The activities of amodiaquine, artesunate, and artesunate-amodiaquine against asexual-and sexual-stage parasites were evaluated in 360 Nigerian children with uncomplicated Plasmodium falciparum malaria randomized to the standard dose regimens of the three drugs/combination. Clinical recovery from illness occurred in all children. There were no significant differences in fever clearance times. Patients treated with artesunate or artesunate-amodiaquine had significantly shorter parasite clearance times (1.4 ؎ 0.5 days or 1.4 ؎ 0.6 days versus 3.2 ؎ 2.3 days, P ‫؍‬ 0.0001) and lower gametocyte carriage rates (3.3 or 1.7% versus 11.7%, P ‫؍‬ 0.001) than those treated with amodiaquine alone. Gametocytemia was detected in 62 patients (11.7% before treatment and 5.6% after treatment). The pretreatment gametocyte sex ratio, which was female biased, increased significantly during the course of treatment with amodiaquine but not with artesunate and artesunateamodiaquine. These results suggest that artesunate and artesunate-amodiaquine reduce gametocyte carriage and may reduce transmissibility in P. falciparum malaria by accelerating asexual clearance and influencing gametocyte sex ratio.

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Artemisinin‐based combination antimalarial therapy (ACTs), is still highly effective in uncomplicated falciparum malaria, however, there remain some concerns in relation to its safety and tolerability. Comorbid disease conditions may influence susceptibility to adverse drug reactions (ADRs) as the presence of multiple disease conditions may predisposes patients to ADRs due to the use of many medicines. There is therefore need to assess the impact of comorbidities on the ADR profile of malaria patients treated with ACTs. The study was carried out in health care facilities spread across Nigeria. From the database of over 10,000 patients recruited into an initial cohort, data for 1000 patients with comorbidities was extracted and matched with a control group of 1000 randomly selected patients with no comorbidity. There were 1105 adverse drug reactions in all, of which 66.2% were recorded in patients with comorbidity, and 34% are patients without comorbidity. The mean age of patients with comorbidities was 38.3 ± 17.5 years and 23.8 ± 17.2 for those without comorbidity. Out of the 979 patients with comorbidity, 36% were hypertensive, 2.2% hypertensive‐diabetes, 16.4% peptic ulcer disease, 10.4% HIV/AIDS, 4.4% diabetes and 4.3% were asthmatic. Patients with comorbidity were three times more likely to have adverse drug reaction than those without comorbidity (Odds ration = 2.96; 95% CI = 2.23–3.93). HIV/AIDS and osteoarthritis were significantly associated with development of adverse drug reactions. Probability was <0.0001. Age, weight, and height of patients were also found to be risk factor for development of adverse drug reactions.

The gametocyte sex ratio (proportion of gametocytes that are male) of Plasmodium falciparum may influence transmission. The distribution of P. falciparum sex ratios, the extent of inbreeding, the relationship between clone multiplicity and sex ratio, and the pre-and post-treatment factors influencing a sex ratio of 0.5 were determined in 1609 children, with acute malaria. Gametocytes were sexed by morphological appearance and asexual clone multiplicity was determined by polymerase chain reaction (PCR) using polymorphic loci of merozoite surface proteins-1 and -2 (MSP-1, MSP-2) and glutamine-rich protein (GLURP). The weighted mean population sex ratio on presentation in 162 gametocyte carriers was 0.22, that is, 3.5 female to 1 male (95% CI 0.15-0.28), with an estimated inbreeding rate (f) (the proportion of a mother's daughters that is fertilized by her sons) of 0.56 (95% CI 0.44-0.70). Sex ratio was significantly higher when clone multiplicity was >1 infecting clone than when it was 1 (P=0.02). The frequency of a pre-treatment sex ratio of 0.5 was low (3%), and was significantly increased by non-artemisinin but not by artemisinin -mono or combination -drugs by day 7 after therapy commenced (P=0. 03 and P=0.44, respectively). No factor was associated with a pre-treatment sex ratio of 0.5 but two factors were independent predictors of a sex ratio of 0.5 by day 7 after therapy commenced: an age ≥5 years and anaemia. These population data provide some empirical support for the predictions of local mate competition (LMC) theory and, in conjunction with effects of antimalarials on a sex ratio of 0.5, may have implications for malaria control efforts in endemic settings.