Malaria is a leading cause of morbidity and mortality among children in malaria-endemic areas. Artemisinin-based combination treatments (ACTs) are preferred for malaria, especially in malaria-endemic areas. The systematic review and meta-analysis were aimed to determine the efficacy and safety of ACTs in children with uncomplicated malaria. Until March 6, 2020, researchers searched a body of evidence for published ACT trials. The focus of the search was on ACT efficacy and safety trials in children with uncomplicated malaria. They used the endnote library to export the references screened by Covidence. They used the Covidence platform to extract the data. The efficacy per-protocol analysis report and the safety intention-to-treat analysis report were combined. They used the Open Meta-Analyst program to conduct the meta-analysis. The random-effects model was used, and the I2 statistic was used to assess study heterogeneity.
The total number of studies included in the final analysis was nineteen. For days 28 and 42, the crude, PCR-corrected P. falciparum malaria treatment success rate was 96.3% and 93.9%, respectively. The PCR-corrected adequate clinical and parasitological response (ACPR) of dihydroartemisinin-piperaquine (DP) was 99.6% (95% CI: 99.1 to 100%, I2 = 0%; 4 studies) at day 28 and 99.6% (95% CI of 99 to 100%, I2 = 0%; 3 studies) at day 42 in the subgroup analysis. A total of 9 trials (8.3%, 356/4304) identified ACT-related adverse drug reactions (ADR). The percentage of people who had drug-related side effects ranged from 1.8% in DP (two studies) to 23.3% in artesunate-pyronaridine (AP). The most prevalent ACT-related side effects were gastrointestinal problems, and all ADRs disappeared spontaneously. The crude effectiveness and tolerability of ACTs against P. falciparum were both high. The excellent treatment effectiveness and tolerability of DP, combined with minimal heterogeneity, has implications for policymakers considering using ACTs in pediatrics uncomplicated falciparum malaria treatment.