of an intervention using two patient tracers to track patients lost to follow up at a large HIV clinic in Trinidad. Methods Two Social Workers were trained as patient tracers and hired for 15 months (April 2017–June 2018) to call patients who were lost to follow up for 30 days or more during the period July 2016–May 2018 at the HIV clinic Medical Research Foundation of Trinidad and Tobago. Results Over the 15-month period, of the of 2473 patients who missed their scheduled visits for 1 month or more, 261 (10.6%) patients were no longer in active care—89 patients dead, 65 migrated, 55 hospitalized, 33 transferred to another treatment clinic and 19 incarcerated. Of the remaining 2212 patients eligible for tracing, 1869 (84.5%) patients were returned to care, 1278 (68.6%) were virally unsuppressed (viral load > 200 copies/ml) and 1727 (92.4%) were re-initiated on ART. Twelve months after their return, 1341 (71.7%) of 1869 patients were retained in care and 1154 (86.1%) of these were virally suppressed. Multivariate analysis using logistic regression showed that persons were more likely to be virally suppressed if they were employed (OR, 1.39; 95% CI 1.07–1.80), if they had baseline CD4 counts < 200 cells/mm3 (OR, 1.71; 95% CI 1.26–2.32) and if they were retained in care at 12 months (OR, 2.48; 95% CI 1.90–3.24). Persons initiated on ART for 4–6 years (OR, 3.09; 95% CI 1.13–8.48,), 7–9 years (OR, 3.97; 95% CI 1.39–11.31), > 10 years (OR, 5.99; 95% CI 1.74–20.64 were more likely to be retained in care. Conclusions Patient Tracing is a feasible intervention to identify and resolve the status of patients who are loss to follow up and targeted interventions such as differentiated care models may be important to improve retention in care.

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