Faculty of Medicine, University of Khartoum, P.O. Box 102, Khartoum, Sudan.
Faculty of Medicine, University of Tabuk, P.O. Box 741, Tabuk, Kingdom of Saudi Arabia.
Malar J. 2018 Mar 13;17(1):110. doi: 10.1186/s12936-018-2265-x.
Malaria is a major public health problem in endemic countries including Sudan, where about 75% of populations are at risk. Due to widespread of chloroquine-resistant strains of Plasmodium falciparum, artemisinin-based combination therapy (ACT) is currently treatment of choice for malaria in the vast majority of malaria-endemic countries. This systematic review and meta-analysis is performed to obtain an overall stronger evidence of the outcomes of ACT in the treatment of uncomplicated falciparum malaria from the existing literature in Sudan.
The preferred reporting items for systematic review and meta-analysis statement were used to select studies to be included in this review. A computerized systematic strategy was adopted to search articles from PubMed, Google Scholar and Science Direct databases. Unpublished materials were also included. Open Meta-Analyst software was used to perform the meta-analysis. Random effects model was used to combine the included studies and the heterogeneity of studies was assessed using Cochrane Q and I (χ = 73.05, df (19), P < 0.001 and I = 73.99).
Twenty studies fulfilled the inclusion criteria (ACT in the treatment of uncomplicated falciparum malaria) and were included in the final analysis with a total number of 4070 participants. Malaria treatment outcome was assessed using World Health Organization guidelines. Adequate clinical and parasitological response was used to assess treatment success at the 28th day. Treatment success of all combined studies was 98% [(95% CI 97.2-98.8%), P < 0.001]. Treatment success was higher in malaria patients treated with artemether + lumefantrine (AL) than patients treated with artesunate + sulfadoxine-pyrimethamine (AS + SP) (98.9% (95% CI 98.4-99.4%) vs 97.1% (95% CI 95.5-98.6%), P < 0.001). Eleven studies reported adverse drug reactions (ADRs) to ACT (184 participants out of 3957 (4.65%). The ADRs were mild and resolved spontaneously. There was no severe ADRs or deaths.
Based on this review, the overall malaria treatment success was high (98%). AL regimen showed higher efficacy compared to AS + SP. The overall regimens were associated with mild low rates ADRs.
疟疾是包括苏丹在内的流行地区的一个主要公共卫生问题，约 75%的人口面临风险。由于恶性疟原虫对氯喹的抗药性广泛存在，青蒿素为基础的联合疗法（ACT）目前是绝大多数疟疾流行国家治疗疟疾的首选方法。本系统评价和荟萃分析旨在从苏丹现有文献中获得更有力的证据，证明 ACT 在治疗无并发症恶性疟中的疗效。
采用系统综述和荟萃分析首选报告项目来选择纳入本综述的研究。采用计算机系统策略从 PubMed、Google Scholar 和 Science Direct 数据库中搜索文章。也包括未发表的资料。采用 Open Meta-Analyst 软件进行荟萃分析。采用随机效应模型合并纳入研究，采用 Cochrane Q 和 I（χ²=73.05，df（19），P<0.001 和 I=73.99）评估研究的异质性。
20 项研究符合纳入标准（ACT 治疗无并发症恶性疟），并纳入最终分析，共有 4070 名参与者。采用世界卫生组织指南评估疟疾治疗结果。第 28 天评估适当的临床和寄生虫学反应来评估治疗成功。所有合并研究的治疗成功率为 98%（[95%CI 97.2-98.8%]，P<0.001）。用青蒿琥酯联合甲氟喹（AL）治疗的疟疾患者的治疗成功率高于用青蒿琥酯联合磺胺多辛-乙胺嘧啶（AS+SP）治疗的患者（98.9%（95%CI 98.4-99.4%）比 97.1%（95%CI 95.5-98.6%），P<0.001）。11 项研究报告了 ACT 的不良反应（ADR）（3957 名参与者中有 184 名（4.65%））。ADR 为轻度，自发消退。没有严重的 ADR 或死亡。
根据本综述，疟疾整体治疗成功率较高（98%）。AL 方案的疗效高于 AS+SP。整体方案与轻度低发生率的 ADR 相关。
