Monitoring the efficacy of artemether-lumefantrine and artesunate-sulfadoxine/pyrimethamine combinations for treating uncomplicated Plasmodium falciparum malaria in Boali, Central African Republic.

OBJECTIVE: To evaluate the effectiveness of artemether-lumefantrine (AL) and artesunate-sulfadoxine-pyrimethamine (ASSP) for treating uncomplicated Plasmodium falciparum malaria in children aged 6 months to 14 years in Boali, Central African Republic. METHODS: From August 24 to November 27, 2024, a simple randomized cross-sectional study was conducted among 199 children aged 6 months to 14 years who were treated for uncomplicated falciparum malaria in Boali. One hundred and one children were treated with AL, and 98 with ASSP. All children were followed up for 28 days. Assignment to treatment groups was randomized. Responses were classified according to World Health Organization (WHO) criteria as adequate clinical and parasitological responses (ACPR), early treatment failure (ETF), late parasitological failure (LPF), and late clinical failure (LCF). Parasite DNA was extracted using a QIAGEN kit. The resistance markers dhfr, dhps, and kelch13 were analyzed by PCR. Spearman's correlation test was used. RESULTS: TThe ADR was 81.8% and 81.7% for AL and ASSP, respectively. There was no significant difference in the reduction of anemia, fever, or parasitemia between the two groups (p > 0.05). The dhfr-N51I-C59R-S108N-dhps-S436A mutants were the most common (66.7%). Polymorphism in the K13 genes revealed nine synonymous mutations: A621A, A627A, D646D, G496G, G690G, Q707Q, and S425S. There were also four non-synonymous mutations: A578S, V589I, and V520I/V637I. CONCLUSION: This study shows that Plasmodium parasites carrying both synonymous and non-synonymous mutations were detected, highlighting the need to regularly monitor these resistance markers.