Six Differences in the Efficacy of Antimalarial Drugs and Related Changes in the Haemoglobin Levels of Children Under Five in Ghana

Abstract

Background: One of the consequences of drug resistance to malaria parasites, is poor haematological recovery (Bloland et al., 1993; Verhoeff et al., 1997; Ekvall et al., 1998). Use of the right antimalarial is the key to avert this situation. Few studies have explored sex differences of these drug interventions in pediatric populations. ( Domellöf M et al 2002 and Songül S et al 2009). Methods: This study is a descriptive study analyzing secondary data collected from a primary comparative efficacy study of four antimalarials in Ghanaian children under five in 2005. Age, sex, haemoglobin levels, parasite counts and temperature between sexes were used for the analysis. Pearson Chi square test, ANOVA and paired t-test were performed between sexes and day of treatment. Comparison of means, standard deviation, risk difference and mean difference were done where it applies stating p values of <0.05 as significant and 95% confidence intervals. Results: The treatment groups were distributed as follows at baseline; Chloroquine (CQ) 36, Artesunate-Amodiaquine (ART/AMQ) 27, Sulphadoxine-Pyrimethamine (SP) 29, and Artemether –Lumefantrine (AL) 19. The mean age was highest in the AL group 38.6 months (SD±9.9). Adequate Clinical and Parasitological Response for evaluable patients was also highest among females in the AL group 72% (13/18) at day 14 and followed a similar trend at day 28; 69.23% (9/18). About 70% (62/94) of all males in all treatment groups were anaemic while 43% (40/94) of all females were anaemic at baseline. A total of 88.3% in both sexes and treatment groups were still anaemic by day 7 assessment. Haemoglobin (Hb) levels increased in both sexes and all groups during and after treatment but the cross comparisons between days were mostly significant among ACT females. Among the ACT’s, females in AL were always significant comparing Hb’s levels on any day of treatments but only significant at day 0 and 28 for ART/AMQ (p=0.0188). Conclusion: No significant difference in efficacy was found between males and females and between antimalarial treatment groups. This could be attributed to a small sample size used in the evaluation. Considering the permuted days of comparisons in both ACT groups, females were found to have a statistically significant haematological recovery than boys with mean ages in months of 35.1 and 31.5 respectively. Further studies to establish local haematological reference values, followed by studies to ascertain haematological recovery rates among Ghanaian children are recommended.