Browsing by Author "Guthmann, Jean-Paul"

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    Adherence to a six-dose regimen of artemether-lumefantrine for treatment of uncomplicated Plasmodium falciparum malaria in Uganda.
    (The American journal of tropical medicine and hygiene., 2004) Fogg, Carole; Bajunirwe, Francis; Piola, Patrice; Biraro, Samuel; Checchi, Francesco; Kiguli, James; Namiiro, Proscovia; Musabe, Joy; Kyomugisha, Agnes; Guthmann, Jean-Paul
    Measuring baseline levels of adherence and identifying risk factors for non-adherence are important steps before the introduction of new antimalarials. In Mbarara in southwestern Uganda, we assessed adherence to artemether-lumefantrine (Coartem) in its latest World Health Organization blister formulation. Patients with uncomplicated Plasmodium falciparum malaria were prescribed artemether-lumefantrine and received an explanation of how to take the following five doses at home. A tablet count was made and a questionnaire was completed during a home visit. Among 210 analyzable patients, 21 (10.0%) were definitely or probably non-adherent, whereas 189 (90.0%) were probably adherent. Age group was not associated with adherence. Lack of formal education was the only factor associated with non-adherence after controlling for confounders (odds ratio = 3.1, 95% confidence interval [CI] = 1.1-9.7). Mean lumefantrine blood levels were lower among non-adherent (n = 16) (2.76 microg/mL, 95% CI = 1.06-4.45) than among adherent (n = 171) (3.19 microg/mL, 95% CI = 2.84-3.54) patients, but this difference was not statistically significant. The high adherence to artemether-lumefantrine found in our study suggest that this drug is likely to be very effective in Mbarara provided that patients receive clear dosage explanations.
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    Assessment of three new parasite lactate dehydrogenase (pan-pLDH) tests for diagnosis of uncomplicated malaria.
    (Transactions of the Royal Society of Tropical Medicine and Hygiene, 2008) Fogg, Carole; Twesigye, Rogers; Batwala, Vincent; Piola, Patrice; Nabasumba, Carolyn; Kiguli, James; Mutebi, Frederick; Hook, Christa; Guillerm, Martine; Moody, Anthony; Guthmann, Jean-Paul
    A study to assess the diagnostic capabilities of three parasite lactate dehydrogenase (pan-pLDH) tests, Vistapan®, Carestart™ and Parabank®, was conducted in Uganda. An HRP2 test, Paracheck-Pf®, and a Giemsa-stained blood film were performed with the pLDH tests for outpatients with suspected malaria. In total, 460 subjects were recruited: 248 with positive blood films and 212 with negative blood films. Plasmodium falciparum was present in 95% of infections. Sensitivity above 90% was shown by two pLDH tests, Carestart (95.6%) and Vistapan (91.9%), and specificity above 90% by Parabank (94.3%) and Carestart (91.5%). Sensitivity decreased with low parasitaemia (χ2 trend, P < 0.001); however, all tests achieved sensitivity >90% with parasitaemia ≥100/μl. All tests had good inter-reader reliability (κ > 0.95). Two weeks after diagnosis, 4–10% of pLDH tests were still positive compared with 69.7% of the HRP2 tests. All tests had similar ease of use. In conclusion, two pLDH tests performed well in diagnosing P. falciparum malaria, and all pLDH tests became negative after treatment more quickly than the HRP2. Therefore the rapid test of choice for use with artemisinin-combination therapies in this area would be one of these new pLDH tests.
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    Malaria in camps for internally-displaced persons in Uganda: evaluation of an insecticide-treated bednet distribution programme
    (Transactions of the Royal Society of Tropical Medicine and Hygiene, 2004) Spencer, Sebastian; Grant, Alison D.; Piola, Patrice; Tukpoa, Kodzo; Okia, Michael; Garcia, Marlon; Salignon, Pierre; Genevier, Christine; Kiguli, James; Guthmann, Jean-Paul
    Malaria is a key health problem among displaced populations in malariaendemic areas. Mass distribution of insecticide-treated bednets (ITN) to prevent malaria is often carried out in complex emergencies, but there are few data on the outcome or operational effectiveness of such programmes. In June 2001, Médecins Sans Frontières completed a mass distribution of ITNs (Permanet®) to internally displaced persons in Bundibugyo, southwest Uganda, distributing one to four nets per household, and aiming to provide coverage for all residents. In July 2002, we did a cross-sectional survey using three-stage cluster sampling to evaluate the programme. A total of 1245 individuals from 835 households were interviewed. An ITN was present in 75.6% (95% CI 72.7—78.5) of the households, but only 56.5% (95% CI 52.3—60.4) of individuals were sleeping under an ITN, and nets were often damaged. The prevalence of malarial parasitaemia was 11.2% (95% CI 9.4—13.0), and was significantly lower in ITN users compared to non-users (9.2% vs. 13.8%, relative risk [RR] 0.63, 95% CI 0.46—0.87); ITNs with severe damage remained effective (RR for severely damaged net 0.58, 95% CI 0.35—0.98). There was no significant difference in haemoglobin concentration between ITN users and non-users.
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    Supervised Versus Unsupervised Intake Of Six-Dose Artemether-Lumefantrine For Treatment Of Acute, Uncomplicated Plasmodium Falciparum Malaria In Mbarara, Uganda: A Randomised Trial
    (The Lancet, 2005) Piola, Patrice; Fogg, Carole; Bajunirwe, Francis; Biraro, Samuel; Grandesso, Francesco; Ruzagira, Eugene; Babigumira, Joseph; Kigozi, Isaac; Kiguli, James; Kyomuhendo, Juliet; Ferradini, Laurent; Taylor, Walter; Checchi, Francesco; Guthmann, Jean-Paul
    The six-dose regimen of artemether-lumefantrine is effective and is among combination therapies prioritised to replace antimalarials that no longer work in Africa. However, its effectiveness has not been assessed in the field, and could be compromised by poor adherence, incorrect timing of doses, and insufficient intake of fatty foods with every dose. Our aim, therefore, was to assess the effectiveness of artemether-lumefantrine prescribed under routine outpatient conditions, compared with its efficacy when given under supervision to inpatients with acute uncomplicated falciparum malaria.We did a randomised trial to compare the efficacy, safety, and pharmacokinetics of artemether-lumefantrine when given in a supervised (all doses observed with fatty-food intake; n=313) or unsupervised (first dose supervised followed by outpatient treatment with nutritional advice; n=644) setting to patients of all ages (weight >10 kg) with acute, uncomplicated falciparum malaria in Mbarara, Uganda. Our primary endpoint was 28 day, PCR-adjusted, parasitological cure rate. Analysis was by intention to treat and evaluability analysis.38 patients were lost to follow-up and one withdrew consent. Day-28 cure rates were 97·7% (296 of 303) and 98·0% (603 of 615) in the supervised and unsupervised groups, respectively. We recorded 15 non-severe, drug-related adverse events, all of which resolved.Artemether-lumefantrine has a high cure rate irrespective of whether given under supervision with food or under conditions of routine clinic practice. If used as first-line treatment, artemether-lumefantrine could make a substantial contribution to malaria control in Africa, though cost is an issue.