Global malaria control is threatened by the spread of antimalarial drug resistance.  Combination antimalarial regimens offer hope for improving treatment outcomes and delaying development of drug resistance.  Currently, data on the use of such regimens in Africa is limited.  Uganda Malaria Surveillance Project (UMSP) has conducted trials of antimalarial treatment at diverse sentinel sites around Uganda. Our studies have led to over 20 publications and have impacted on the management of malaria in Africa. We are linked with the East African Network for Monitoring Antimalarial Treatment (EANMAT) in a region-wide malaria surveillance and control effort.

Results of UMSP antimalarial drug surveillance studies.

Year and reference	Study site	Duration of follow-up	Treatment arms*	Number enrolled	Risk of treatment failure
					Unadjusted by genotyping	Adjusted by genotyping
2003	Kyenjojo	28 days	CQ+SP AQ+SP	175 190	74% 43%	34% 16%
2003	Mubende	28 days	CQ+SP AQ+SP	193 180	76% 47%	37% 13%
2003	Kanungu	28 days	CQ+SP AQ+SP	177 190	85% 55%	64% 32%
2003	Kampala	28 days	CQ+SP AQ+SP AQ+AS	132 134 134	60% 18% 18%	40% 9% 3%
2003	Jinja	28 days	CQ+SP AQ+SP AQ+AS	168 186 189	63% 29% 19%	39% 13% 4%
2004	Apac	28 days	CQ+SP AQ+SP AQ+AS	185 183 174	67% 37% 54%	25% 7% 11%
2004	Tororo	28 days	CQ+SP AQ+SP AQ+AS	166 181 194	88% 61% 75%	37% 19% 13%
2004	Arua	28 days	CQ+SP AQ+SP AQ+AS	180 180 174	87% 53% 51%	51% 14% 8%
2005	Tororo	28 days	AQ+AS AL	204 204	66% 52%	4% 7%
2006	Kampala	28 days	AQ+SP AQ+AS AL	253 232 202	26% 17% 7%	14% 5% 1%
2006	Apac	42 days	AL DP	210 211	53% 43%	16% 7%
2007	Kanungu	42 days	AL DP	199 215	33% 12%	6% 2%
2008	Tororo	28 days	AL DP	320 315	35% 11%	1.0% 0.3%

                               
Ongoing studies.

1. Evaluation of 3 artemisinin-based combinations for treating uncomplicated malaria in African children. The main objective is to compare the safety and efficacy of 3 ACT’s (DP, AL and CDA) for single and repeat treatments of uncomplicated malaria in children. The studies are being conducted in Jinja and Tororo and recruited a total of 1340 subjects.

2. Evaluation of the best approach to retreating patients with recurrent malaria within 28 days of initial therapy with ACT’s. This is an evaluation of rescue therapy among patients who develop recurrent malaria within 28 days of treatment with ACT’s in a related main study. Patients who develop recurrent uncomplicated malaria after day 3 of   active follow up of the main study are recruited and randomized to either quinine or another ACT regimen (AL to quinine or DP, CDA to quinine, AL or DP, DP to quinine or AL) and followed for 28 days to assess their response to therapy. The study is being conducted in Tororo. A total of 260 subjects shall be recruited.

3. A randomised study to compare a fixed dose combination of artesunate plus amodiaquine versus a fixed dose combination of artemether plus lumefantrine in treatment of repeated uncomplicated Plasmodium falciparum malaria attacks occurring during 2 years of follow-up, in children in Uganda. The study is ongoing at Tororo. A cohort of 400 children were recruited and are being followed up.

4. Effectiveness of oral quinine and Artemether-Lumefantrine in the treatment of un-complicated falciparum malaria in Ugandan children: The study was conducted at Kampala.