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falciparum isolates that were resistant to chloroquine. Reports from drug efficacy study conducted in the country provided strong evidence of the existence of P. Early presumptive treatment of febrile illness with chloroquine was the mainstay of malaria control in Ghana until 2005 when there was strong indication of P. The disease is responsible for up to 40% of daily outpatient consultations at hospitals and clinics across the country, accounting for over 23% of deaths among children below the age of five years. It is the single most important cause of mortality and morbidity especially among children under five years and pregnant women.
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In Ghana, malaria is hyper-endemic and remains the most widely diagnosed infectious disease in the country. Countries in sub-Saharan Africa, comprising some of the poorly developed nations in the world, bear a major part of the disease burden with at least 90% of the reported deaths. Most of these cases occur among children within whom the disease can sometimes present in a severe form, often with devastating consequences. According to the World Health Organization (WHO) World Malaria Report, there were about 219 million cases of malaria in 2010 and an estimated 660,000 deaths. Malaria, caused by an infection with Plasmodium falciparum, is complex and affects a significant number of people living in disease-endemic areas of the world, especially sub-Saharan Africa. Continuous monitoring of ACT in Ghana is recommended. falciparum isolates, to some extent, have become susceptible to chloroquine in vitro, however the increasing trend in artesunate IC 50 value observed should be of concern. The results also suggest the existence of possible cross-resistance among some of the test drugs.
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Compared to that measured prior to the change in treatment policy, significant elevation of artesunate IC 50 value was observed. This observation is important, since it suggests a significant improvement in the efficacy of chloroquine, probably as a direct consequence of reduced drug pressure after cessation of its use.
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There was nearly a two-fold decrease in the IC 50 value determined for chloroquine in this study compared to that determined in 2004 (57.56 nM). With reference to the literature threshold value indicative of resistance, the parasites showed resistance to all the test drugs except the artemisinin derivatives, atovaquone and to a lesser extent, lumefantrine. Pooled results from all the sentinel sites indicated geometric mean IC 50 values of 1.60, 3.80, 4.00, 4.56, 5.20, 6.11, 10.12, 28.32, 31.56, 93.60, 107.20, and 8952.50 nM for atovaquone, artesunate, dihydroartemisin, artemether, lumefantrine, amodiaquine, mefloquine, piperaquine, chloroquine, tafenoquine, quinine, and doxycycline, respectively. The concentration of anti-malarial drug inhibiting parasite growth by 50% (IC 50) for each drug was estimated using the online program, ICEstimator. The isolates were obtained from children visiting health facilities in sentinel sites located in Hohoe, Navrongo and Cape Coast municipalities. falciparum to a panel of 12 anti-malarial drugs in three distinct eco-epidemiological zones in Ghana. MethodsĪ SYBR Green 1 fluorescent-based in vitro drug sensitivity assay was used to assess the susceptibility of clinical isolates of P. The sensitivity of Ghanaian Plasmodium falciparum isolates to anti-malarial drugs was, therefore, assessed and the data compared with that obtained prior to the change in the malaria treatment policy. Since then, there has not been any major evaluation of the efficacy of anti-malarial drugs in Ghana in vitro. Based on report of declining efficacy of chloroquine, Ghana shifted to the use of artemisinin-based combination therapy (ACT) in 2005 as the first-line anti-malarial drug.