Togo, Africa

STEPHANIE NG
NTRS 519
SPECIFIC TOPICS IN FOOD AND
NUTRITIONAL SCIENCE
FALL QUARTER 2015
CALIFORNIA STATE UNIVERSITY, LOS
ANGELES

Togo, West Africa

Togo, West Africa

One of the smallest

country in Africa

population of about 6.7

million

Savannah woodland

plateau
Tropical weather with a
dry climate, 73F to 86
F

Statement of Problem: Malaria

Mosquito-borne disease caused by the parasite,

Plasmodium falciparum
preventable and treatable with drugs
Most infectious disease in the world, often very
fatal
300 million new diagnoses cases
1.5 million people die from disease
Most are children under age of 6
15% affected population in Togo: children under 5
No vaccination

Malaria
Symptoms + flu-like
Fever
Fatigue
Vomiting
Headache
Severe Stage
Yellowing of skin,
seizure
Coma
Fatal death

Malaria Treatment and Prevention

Anti-malarial medications

sulfadoxine/pyrimethamine, mefloquine,
amodiaquine, piperaquine, & lumefantrine
multi-drug resistant Plasmodium. falciparum

Insect repellant
Long sleeve clothing and pants
Mosquito nets
Insecticide

Artemisinin aka Artemisia annua

Artemisinin
Sweet wormwood plant
Grown mostly in Vietnam and China

high demand but limited supply

Releases high [ ] of free radicals to
attach to parasite membrane.

Artemisinin Combination Therapy (ACT)

Combination of artemisinin derivative + drug
Ex. aremether+lumefantrine, artesunate+amodiaquine
Artemisinin derivative
dihydroartemisinin, artesunate and artemether.
Antimalarial drug
Clears the body of parasites prevents reccurence
Artemisinin used alone = not recommended by WHO

Solution to the Problem

To treat severe malaria caused by

Plasmodium falciparum malaria

with a combination drug therapy of
artesunate and lumefantrine.

Artemisinin Combination Therapies (ACTs) for Treatment of

Uncomplicated Malaria in Uganda

compares the efficacy and safety of ACTs for the

treatment of uncomplicated Plasmodium falciparum

malaria
Tororo, Uganda
408 children, age 1-10
Amodiaquine+artesunate (AA) vs
artemether-lumefantrine (AL)
Both ACTs were well tolerated and efficacious
artemether-lumefantrine was more superior to
amodiaquine+artesunate (AA) for prevention of new
infections, risk reduction, and delay of for malaria
recurrence

Malaria Transmission After Artemether-Lumefantrine and

Dihydroartemisinin-Piperaquine: A Randomized Trial

Observe gametocyte carriage in mosquito feeding

assays
~300 children, aged 6 months 10 years
Artemether-lumefantrine (AL) or
dihydroartemisinin-piperaquine (DP)
AL = Shorter duration of gametocyte and less
infections malaria transmission is lower

Molecular Structure

Artemisinin

Artesunate

Research Proposal
Aim. The purpose of the study is to test the efficacy

of intravenous artesunate on severe malaria caused

by Plasmodium falciparum.
Study design. A randomized, double blind-placebo

controlled trial will be performed to test the efficacy

of intravenous artesunate on severe malaria caused
by Plasmodium falciparum malaria in a period of 21
days in Togo, Africa.

Materials and Methods

5000 patients in Togo, diagnosed with severe

malaria
Inclusion criteria

Patients aged 13 and older

Patients with severe malaria; tested (+) on blood antigen stick
for P. falciparum

Exclusion criteria
Pregnant and lactating women
Children under 13 years of old
Patients with quinine and artemisinin treatment in last 24
hours

Materials and Methods

Artesunate vs quinine group
Physicians will administer intravenous dosage of

artesunate or quinine to each group

Observation at 0, 7, 14, 21 day

Conclusion
Mortality rate of artesunate group is higher than

quinine group
Artesunate has broader- stage specificity of action
Kill circulating parasites & removing from body
Prevent parasite maturation
Quinine cannot do this
Intravenous used until patients can orally take it

World Concern Organization

Christian global relief and development

agency
Donation
Malaria medication
Mosquito net

References

BBC News (2015). Togo country profile. Retrieved from http://www.bbc.com/news/world-africa-14106781

Bethell, D., Youry Se., Lon, C., Tyner, S., Saunders, D, Sriwichai, S.,Fukuda, M. (2011). Artesunate Dose Escalation for
the Treatment of Uncomplicated Malaria in a Region of Reported Artemisinin Resistance: A Randomized Clinical Trial.
PLOS One, 12, 786-993.
Bukirwa, H., Yeka, A., Kamya, M., Talisuna, A., Banek, K., Bakyaita, N.,Staedke, S. (2006). Artemisiin Combination
Therapies for Treatment of Uncomplicated Malaria in Uganda. PLOS Clinical Trials, 1(1)
Centers for Disease Control and Prevention (2015). Health Information for Travelers to Togo Traveler View. Retrieved
from http://wwwnc.cdc.gov/travel/destinations/traveler/none/togo
Dondorp, A., Fanello, C., Hendriksen, I., Gomes, E., Seni, A., Chhaganlal, K.,White, J. (2010) Artesunate versus
quinine in the treatment of severe falciparum malaria in African children (AQUAMAT): an open-label, randomised trial.
The Lancet, 376, 1647-1657.
Falade, C., Makanga, M., Premji, Z., Ortmann, C., Stockmeyer, M., & Palacios, P. (2005). Efficacy and safety of
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Phu, N., Tuan, P., Day, N., Mai, N., Chau, T., Choung, L.,Tran, H. (2010). Randomized controlled trial of artesunate or
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Price, R. & Douglas, N. (2009). Artemisinin Combination Therapy for Malaria Beyond Good Efficacy. Clinical Infectious
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Sawa, P., Shekalaghe, S., Drakeley, C., Sutherland, C., Mweresa, C., Baidjoe, A.,Bousema, T., (2013). Malaria
Transmission After Artermether-Lumefantrine and dihydroartemisinin-piperaquine: A Randomized Trial. Journal of
Infectious Diseases, 20, 1637-1645.
Yeka, A., Banek, K., Bakvaita, N. Staedke, S., Kamya, M., Talisuna, A., Dorsey, G. (2005). Artemisinin versus
Nonartemisinin Combination Therapy for Uncomplicated Malaria: Randomized Clinical Trials from Four sites in
Uganda. PLOS Medicine, 1667-1671.
World Health Organization. (2015). Togo. Retrieved from http://www.who.int/countries/tgo/en/