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Is parasite clearance clinically important after malaria treatment in a high transmission area? A 3-month follow-up of home-based management with herbal medicine or ACT

Is parasite clearance clinically important after malaria treatment in a high transmission area? A 3-month follow-up of home-based management with herbal medicine or ACT
Is parasite clearance clinically important after malaria treatment in a high transmission area? A 3-month follow-up of home-based management with herbal medicine or ACT
Argemone mexicana (AM), a validated herbal medicine for uncomplicated malaria, seems to prevent severe malaria without completely clearing parasites in most patients. This study, in a high transmission area of South Mali, explores whether residual parasitaemia at day 28 was associated with subsequent malaria episodes and/or anaemia.

Three hundred and one patients were randomly assigned to AM or artesunate/amodiaquine as first line treatment, of whom 294 were followed up beyond the standard 28 days, to 84 days. From day 29 to day 84, there were no significant differences between treatment groups in new clinical episodes of uncomplicated malaria (0.33 vs 0.31 episodes/patient), severe malaria (<6% per month of patients aged ?5 years) or moderate anaemia (hematocrit <24%: 1.1% in both groups at day 84). Total parasite clearance at day 28 was not correlated with incidence of uncomplicated or severe malaria or of moderate anaemia over the subsequent two months.

Total parasite clearance at day 28 was not clinically important in the context of high transmission. If this finding can be confirmed, some antimalarials which are clinically effective but do not completely clear parasites could nevertheless be appropriate in high transmission areas. Such a policy could be tested as a way to delay resistance to artemisinin combination therapies.
0035-9203
23-31
Willcox, Merlin L.
18b6a754-da99-4f3b-aba1-6283941fbabb
Graz, Bertrand
33383bb4-8763-40bc-8e09-a045934a536e
Diakite, Chiaka
cf299e12-48cd-4591-bcc3-21a54e84e740
Falquet, Jacques
9a176245-1ffc-4b6d-8f44-357a23f6ec42
Dackouo, Florent
6fcda131-2a54-4387-8817-6084932e1d12
Sidibe, Oumar
66dea828-1aa1-473b-9466-10ad65dd25a9
Giani, Sergio
6799c9d9-04b2-46fd-8593-b89f56844b0b
Diallo, Drissa
39a791e4-1b09-4733-b9c1-693fc53188eb
Willcox, Merlin L.
18b6a754-da99-4f3b-aba1-6283941fbabb
Graz, Bertrand
33383bb4-8763-40bc-8e09-a045934a536e
Diakite, Chiaka
cf299e12-48cd-4591-bcc3-21a54e84e740
Falquet, Jacques
9a176245-1ffc-4b6d-8f44-357a23f6ec42
Dackouo, Florent
6fcda131-2a54-4387-8817-6084932e1d12
Sidibe, Oumar
66dea828-1aa1-473b-9466-10ad65dd25a9
Giani, Sergio
6799c9d9-04b2-46fd-8593-b89f56844b0b
Diallo, Drissa
39a791e4-1b09-4733-b9c1-693fc53188eb

Willcox, Merlin L., Graz, Bertrand, Diakite, Chiaka, Falquet, Jacques, Dackouo, Florent, Sidibe, Oumar, Giani, Sergio and Diallo, Drissa (2011) Is parasite clearance clinically important after malaria treatment in a high transmission area? A 3-month follow-up of home-based management with herbal medicine or ACT. Transactions of the Royal Society of Tropical Medicine and Hygiene, 105 (1), 23-31. (doi:10.1016/j.trstmh.2010.10.003).

Record type: Article

Abstract

Argemone mexicana (AM), a validated herbal medicine for uncomplicated malaria, seems to prevent severe malaria without completely clearing parasites in most patients. This study, in a high transmission area of South Mali, explores whether residual parasitaemia at day 28 was associated with subsequent malaria episodes and/or anaemia.

Three hundred and one patients were randomly assigned to AM or artesunate/amodiaquine as first line treatment, of whom 294 were followed up beyond the standard 28 days, to 84 days. From day 29 to day 84, there were no significant differences between treatment groups in new clinical episodes of uncomplicated malaria (0.33 vs 0.31 episodes/patient), severe malaria (<6% per month of patients aged ?5 years) or moderate anaemia (hematocrit <24%: 1.1% in both groups at day 84). Total parasite clearance at day 28 was not correlated with incidence of uncomplicated or severe malaria or of moderate anaemia over the subsequent two months.

Total parasite clearance at day 28 was not clinically important in the context of high transmission. If this finding can be confirmed, some antimalarials which are clinically effective but do not completely clear parasites could nevertheless be appropriate in high transmission areas. Such a policy could be tested as a way to delay resistance to artemisinin combination therapies.

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More information

Accepted/In Press date: 4 October 2010
Published date: January 2011
Organisations: Primary Care & Population Sciences

Identifiers

Local EPrints ID: 403766
URI: http://eprints.soton.ac.uk/id/eprint/403766
ISSN: 0035-9203
PURE UUID: 12bb5653-fa3c-4959-abd8-f201aa7da706

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Date deposited: 09 Dec 2016 15:34
Last modified: 15 Mar 2024 03:50

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Contributors

Author: Merlin L. Willcox
Author: Bertrand Graz
Author: Chiaka Diakite
Author: Jacques Falquet
Author: Florent Dackouo
Author: Oumar Sidibe
Author: Sergio Giani
Author: Drissa Diallo

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