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1. Antibodies to malaria vaccine candidates are associated with chloroquine or sulphadoxine/pyrimethamine treatment efficacy in children in an endemic area of Burkina Faso

Author

Michael Theisen, Daniel Dodoo, Amidou Diarra, Issa Nebie, Issiaka Soulama, Amadou T. Konaté, Sodiomon B. Sirima, Alfred S. Traore, Alfred B. Tiono, and Alphonse Ouedraogo

Subjects
Male, medicine.medical_treatment, Protozoan Proteins, Sulphadoxine/pyrimethamine, Antibodies, Protozoan, Drug resistance, Chloroquine, Malaria, Falciparum, Child, biology, Malaria vaccine, Drug Combinations, Infectious Diseases, Pyrimethamine, Treatment Outcome, Child, Preschool, Drug Therapy, Combination, Female, medicine.drug, lcsh:Arctic medicine. Tropical medicine, Adolescent, lcsh:RC955-962, Sulfadoxine, Plasmodium falciparum, Antibodies, lcsh:Infectious and parasitic diseases, Antimalarials, parasitic diseases, Burkina Faso, Malaria Vaccines, medicine, Humans, lcsh:RC109-216, GLURP, Chemotherapy, business.industry, MSP3, Research, Infant, biology.organism_classification, Parasitology, Immunoglobulin G, Immunology, MSP1-19, business, Biomarkers
Abstract

Background Patient immune status is thought to affect the efficacy of anti-malarial chemotherapy. This is a subject of some importance, since evidence of immunity-related interactions may influence our use of chemotherapy in populations with drug resistance, as well as assessment of the value of suboptimal vaccines. The study aim was to investigate relationship between antibodies and anti-malarial drug treatment outcomes. Methods Some 248 children aged 0.5 and 15 years were recruited prior to the high malaria transmission season. Venous blood (5 ml) was obtained from each child to measure antibody levels to selected malaria antigens, using ELISA. Blood smears were also performed to assess drug efficacy and malaria infection prevalence. Children were actively followed up to record clinical malaria cases. Results IgG levels to MSP3 were always higher in the successfully treated group than in the group with treatment failure. The same observation was made for GLURP but the reverse observation was noticed for MSP1-19. Cytophilic and non-cytophilic antibodies were significantly associated with protection against all three antigens, except for IgG4 to MSP1-19 and GLURP. Conclusion Acquired anti-malarial antibodies may play an important role in the efficacy of anti-malarial drugs in younger children more susceptible to the disease.

Published
2012

2. Placental malaria and low birth weight in pregnant women living in a rural area of Burkina Faso following the use of three preventive treatment regimens

Author

Sodiomon B. Sirima, Edith C. Bougouma, Amadou T. Konaté, Alfred B. Tiono, Amidou Diarra, Alphonse Ouedraogo, and Issa Nebie

Subjects
Adult, Rural Population, medicine.medical_specialty, lcsh:Arctic medicine. Tropical medicine, Placenta Diseases, Sulfadoxine, lcsh:RC955-962, medicine.medical_treatment, Placenta, Plasmodium falciparum, Chemoprevention, lcsh:Infectious and parasitic diseases, Antimalarials, Young Adult, Chloroquine, Pregnancy, parasitic diseases, Burkina Faso, medicine, Animals, Humans, lcsh:RC109-216, Malaria, Falciparum, Pregnancy Complications, Infectious, Obstetrics, business.industry, Research, Infant, Newborn, Infant, Low Birth Weight, medicine.disease, Fetal Blood, Regimen, Low birth weight, Drug Combinations, Pyrimethamine, Infectious Diseases, Treatment Outcome, Chemoprophylaxis, Parasitology, Female, medicine.symptom, business, Malaria, medicine.drug
Abstract

Background The weekly chemoprophylaxis of malaria during pregnancy with chloroquine (CQ) has become problematic with the increasing resistance of Plasmodium falciparum to this drug. There was a need to test the benefits of new strategies over the classical chemoprophylaxis. This study was conducted to provide data to the National Malarial Control Programme for an evidence-based policy change decision making process. It compares the efficacy of two IPT regimens, using chloroquine (CQ) or sulphadoxine/pyrimethamine (SP), with the classical chemoprophylaxis regimen using CQ in reducing the adverse outcomes of malaria infection, for the mother and the foetus. Methods Pregnant women attending the first antenatal care visit were randomly assigned to one of the three treatment regimens. They were subsequently followed up till delivery. Maternal, placental and cord blood samples were obtained upon delivery to check for P. falciparum infection. Results A total of 648 pregnant women were enrolled in the study. Delivery outcome were available for 423 of them. Peripheral maternal P. falciparum infection at delivery was found in 25.8% of the women. The proportion of women with maternal infection was significantly lower in the IPTp/SP group than in the CQ group (P << 0.000). The prevalence of placental malaria was 18.8% in the CWC/CQ group; 15.9% in the IPTp/CQ group and 10.6% in the IPTp/SP group. The incidence of LBW (weigth < 2,500 g) was significantly higher among infants of mothers in the CWC/CQ group (23.9%) as compared with those of mothers in the IPTp/CQ (15.6%) and IPTp/SP (11.6%) groups (p = 0.02) Conclusion Intermittent preventive treatment with SP has shown clear superiority in reducing adverse outcomes at delivery, as compared with intermittent preventive treatment with CQ and classical chemoprophylaxis with CQ.

Published
2009

3. Plasmodium falciparum genotypes diversity in symptomatic malaria of children living in an urban and a rural setting in Burkina Faso

Author

Edith C. Bougouma, Amadou T. Konaté, Issa Nebie, Walter Rj Taylor, Sodiomon B. Sirima, Alfred B. Tiono, Alphonse Ouedraogo, Amidou Diarra, Issiaka Soulama, Adama Gansané, and Gustave B. Kabre

Subjects
Male, Rural Population, medicine.medical_specialty, lcsh:Arctic medicine. Tropical medicine, Genotype, Urban Population, lcsh:RC955-962, Plasmodium falciparum, Protozoan Proteins, Antigens, Protozoan, Urban area, Polymerase Chain Reaction, lcsh:Infectious and parasitic diseases, Urbanization, Genetic variation, parasitic diseases, Burkina Faso, medicine, Animals, Humans, lcsh:RC109-216, Genetic variability, Malaria, Falciparum, Merozoite Surface Protein 1, geography, geography.geographical_feature_category, biology, Research, Genetic Variation, Infant, biology.organism_classification, medicine.disease, Infectious Diseases, Child, Preschool, Tropical medicine, Immunology, Parasitology, Female, Rural area, Malaria, Demography
Abstract

Background The clinical presentation of malaria, considered as the result of a complex interaction between parasite and human genetics, is described to be different between rural and urban areas. The analysis of the Plasmodium falciparum genetic diversity in children with uncomplicated malaria, living in these two different areas, may help to understand the effect of urbanization on the distribution of P. falciparum genotypes. Methods Isolates collected from 75 and 89 children with uncomplicated malaria infection living in a rural and an urban area of Burkina Faso, respectively, were analysed by a nested PCR amplification of msp1 and msp2 genes to compare P. falciparum diversity. Results The K1 allelic family was widespread in children living in the two sites, compared to other msp1 allelic families (frequency >90%). The MAD 20 allelic family of msp1 was more prevalent (p = 0.0001) in the urban (85.3%) than the rural area (63.2%). In the urban area, the 3D7 alleles of msp2 were more prevalent compared to FC27 alleles, with a high frequency for the 3D7 300bp allele (>30%). The multiplicity of infection was in the range of one to six in the urban area and of one to seven in the rural area. There was no difference in the frequency of multiple infections (p = 0.6): 96.0% (95% C.I: 91.6–100) in urban versus 93.1% (95%C.I: 87.6–98.6) in rural areas. The complexity of infection increased with age [p = 0.04 (rural area), p = 0.06 (urban area)]. Conclusion Urban-rural area differences were observed in some allelic families (MAD20, FC27, 3D7), suggesting a probable impact of urbanization on genetic variability of P. falciparum. This should be taken into account in the implementation of malaria control measures.

Published
2009

4. Hospital-based surveillance of severe paediatric malaria in two malaria transmission ecological zones of Burkina Faso.

Author

Tiono, Alfred B., Konaté, Amadou T., Kargougou, Désiré, Diarra, Amidou, Ouedraogo, Issa Nébié, Ouedraogo, Amidou, Pagnoni, Franco, Modiano, David, and Sirima, Sodiomon B.

Subjects
ECOLOGICAL zones, MALARIA, SYMPTOMS, HEALTH programs, RESOURCE allocation, DEHYDRATION
Abstract

Background: In the current context of tailoring interventions to maximize impact, it is important that current data of clinical epidemiology guide public health programmes and health workers in the management of severe disease. This study aimed at describing the burden of severe malaria at hospital level in two areas with distinct malaria transmission intensity. Methods: A hospital-based surveillance was established in two regional hospitals located in two areas exposed to different malaria transmission. Data on paediatric severe malaria admissions were recorded using standardized methods from August 2017 to August 2018 with an interruption during the dry season from April to June 2018. Results: In total, 921 children with severe malaria cases were enrolled in the study. The mean age was 33.9 (± 1.3) and 36.8 (± 1.6) months in lower malaria transmission (LMT) and higher malaria transmission (HMT) areas (p = 0.15), respectively. The geometric mean of asexual P. falciparum density was significantly higher in the LMT area compared to the HMT area: 22,861 trophozoites/µL (95% CI 17,009.2–30,726.8) vs 11,291.9 trophozoites/µL (95% CI 8577.9–14,864.5). Among enrolled cases, coma was present in 70 (9.2%) participants. 196 patients (21.8%) presented with two or more convulsions episodes prior to admission. Severe anaemia was present in 448 children (49.2%). Other clinical features recorded included 184 (19.9%) cases of lethargy, 99 (10.7%) children with incoercible vomiting, 80 (8.9%) patients with haemoglobinuria, 43 (4.8%) children with severe hypoglycaemia, 37 (4.0%) cases where child was unable to drink/suck, 11 (1.2%) cases of patients with circulatory collapse/shock, and 8 cases (0.9%) of abnormal bleeding (epistaxis). The adjusted odds of presenting with coma, respiratory distress, haemoglobinuria, circulatory collapse/shock and hypoglycaemia were significantly higher (respectively 6.5 (95%CI 3.4–12.1); 1.8 (95%CI 1.0–3.2); 2.7 (95%CI 1.6–4.3); 5.9 (95%CI 1.3–27.9); 1.9 (95%CI 1.0–3.6)) in children living in the HMT area compared to those residing in the LMT area. Overall, forty-four children died during hospitalization (case fatality rate 5.0%) with the highest fatalities in children admitted with respiratory distress (26.0%) and those with hypoglycaemia (25.0%). Conclusion: The study showed that children in the HMT area have a higher risk of presenting with coma, shock/dehydration, haemoglobinuria, hypoglycaemia, and respiratory distress. Case-fatality rate is higher among patients with respiratory distress or hypoglycaemia. Hospital surveillance provides a reliable and sustainable means to monitor the clinical presentation of severe malaria and tailor the training needs and resources allocation for case management. [ABSTRACT FROM AUTHOR]

Published
2023
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7. The efficacy and safety of a new fixed-dose combination of amodiaquine and artesunate in young African children with acute uncomplicated Plasmodium falciparum.

Author

Sirima, Sodiomon B., Tiono, Alfred B., Gansané, Adama, Diarra, Amidou, Ouédraogo, Amidou, Konaté, Amadou T., Kiechel, Jean René, Morgan, Caroline C., Olliaro, Piero L., and Taylor, Walter R. J.

Subjects
MALARIA treatment, PLASMODIUM falciparum, JUVENILE diseases, ARTEMISININ, DRUGS, HEPATITIS
Abstract

Background: Artesunate (AS) plus amodiaquine (AQ) is one artemisinin-based combination (ACT) recommended by the WHO for treating Plasmodium falciparum malaria. Fixed-dose AS/AQ is new, but its safety and efficacy are hitherto untested. Methods: A randomized, open-label trial was conducted comparing the efficacy (non-inferiority design) and safety of fixed (F) dose AS (25 mg)/AQ (67.5 mg) to loose (L) AS (50 mg) + AQ (153 mg) in 750, P. falciparum-infected children from Burkina Faso aged 6 months to 5 years. Dosing was by age. Primary efficacy endpoint was Day (D) 28, PCR-corrected, parasitological cure rate. Recipients of rescue treatment were counted as failures and new infections as cured. Documented, common toxicity criteria (CTC) graded adverse events (AEs) defined safety. Results: Recruited and evaluable children numbered 750 (375/arm) and 682 (90.9%), respectively. There were 8 (AS/AQ) and 6 (AS+AQ) early treatment failures and one D7 failure (AS+AQ). Sixteen (AS/AQ) and 12 (AS+AQ) patients had recurrent parasitaemia (PCR new infections 10 and 6, respectively). Fourteen patients per arm required rescue treatment for vomiting/spitting out study drugs. Efficacy rates were 92.1% in both arms: AS/AQ = 315/342 (95% CI: 88.7-94.7) vs. AS+AQ = 313/340 (95% CI: 88.6-94.7). Non-inferiority was demonstrated at two-sided α = 0.05: Δ (AS+AQ - AS/AQ) = 0.0% (95% CI: -4.1% to 4.0%). D28, Kaplan Meier PCR-corrected cure rates (all randomized children) were similar: 93.7% (AS/AQ) vs. 93.2% (AS+AQ) Δ = -0.5 (95% CI -4.2 to 3.0%). By D2, both arms had rapid parasite (F & L, 97.8% aparasitaemic) and fever (97.2% [F], 96.0% [L] afebrile) clearances. Both treatments were well tolerated. Drug-induced vomiting numbered 8/375 (2.1%) and 6/375 (1.6%) in the fixed and loose arms, respectively (p = 0.59). One patient developed asymptomatic, CTC grade 4 hepatitis (AST 1052, ALT 936). Technical difficulties precluded the assessment and risk of neutropaenia for all patients. Conclusion: Fixed dose AS/AQ was efficacious and well tolerated. These data support the use of this new fixed dose combination for treating P. falciparum malaria with continued safety monitoring. [ABSTRACT FROM AUTHOR]

Published
2009
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