Abstract:
Artemisinin-based combination therapy (ACT) is currently adopted drug regimen the management of both uncomplicated and severe falciparum
malaria, targeting asexual blood-stage Plasmodium falciparum parasites. However, the effect of ACTon sexual-stage parasites remains debatable.
We evaluated the evidence for and estimated the effects of the most widely-deployed ACTs, artemether-lumefantrine (AL) and Dihydroartemisinin
piperaquine phosphate (DP) on gametocyte clearance and transmission interruption in Kenya.Electronic databases for randomized controlled trials
evaluating the effect of AL and DP that reported gametocyte prevalence and densities or results of mosquito-feeding assays were searched. Two
authors working independently assessed suitability, extracted data, and assessed the risk of bias. Identification of 15 eligible trials conducted in
Kenya was done. Generally combined odds of gametocytemia at 7days were lower in both AL and DP treated groups (odds ratio [OR] 0.08; 95%
confidence interval [CI], 0.05–0.10; I2 = 0.60, P < .01; 15 trials). The odds of transmission to mosquitoes were also lower but not significant in AL
and DP treatment groups (OR 0.16; 95% CI, 0.01–0.4, P < .05 after 1week post-treatment; 1).AL and DP may reduce gametocytemia however
presence of submicroscopic gametocytes shortly after treatment with AL and DP in children highlights the limitation of interventions that aim to
reduce malaria transmission by use of antimalarial drugs therefore a gametocidal drug in combination to ACTs will be useful in blocking malaria
transmission more efficiently
