Abstract

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The efficacy of antimalarial drugs may be influenced by other factors independent of the parasite susceptibility to the drugs. This study aimed at evaluating the effect of some clinical factors on Arthemeter – Lumefantrine (AL) treatment failure in patients with uncomplicated malaria receiving care in selected community pharmaceutical shops and hospitals from Kano Municipal, Gwale, Tarauni and Kura Local Government Area. Four hundred (400) consenting patients with AL prescription were randomly selected for the study. Plasmodium falciparum positive subjects were confirmed by microscopic examination using Giemsa stained blood films techniques. Clinical and parasitological responses of the enrolled patients were evaluated using 28 days follow up according to WHO protocols for therapeutic efficacy. Structured questionnaire was used to record clinical details of each of the patients. Hematological parameters were assessed using automated hematology analyzer and blood group using antisera agglutination test kit. Among the 400 subjects enrolled, 220 (55%) completed the 28 days follow-up, out of which 170 (77.3%) had adequate clinical and parasitological response (ACPR) and 50 (22.7%) had treatment failure. The mean duration of symptoms before treatment, pre-treatment parasite density, parked cell volume(PCV),erythrocyte sedimentation rate(ESR) and white blood cell count (WBC) of patients with ACPR (4.3+2.1 days, 8,300+3,250/µl, 36+8.2%, 10.9+2.9mm/H and 5.8+2.5.1x109/L) were found to be significantly different (P<0.05) from that of patients with treatment failure (6.7+4.2days, 12,210+2,160/µL, 24+6.1%, 14.1+5.3mm/H and 8.4+4.1x109/L) respectively. Treatment failure was found to be more common among patients suffering from malaria and other diseases such as typhoid and hypertension (36%) when compared to those with malaria only (20.8%).It was also found to be less common among patients with O blood group (11.8%) when compared with those of AB, A and B blood groups with treatment failure rate of 27%, 31% and 29% respectively (P<0.05). Treatment failure was found to be not significantly associated with pretreatment body temperature (P>0.05).This study revealed that some pretreatment clinical factors such as high parasitaemia level, long duration of symptoms and abnormal hematological parameters could predispose individual to failed treatment and consequently increases the risk of developing antimalarial drug resistance in a population.

Keywords: Treatment failure, Malaria, Artemether-Lumefantrine, clinical factors