Effectiveness and Safety of Artemether-lumefantrine in Bungoma County Referral Hospital

Abstract

Malaria is a worldwide healthcare issue that is causing millions of deaths. In Kenya, malaria is one of the leading causes of death especially for children under the age of 5 years and expectant mothers. There are strategies in place to try and eliminate malaria, one of which involve prompt diagnosis and treatment. Artemether and Lumefantrine are recommended first line drugs against uncomplicated malaria. With continuous exposure of drugs to the parasite, resistance is bound to occur. World Health Organization has recommended that the efficacy of Artemether and Lumefantrine be checked in endemic areas every two years. Increased screening of malaria has led to prompt treatment of malaria which has saved lives. This also has led to an increased number of people being exposed to the drugs sometimes repeatedly. With this, some rare adverse events are likely to be unmasked. Objective The main objective of this study is to determine the effectiveness and safety of Artemether-Lumefantrine in Bungoma County Referral Hospital. Method A longitudinal study was carried out involving following up of participants diagnosed with uncomplicated malaria in Bungoma County Referral Hospital. Two hundred and sixty participants on treatment with Artemether-Lumefantrine were randomly selected and followed up by calling using a mobile phone. Any adverse events were recorded in a form. Data was analyzed using STATA version 13. Both descriptive and inferential statistics were used to summarize the data at 0.05 level of significance. Results A total of 260 malaria participants participated in the study, of which the majority were female, 53.5%. The age range was 1 month to 61 years and median of 36 months (3years). AL was found to be effective against uncomplicated malaria. Lumefantrine was able to protect all the participants against malaria for the 28 day period irrespective of whether they protected themselves against mosquito bite or not. AL was generally well tolerated with only 23% of the participants reporting adverse events of which abdominal discomfort 43.3 %(26 participants), 11 cough 43.3 (26 participants) and headache 31.7 % (19 participants). 5 participants reported blisters on the body and 5 had swollen abdomen. The adverse events might be associated with the fatty meal the participant was advised to eat before taking the drugs. Conclusion AL is still safe and ffective against uncomplicated malaria in Bungoma County Referral Hospital. Lumefantrine is also able to protect the participants for 28 days after taking the first dose of AL. There were however strange adverse events reported during the study that requires further investigation. Recommendations Intense pharmacovigilance is required to identify and document adverse events associated with AL. the healthcare workers should be assured that AL is still effective against uncomplicated malaria in order to restore their faith and prevent them from using second line in place of first line. Emphasis to confirm malaria before treatment should be done to avoid overmedication and reduce drug pressure. Participants and healthcare personnel should be taught and encouraged to report adverse events.