Efficacy of artemether-lumefantrine combination for the treatment of uncomplicated Plasmodium falciparum malaria after 16 years of its introduction into Ghana's antimalarial medicines policy.

BACKGROUND

Artemether-lumefantrine (AL) was introduced into Ghana's antimalarial medicines policy in 2008 as an alternative to artesunate-amodiaquine (AS-AQ) for the treatment of uncomplicated malaria. Studies conducted between 2010 and 2021 had shown the efficacy of AL to be above 90%. This study aimed at determining the current efficacy of AL in 10 sentinel sites after 16 years of its formal introduction as one of the first-line medicines for uncomplicated malaria in the country.

METHODS

The study was conducted among febrile children aged 6 months to 9 years between August 2024 and January 2025 using the WHO protocol for surveillance of antimalarial drug efficacy and reported using the standardized antimalarial therapeutic efficacy reporting (STARTER) checklist. Children enrolled were followed-up for 28 days. Parasite recrudescence and re-infections were determined using merozoite surface protein 1 (msp1), merozoite surface protein 2 (msp2), and one microsatellite (poly-α) in the recommended 3/3 PCR-genotyping approach.

RESULTS

Out of 1387 suspected uncomplicated malaria cases screened, 747 met the inclusion criteria and were subsequently enrolled. Out of this, 738 completed their follow-up visits. PCR-uncorrected cure rates across the 10 sentinel sites ranged between 85.9% (95% CI 76.6-92.5) and 100% with a national rate of 96.3% (95% CI 94.7-97.6) whilst PCR-corrected cure rates ranged between 91.9% (95% CI 78.1-98.3) and 100% with a national rate of 98.9% (95% CI 97.8-99.5). No early treatment failures were observed at any of the sites. Also, no child enrolled was parasitaemic on Day 3.

CONCLUSIONS

AL has remained highly efficacious (> 90%) in the treatment of uncomplicated malaria in Ghana, even after 16 years of its formal introduction into the country's antimalarial medicines policy. Preserving this high efficacy through strategies such as the deliberate implementation of multiple first-line therapy (MFT) has become critical, particularly as lumefantrine is needed for the development of non-artemisinin combination therapies in response to the spread of artemisinin resistance. Trial Registration Pan African Clinical Trial Registry-PACTR202502791855505.