Associated Symptoms and Therapeutic Efficacy of Artemeter-Lumefantrine in Subclinical Malaria in Owerri, Imo State, Nigeria

ABSTRACT

Despite the remarkable progress made towards the reduction in the number of malaria cases and death globally, malaria still remains a life threatening disease of great public health importance in the world today, more especially in sub-Saharan Africa. Detection and treatment of malaria with Artemeter-Lumefantrine at the early stage of the disease could be of immense help. The general objective of the study was to establish the major symptoms associated with subclinical malaria and to assess the efficacy of Artemeter-Lumefantrine in subclinical malaria in Owerri Nigeria. It was a community based interventional (therapeutic) study conducted between March and April 2016 at Naze(Owerri North) and Ikenegbu (Owerri Municipal) communities in Imo State Nigeria. The study population consisted of two groups(subclinical and clinical) both of which included consenting male and female aged 18 years and above, who fulfilled the inclusion criteria and were living in the study areas as at the period of study. A systematic house to house sampling technique was employed in selection of the participants who fulfilled the inclusion criteria for both groups. A total of 117 and 66 participants were recruited from study sites for the subclinical and clinical groups respectively. Data collections were done through screening using questionnaire, RDT, thick and thick film microscopy followed by treatment and follow up of recruited participants. The Data obtained were analyzed using IBM-SPSS Statistics version 20.0. Most findings were represented with frequency tables or bar chart. Chi square test was used to test the null hypothesis of no significant difference between parasite clearance rates in subclinical and clinical malaria. Ninety three out of 117 and 65/66 of participants in the subclinical and clinical groups respectively were successfully followed up to days 3 and 7. The major symptoms of subclinical malaria established were body itching, 111(12.9%), bone pains, 110(12.8%), sleepiness,110 (12.8%), bad dreams,107(12.4%), dizziness, 92(10.7%), bitter/soar taste, 90(10.5%), joints/muscular pains, 77(9.0%), and weakness of the body, 75(8.7%).Others, 88(10.2%), reported cough/catarrh,23(2.7%),abdominal discomfort,23(2.7%), loss of appetite,23(2.7%), yellow urine,7(0.8%),constipation,7(0.8%), and sleeplessness,5(0.6%). Day 3 parasite clearance rate was significantly higher (86.0%) in subclinical cases than in clinical cases(67.7%)with P-value < 0.05 at CI of 95%. On day 7, parasite clearance rate was apparently higher in subclinical cases (87.1%) than in the clinical cases (78.5%) with P-value> 0.05 at CI of 95%.The sensitivity rate of RDT (Carestat) in subclinical malaria was calculated to be 19.7% while the specificity was 96.5% using thick film microscopy as the gold standard. No adverse effect from Artemeter-Lumefantrine was reported, only some side effects like headache, abdominal discomfort, dizziness, watery stooling and restlessness. In conclusion, there are associated symptoms of subclinical malaria which can aid early detection. Treatment of malaria with Artemeter-Lumefantrine provides a better outcome in subclinical stage than in the clinical stage. Further studies are urgently needed to rule out imminent Artemeter-Lumefantrine resistance in the study areas.

Keywords: Major symptoms; subclinical malaria; therapeutic efficacy; arthemeter-lumefariline;