Effectiveness of Injectable Artesunate Versus Quinine in The Treatment of Severe Malaria in Children Aged 0-59 Months in Kenge, DRC

Malaria Threatens globally the lives of 3.3 trillion people living in 109 countries. This study compares the effectiveness avocation to of the drug artesunate versus quinine That of in the treatment of severe malaria Among the children of less than 59 months. For That reason, a survey and quantitative cross-sectional analysis has documentary Were Conducted one year based design to suit les explanatory correlation has entre les drugs and the rate of malaria treatment. A sample size of 380 children Was selected from the City of Kenge, half of Whom Were Treated with artesunate (190 children) and the other half with quinine (190 children). Results indicate indication at 5% significance level That 59% of patients Treated with artesunate drug Had a drop in temperature During the first day of treatment contre 49.5% Treated with drug quinine. The cure rate Was Observed 88. 9% for the artesunate group versus 83.7% for the quinine group. The death rate Was Established at 7.9% for the quinine group contre 1.1% for the artesunate group. Finally, a correlation Was Established entre les kind of treatment, parasitaemia at the start of the treatment, the adjuvant treatment, the Evolution of clinical signs During treatment, the final assessment, and the treatment effectiveness.


Introduction
Malaria is a major public health problem that threatens 3.3 billion people in 109 countries around the world, especially in Sub-Saharan Africa, with high mortality, in the order of 1 death every 30 seconds in children under 5 years old. Its socio-economic impact is in the billions of dollars [1]. While the entire population seems to be at risk of infection, children under 5 years and pregnant women are the most affected [2]. In the Democratic Republic of Congo (DRC), malaria is a major public health problem. It is the leading cause of

Literature paper
Malaria treatment still pose serious difficulties. Several classes of products have successively emerged, each with its advantages and disadvantages, but the range of drugs remains narrow for the discovery of new malaria seems laborious [5]. Despite these advances in malaria surveillance and treatment availability, some people worry that it will take to adopt "radical measures" to curb forms of malaria resistant to drugs and prevent that history has proven to be intercontinental deadly spread [6]. Antimalarial drug resistance is a real public health impact. Individually, treatment failures it generates increase malaria mortality [7]. Moreover, the persistence of parasites in the blood increases the risk of severe anemia and consequently the frequency of blood transfusions with all the risks that entails. Collectively, the resistors increase the level of malaria transmission, which raises the number of accesses and therefore the cost of consultations per patient. The development of resistance of Plasmodium falciparum to amino-4-quinoléites and its rapid spread throughout the malarious areas of the world quickly revealed the need to consolidate the policies against malaria. The distribution of known resistance to other antimalarial drugs and decreased sensitivity to quinine has prompted the development of new molecules with antimalarial activity. The development of these antimalarial substances was based on extensive studies of traditional pharmacopoeia [8].
Experts from Public Health and scientists fear that the third wave of resistance to antimalarial history spreads in Asia and Africa if "radical measures" are not adopted quickly. The presence of strains resistant to artemisinin on Thailand-Cambodia border threatens indeed the effectiveness of treatment and poses challenges regarding the containment of the disease. Resistance has also been associated with the use of counterfeit drugs, poor quality or unregulated migration and unusual genetic structure of malaria parasites found in western Cambodia [6]. At present, the resistance thresholds in several major antimalarials (quinine, amodiaquine, artemisinin, mefloquine, lumefantrine) remain undefined. Quinine is still today the standard treatment for severe malaria falciparum worldwide [9]. If one is striving to recommendations WHO (2014), One can readily say that the effectiveness of the injectable artemisinin would be higher than quinine in terms of the treatment of severe malaria. Factors related to patients' behavior such as the observance of medical prescriptions, self-medication, factors

Sampling Method and Techniques Data Collection
This study is based on data collected during a period from 01 January to 31 December 2016, after a cross quantitative survey correlational explanatory quotes and literature review.   The chi-square statistic (Khi2) was tested at the 5% significance level (p = 0.05) using the SPSS 12.0 software and MS Excel 2010.

Profile of The Surveyed Patients
The results in Table 1 Figure   1. It is apparent from Table 2 that in the parasitemia quinine group is characterized by a TDR much more positive (78.9% of cases) followed by positive thick smear (GE +) (12.6% of cases) and GE and TDR + (4.2%). TDR negative and negative GE were not significant respectively 6 and 2 cases out of 190, representing 3.2% and 1.1%.
From the group of artesunate, the parasitemia was characterized by positive GE (83.7% of cases) followed by the TDR positive (8.4%) and the negative GE (7.9%). No cases of TDR negative were recorded in patients treated with artesunate.  Source : Authors (2017)

Factors Related to Medication Taken by Patients
Regarding the adjuvant,  Table 4 shows   Furthermore, the assessment of non-effectiveness revealed 0.5% inefficiency for the group of artesunate and 10.5% inefficiency for the group of quinine Figure 2. In conclusion, the administration of artesunate contribute more effectively and efficiently in the treatment of severe malaria or severe malaria.

Discussion of The Therapeutic Efficacy of The Treatment of Severe Malaria
The first objective of this study was to determine the therapeutic efficacy of artesunate vis-à-vis the quinine in the treatment of in artemether and between 24 and 64 hours (with a confidence interval 42.4 ± 9.7) as quinine. The study notes a significant gain of 7.8 hours (p = 0.0004) in patients receiving artemether [11][12][13].
In his study on the efficacy of artemether versus that of quinine in the treatment of severe malaria in children in Rwanda

Discussion of Factors Associated with Treatment Effectiveness
The other objective of this study was to identify factors asso- were transfused (28.5%) before being cured [18][19][20].

Conclusion
At present, the malaria resistance thresholds in several major antimalarials (quinine, amodiaquine, artemisinin, mefloquine, lumefantrine) still remain to be defined. The recommendations of WHO (2014) on the introduction of injectable artesunate molecule in the first line treatment of severe malaria instead of quinine infusion was widely followed. The question is whether this regimen can be considered effective after a consistent evaluation of different parameters leading to such efficiency. This study had to compare the efficacy of injectable artemisinin than quinine in the treatment of severe malaria in children under 5 years to identify factors associated with effectiveness. From the above, we can confirm that artesunate is more effective than quinine. The healing gain obtained with artesunate was 5.2% and the risk of death in a treatment quinine was 6.8% higher. Moreover, the hospital stay is shorter with artesunate rather than quinine. The study also demonstrated that the addition of a drug (antipyretic or antibiotic or blood transfusion) would improve patient health. These results are consistent with several studies previously conducted in Africa, America, Asia and Europe available in the review of the international literature.