Patients experiences on the use of dihydroartemisinin piperaquine as an alternative first line artemisinin-based combination treatment for uncomplicated malaria in Northern Ghana

Samuel Chatio, Philip B. Adongo, Philip A. Dalinjong, Maxwell A. Dalaba, Paula Beeri, Patricia Akweongo, Abraham Oduro


Background: Three different artemisinin-based combination therapies (ACTs) namely; artesunate-amodiaquine, artemether-lumefantrine and dihydroartemisinin-piperaquine (being the latest to be introduced) are concurrently being used for the treatment of falciparum malaria in Ghana. This study assessed patients’ experience, perceptions and willingness to use dihydroartemisinin-piperaquine, brand name duo-cotecxin as an alternative first line ACT for the treatment of falciparum malaria in Northern Ghana.

Methods: This was a qualitative study using phenomenology approach where sixty in-depth interviews were conducted with two groups; thirty patients who were given duo-cotecxin, one group and thirty interviews with patients who were given other ACTs (artesunate-amodiaquine, artemether-lumefantrine) as another group. The interviews were conducted between August and November, 2015 Purposive sampling technique was used to select study participants. The interviews were transcribed and coded into themes using QSR NVivo 11 software for thematic content analysis.

Results: All patients who used duo-cotecxin reported that the drug was very good in treating uncomplicated malaria compared to other ACTs they had used in the past. Some of the patients who used other ACTs could not complete their doses because of the side effects. However, none of the patients who used duo-cotecxin reported side effects. The findings revealed high acceptance and preference to use duo-cotecxin to treat uncomplicated malaria compared with other ACTs. All the participants were also willing to recommend duo-cotexcin to their relatives and friends to use.

Conclusions: Duo-cotecxin as an alternative first line ACT for treatment of uncomplicated malaria is highly accepted, preferred and there was willingness to use it compared with other first line recommended ACTs.


Dihydroartemisinin piperaquine, First line, Artemisinin-based combination treatment, Uncomplicated malaria, Northern Ghana

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WHO. World Malaria Report 2017. Geneva:World Health Organization, 2017. Available at: Accessed on 12 September 2018.

UNICEF Ghana Fact Sheet, UNICEF, 2007. Available at Accessed on 14 September 2018.

Donovan C, Siadat B, Frimpong J. Seasonal and socio-economic variations in clinical and self-reported malaria in Accra, Ghana: Evidence from facility data and a community survey. Ghana Med J. 2012;46:85–94.

Oduro AR, Koram KA, Rogers W, Atuguba F, Ansah P, Anyorigiya T, et al. Severe falciparum malaria in young children of the Kassena-Nankana district of northern Ghana. Malar J. 2007;6:96.

Ghana Health Service. Anti-Malaria Drug Policy, 2009.

World Health Organization Antimalaria Drug Combination Therapy. Report of a WHO Technical Consultation. Geneva, 2001.

Chatio S, Aborigo R, Adongo PB, Anyorigiya T, Akweongo P, Oduro A, et al. Adherence and Uptake of Artemisinin-Based Combination Treatments for Uncomplicated Malaria:A Qualitative Study in Northern Ghana. PLoS ONE. 2015;10(2):e0116856.

Asante KP, Owwusu R, Dosoo D, Awine E, Adjei G, Amenga Etego S, et al. Adherence to Artesunate-amodiaquine therapy for uncomplicated malaria in nrural Ghana:A randomized trial of supervised versus unsupervised drug administration. J Trop Med. 2009;2009:529583.

Adjei GO, Kurtzhals JAL, Rodrigues OP, Alifrangis M, Hoegberg LCG, et al. Amodiaquine-artesunate vs Artemether-lumefantrine for uncomplicated malaria in Ghanaian children:A randomized efficacy and safety trial with one year follow-up. BMC Malaria J. 2008;7:127.

Adisa R, Fakeye T, Dike D. Evaluation of adverse drug reactions to artemisinin-based combination therapy in a Nigeria university community. Trop J Pharm Res. 2008;7(2):937-44.

Koram KA, Abuaku B, Duah N, Quashie N. Comparative efficacy of antimalarial drugs including ACT in the treatment of uncomplicated malaria among children under 5 years in Ghana. Acta Tropica 2005;194-203.

Kamya MR, Yeka A, Bukirwa H, Lugemwa M, Rwakimari JB, Staedke SG, et al. Artemether-lumefantrine versus dihydroartemisinin-piperaquine for treatment of malaria:A randomized trial. PLoS Clin Trials. 2007;2(5):e20.

Yeka A, Dorsey G, Kamya MR, Talisuna A, Lugemwa M. Artemether-Lumefantrine versus Dihydroartemisinin-Piperaquine for Treating Uncomplicated Malaria: A Randomized Trial to Guide Policy in Uganda. PLoS ONE. 2008;3(6):e2390.

Zongo I, Dorsey G, Rouamba N, Dokomajilar C, Se´re´ Y, Rosenthal PJ, et al. Randomized Comparison of Amodiaquine plus Sulfadoxine-Pyrimethamine, Artemether-Lumefantrine, and Dihydroartemisinin-Piperaquine for the Treatment of Uncomplicated Plasmodium falciparum Malaria in Burkina Faso. Clin Infect Dis. 2007;45:1453–61.

Ashley EA, McGready R, Hutagalung R, Phaiphun L, Slight T, Proux S, et al. A Randomized, Controlled Study of a Simple, Once- Daily Regimen of Dihydroartemisinin-Piperaquine for the Treatment of Uncomplicated, Multidrug- Resistant Falciparum Malaria. Clin Infect Dis. 2005;41:425–32.

Oduro AR, Wak G, Azongo D, Debpuur C, Wontuo P, Kondayire F, et al. Profile of the Navrongo Health and Demographic Surveillance System. Int J Epidemiol. 2012;41:968–76.

Awoonor-Williams JK, Sory EK, Nyonator FK, Phillips JF, Wang C. Lessons learned from scaling up a community-based health program in the Upper East Region of northern Ghana. Global Health. 2013;1:1.

Nyonator FK, Awoonor-Williams JK, Phillips JF, Jones TC, Miller RA. The Ghana Community-based Health Planning and Services Initiative for scaling up service delivery innovation. Health Policy Plan. 2005;20:25–34.

Onyango E, Ayodo G, Watsierah C, Were T, Okumu W, Anyona SB, et al. Factors associated with non-adherence to artemisinin-based combination therapy (ACT) to malaria in a rural population from holoendemic region of western Kenya. BMC Infect Dis. 2012;12:143.

Mace KE, Mwandama D, Jafali J, Luka M, Filler SJ, Sande J, et al. Adherence to Treatment With Artemether-Lumefantrine for Uncomplicated Malaria in Rural Malawi. Clin Infect Dis. 2011;53:772–9.

Mayxay M, Thongpraseuth V, Khanthavong M, Lindegardh N, Barends M, Keola S, et al. An open, randomized comparison of artesunate plus mefloquine vs. dihydroartemisinin–piperaquine for the treatment of uncomplicated Plasmodium falciparum malaria in the Lao People’s Democratic Republic (Laos). Tropical Med Int Health. 2006;11(8):1157–65.

Zwang J, Ashley EA, Karema C, D’Alessandro U, Smithuis F, Dorsey G, et al. Safety and Efficacy of Dihydroartemisinin-Piperaquine in Falciparum Malaria: A Prospective Multi-Centre Individual Patient Data Analysis. PLoS ONE. 2009;4(7):e6358.