-By Dr. Akash G Prabhune
Malaria is a vector borne disease of subtropical and tropical regions predominantly caused by Plasmodium falciparum and transmitted to humans by female Anopheles Mosquitoes.(“CDC – Malaria – Malaria Worldwide – Impact of Malaria,” 2017.)According to World Health Organisation (WHO) malaria is prevalent in 95 countries and approximately 3.2 billion people are at risk of malaria transmission as of 2015. The WHO global strategy for malaria elimination has set a target of reducing malaria mortality rates globally by 90% , reducing malaria incidence by 90%, eliminate malaria from at least 35 countries, compared with 2015 rates by 2030.(“GLOBAL TECHNICAL STRATEGY FOR MALARIA 2016–2030,” 2016, “WHO | Fact Sheet,” 2016.). India being a sub-tropical country is endemic to malaria with 2 million confirmed malaria cases per year and estimated thousand malaria related deaths annually being reported country wide.(Kumar et al., 2007).
Malaria is a preventable disease and globally there has been efforts in preventing human transmission of malaria by eliminating the vectors.(WHO Malaria, 2017)While most of the efforts were made in preventing the transmission a major breakthrough was achieved in the latter half of the century with discovery of chloroquine and its derivatives, which was used as standard therapy for management of uncomplicated malaria till the end of century(Price and Douglas, 2009). With the beginning of 21rst century there was rise in chloroquine resistance cases of malaria and the artemisinin combination therapy (ACT) has replaced chloroquine as a standard treatment for uncomplicated malaria.(Geoff Brown, 2006). A recent systematic review published in malaria journal anchors the efficacy of ACT when given as single drug or in combination with other anti-malarial agents in management of uncomplicated malaria. The evidence from the systematic review suggests that ACT therapy compared to Chloroquine and Sulfadoxine showed cure rate of 84% (95% CI 81%-96%) and 72.3% (95% CI 70%-78%) respectively for P. falciparum cases. The efficacy of ACT in P. malariae patients when compared against placebo, was 100% (95% CI 91-100%) versus no cure (95% CI 0-15%) in the placebo group.(Visser et al., 2014). Another meta-analysis compared the efficacy of different ACT combination therapies in African children and adults, wherein ACT compared to AQSP (amodiaquine–sulfadoxine–pyrimethamine) showed that ACT was more efficacious than AQSP (OR = 1.51; 95% CI = [0.80; 2.87]) in non-falciparum cases.(Whegang Youdom et al., 2017). Another review of randomized controlled trials conducted in Tanzania showed that the fever, parasite and gametocyte clearance in studies that reported efficacy of ACTwas 80% (95% CI 79%-81% P <0.0001) at day 1 of the treatment.(Shayo et al., 2015)
Overall ACT based therapies have shown better cure rate, better parasite clearance and better fever control than chloroquine based combination therapies in management of uncomplicated malaria. ACT therapies are extensively used in treatment of P. falciparum malaria which show chloroquine resistance; mostly affecting Sub-Saharan Africa. WHO and National vector borne diseases control programme of India recommendstreatment with: ACT-SP(Artesunate+Sulfadoxine-Pyrimethamine) for 3 days + PQ (Primaquine) Single dose onsecond day for P falciparum positive cases of malaria.(NVBDCP,MoH&FW, Govt. of India, 2010; World Health Organization, 2006).