Treatment Africa

Safe and efficacious artemisinin-based combination treatments for African pregnant women with malaria

The project aims were to identify two treatment regimens that are at least 95% effective as first-line treatment of uncomplicated malaria in second and third trimester pregnancy, and one regimen for the second line (rescue) treatment.

Designed as a non-inferiority, multi-centre, randomized, open label trial it was conducted in four sites across Africa (Burkina Faso, Ghana, Malawi and Zambia) and comparing the fixed dose combinations of artemether-lumefantrine (AL); amodiaquine-artesunate (AQ-AS); mefloquine–artesunate (MQ-AS) and dihydroartemisinin-piperaquine (DQ-PPQ). Pregnant women attending the antenatal clinic at 16 weeks of gestation or above will be screened for P. falciparum malaria infection and, following informed consent, were randomised to one of the above treatments.

Each pregnant woman were actively followed for 63 days post treatment and then monthly until delivery. The newborn was examined for congenital abnormalities. Both the mother and the newborn were reassessed between four and six weeks after delivery for any adverse event. Blood samples for population pharmacokinetics were collected at established times, allowing the analysis of the relationship between drugs levels and response to treatment.

Overall 3428 women were enrolled across the sites.

Results

The PCR adjusted cure rates for all four drugs were high. There was no significant difference in serious adverse events and birth outcomes found between treatment arms. Based on safety and efficacy DHP seems the most suitable treatment for uncomplicated malaria in pregnancy.

The Future

The results were presented to the WHO Evidence Review Group on Malaria in Pregnancy.

Umberto d’Alessandro, MD, MSc, PhD

Current posting: ?

Professor D’Alessandro has substantial work experience in Africa, first as a clinician and later as a clinical epidemiologist. He has been involved in malaria research since 1990, when he carried out the evaluation of the Gambian National programme on insecticide-treated bed nets. He joined the Department of Parasitology at the Prince Leopold Institute of Tropical Medicine, Antwerp, Belgium in 1996, where he set up and led the Epidemiology Unit in the Parasitology Department. There, he developed a research programme around three themes: antimalarial treatment, including drug resistance, malaria prevention, and the P. vivax in vitro cycle.

TK Mutabingwa (Tanzania)

European collaborators: Feiko ter Kuile and Jenny Hill (UK), Raffaella Ravinetto, Jean Pierre Van geertruyden, Joris Menten (Belgium), Henk Schallig and Peter De Vries (The Nederlands), Vera Ecser (Austria)

Site PIs: Halidou Tinto (Burkina Faso); Harry Tagbor (Ghana); Linda Kalilani (Malawi); Modest Mulenga (Zambia); Steven Rulisa (Rwanda)