In vivo efficacy of artemether–lumefantrine against uncomplicated Plasmodium falciparum malaria in Dembia District, northwest Ethiopia

Tekalign Deressa,1 Mengistu Endris Seid,1 Wubet Birhan,1 Yetemwork Aleka,1 Biniam Mathewos Tebeje1,2 1School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia; 2Molecular Parasitology Laboratory, Queensland Institute of Medical Research, Brisbane, Australia Background: Artemether–lumefantrine (AL) has been used as a first-line treatment for uncomplicated Plasmodium falciparum malaria in Ethiopia since 2004. Antimalarial drug resistance is one of the major obstacles for malaria control and curtails the lifespan of several drugs. Thus, continued monitoring of the efficacy of AL is of great public health importance in malaria endemic areas. Objective: This study aimed to investigate the therapeutic efficacy and safety of AL for the treatment of uncomplicated P. falciparum malaria in the Dembia district, northwest Ethiopia. Methods: A prospective study was conducted from April 2015 to February 2016 at Kola Diba Health Center (KHC) in the Dembia district to determine the therapeutic efficacy and safety of AL for the treatment of uncomplicated P. falciparum monoinfection. Patients were treated with the six-dose regimen of AL over 3 days and followed up for 28 days as per the World Health Organization protocol. Results: Of the total 80 patients enrolled in the AL efficacy study, 75 patients completed the 28 days follow-up. None of the participants reported major adverse events. No early treatment failure or late clinical failure were observed during the study, but there were 6 (8.0%) late parasitological failures. The uncorrected per protocol cure rate of AL was 92.0 (95% CI: 85.7–98.3). Treatment with AL cleared parasitemia and fever in >95% of the patients by day 3. Conclusion: This study showed that AL is well tolerated and remains efficacious for treatment of uncomplicated P. falciparum malaria in northwest Ethiopia. However, the observed late parasitological failures in this study are of a concern and warrant continued monitoring of drug efficacy as per the World Health Organization recommendations. Keywords: artemether–lumefantrine, uncomplicated Plasmodium falciparum, Ethiopia, malaria, antimalarial efficac

On the Moments and the Distribution of the Cost of a Semi Markov Model for Healthcare Systems

In this paper we extend our previous semi-Markov reward model which attached costs to duration in states, by including costs of making a transition from one state to another. Theoretical results concerning the moments and consequently the distribution of interval costs for every member and of the total cost per unit period at any time and also through time intervals are obtained and provided in analytic form for the semi Markov reward model with discounting. The results are applied to an open healthcare system. In the healthcare domain such transition costs allow us to evaluate the overall costs of therapy or clinical intervention where an operation or other treatment may be an option. This model can be used for strategic approaches to planning and evaluating long-term patient care. The results demonstrate the potential of the model to demonstrate differential costs of different therapeutic strategies and explore optimal solutions.peer-reviewe