Gametocyte Clearance in Children, From Western Kenya, With Uncomplicated Plasmodium Falciparum Malaria after Artemether–Lumefantrine or Dihydroartemisinin–Piperaquine Treatment

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Date
2019Author
Omondi, Protus
Burugu, Marion
Muhia, Damaris Matoke
Too, Edwin
Nambati, Eva A
Chege, William
Musyoka, Kelvin B
Thiongo, Kelvin
Otinga, Maureen
Muregi, Francis
Kimani, Francis
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Background: The efcacy and safety of artemether–lumefantrine (AL) and dihydroartemisinin–piperaquine (DP)
against asexual parasites population has been documented. However, the efect of these anti-malarials on sexual
parasites is still less clear. Gametocyte clearance following treatment is essential for malaria control and elimination
eforts; therefore, the study sought to determine trends in gametocyte clearance after AL or DP treatment in children
from a malaria-endemic site in Kenya.
Methods: Children aged between 0.5 and 12 years from Busia, western Kenya with uncomplicated Plasmodium falciparum malaria were assigned randomly to AL or DP treatment. A total of 334 children were enrolled, and dried blood
spot samples were collected for up to 6 weeks after treatment during the peak malaria transmission season in 2016
and preserved. Plasmodium falciparum gametocytes were detected by qRT-PCR and gametocyte prevalence, density
and mean duration of gametocyte carriage were determined.
Results: At baseline, all the 334 children had positive asexual parasites by microscopy, 12% (40/334) had detectable
gametocyte by microscopy, and 83.7% (253/302) children had gametocytes by RT-qPCR. Gametocyte prevalence by
RT-qPCR decreased from 85.1% (126/148) at day 0 to 7.04% (5/71) at day 42 in AL group and from 82.4% (127/154) at
day 0 to 14.5% (11/74) at day 42 in DP group. The average duration of gametocyte carriage as estimated by qRT-PCR
was slightly shorter in the AL group (4.5 days) than in the DP group (5.1 days) but not signifcantly diferent (p=0.301).
Conclusion: The study identifes no signifcant diference between AL and DP in gametocyte clearance. Gameto‑
cytes persisted up to 42 days post treatment in minority of individuals in both treatment arms. A gametocytocidal
drug, in combination with artemisinin-based combination therapy, will be useful in blocking malaria transmission
more efciently.
Keywords: Artemether–lumefantrine, Dihydroartemisinin/piperaquine, Plasmodium falciparum gametocyte