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Intermittent preventive treatment with sulfadoxine\/pyrimethamine is also recommended for pregnant women. The therapeutic efficacy of Artesunate\u2013amodiaquine and Artemether\u2013lumefantrine, and the frequency of molecular markers associated with anti-malarial drug resistance were investigated.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      The therapeutic efficacy of ASAQ and AL was evaluated using the standard World Health Organization protocol (WHO. Methods for Surveillance of Antimalarial Drug Efficacy. Geneva: World Health Organization; 2009.\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/www.who.int\/malaria\/publications\/atoz\/9789241597531\/en\/\">https:\/\/www.who.int\/malaria\/publications\/atoz\/9789241597531\/en\/<\/jats:ext-link>\n                      ). Eligible children were recruited and monitored clinically and parasitologically for 28\u00a0days. Polymorphisms in the\n                      <jats:italic>Pfkelch 13<\/jats:italic>\n                      , chloroquine resistance transporter (\n                      <jats:italic>Pfcrt<\/jats:italic>\n                      ), multidrug resistance 1 (\n                      <jats:italic>Pfmdr-1<\/jats:italic>\n                      ), dihydrofolate reductase (\n                      <jats:italic>Pfdhfr<\/jats:italic>\n                      ), and dihydropteroate synthase (\n                      <jats:italic>Pfdhps<\/jats:italic>\n                      ) genes and copy number variations in the plasmepsin-2 (\n                      <jats:italic>Pfpm2)<\/jats:italic>\n                      gene were assessed in pretreatment samples.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Of the 359 children enrolled, 180 were treated with ASAQ (89 in Saclepea and 91 in Bensonville) and 179 with AL (90 in Sinje and 89 in Kakata). Of the recruited children, 332 (92.5%) reached study endpoints. PCR-corrected per-protocol analysis showed ACPR of 90.2% (95% CI: 78.6\u201396.7%) in Bensonville and 92.7% (95% CI: 83.4.8\u201396.5%) in Saclepea for ASAQ, while ACPR of 100% was observed in Kakata and Sinje for AL. In both treatment groups, only two patients had parasites on day 3. No artemisinin resistance associated\n                      <jats:italic>Pfkelch13<\/jats:italic>\n                      mutations or multiple copies of\n                      <jats:italic>Pfpm2<\/jats:italic>\n                      were found. Most samples tested had the\n                      <jats:italic>Pfcrt<\/jats:italic>\n                      76\u00a0T mutation (80\/91, 87.9%), while the\n                      <jats:italic>Pfmdr-1 86Y<\/jats:italic>\n                      (40\/91, 44%) and 184F (47\/91, 51.6%) mutations were less frequent. The\n                      <jats:italic>Pfdhfr<\/jats:italic>\n                      triple mutant (51I\/59R\/108\u00a0N) was the predominant allele (49.2%). For the\n                      <jats:italic>Pfdhps<\/jats:italic>\n                      gene, it was the 540E mutant (16.0%), and the 436A mutant (14.3%). The quintuple allele (51I\/59R\/108\u00a0N-437G\/540E) was detected in only one isolate (1\/357).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>\n                      This study reports a decline in the efficacy of ASAQ treatment, while AL remained highly effective, supporting the recent decision by NMCP to replace ASAQ with AL as first-line treatment for uncomplicated falciparum malaria. No association between the presence of the mutations in\n                      <jats:italic>Pfcrt<\/jats:italic>\n                      and\n                      <jats:italic>Pfmdr-1<\/jats:italic>\n                      and the risk of parasite recrudescence in patients treated with ASAQ was observed. Parasites with signatures known to be associated with artemisinin and piperaquine resistance were not detected. The very low frequency of the quintuple\n                      <jats:italic>Pfdhfr\/Pfdhps<\/jats:italic>\n                      mutant haplotype supports the continued use of SP for IPTp. Monitoring of efficacy and resistance markers of routinely used anti-malarials is necessary to inform malaria treatment policy.\n                    <\/jats:p>\n                    <jats:p>\n                      <jats:italic>Trial registration<\/jats:italic>\n                      ACTRN12617001064392.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12936-022-04140-7","type":"journal-article","created":{"date-parts":[[2022,4,27]],"date-time":"2022-04-27T06:03:03Z","timestamp":1651039383000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":24,"title":["Artesunate\u2013amodiaquine and artemether\u2013lumefantrine for the treatment of uncomplicated falciparum malaria in Liberia: in vivo efficacy and frequency of molecular markers"],"prefix":"10.1186","volume":"21","clinical-trial-number":[{"clinical-trial-number":"actrn12617001064392","registry":"10.18810\/anzctr"}],"author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3774-1219","authenticated-orcid":false,"given":"Victor S.","family":"Koko","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marian","family":"Warsame","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benjamin","family":"Vonhm","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Moses K.","family":"Jeuronlon","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Didier","family":"Menard","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laurence","family":"Ma","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fahn","family":"Taweh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lekilay","family":"Tehmeh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paye","family":"Nyansaiye","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Oliver J.","family":"Pratt","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sei","family":"Parwon","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patrick","family":"Kamara","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Magnus","family":"Asinya","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aaron","family":"Kollie","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pascal","family":"Ringwald","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2022,4,27]]},"reference":[{"key":"4140_CR1","unstructured":"WHO. 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