Effectiveness of quinine versus artemether-lumefantrine for treating uncomplicated falciparum malaria in Ugandan children: randomised trial

Achan, Jane; Tibenderana, James; Kyabayinze, Daniel J; Mangen, Fred Wabwire; Kamya, Moses R.; Dorsey, Grant; D’Alessandro, Umberto; Rosenthal, Philip J.; Talisuna, Ambrose

doi:10.1136/bmj.b2763

Cited by 84 publications

(106 citation statements)

References 33 publications

(41 reference statements)

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“…20,22,23,25,26,29,31,32 The other studies enrolled adults or patients at all ages. [17][18][19]21,24,27,28,30 In 14 studies (87.5%), the patients were infected with falciparum malaria [18][19][20][21][22][23][24][25][26][27][28][29]31,32 and the remaining studies used patients with vivax malaria. 17,30 Six studies (37.5%) used chloroquine, [20][21][22][23][24][25] five studies (31.2%) used artemisinin-based combination therapy (ACT).…”

Section: Resultsmentioning

confidence: 99%

“…Out of the 1,813 potential articles, 16 fulfilled the inclusion criteria ( Figure 1) [17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32] and comprised a total of 9,247 patients. Of these, two studies included two different interventions.…”

Section: Resultsmentioning

confidence: 99%

“…18,22 Studies were published from 1998 to 2011. Ten studies (62.5%) were undertaken in Africa [20][21][22][23][24][25][26]29,31,32 and the remainder were set in Asia. [17][18][19]27,28,30 All the studies were based in the public healthcare sectors (12 in a hospital 17,19 -22,24 -31 and 4 in a community setting) 18,23,25,32 but one study also included a group from the private sector.…”

Section: Resultsmentioning

confidence: 99%

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Intervention to Promote Patients' Adherence to Antimalarial Medication: A Systematic Review

Fuangchan

Dhippayom

Kongkaew³

2014

The American Journal of Tropical Medicine and Hygiene

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Abstract. Non-adherence as a major contributor to poor treatment outcomes. This study aimed to explore the effectiveness of existing interventions promoting adherence to antimalarial drugs by systematic review. The following databases were used to identify potential articles: MEDLINE, EMBASE, the Cochrane CENTRAL, and CINAHL (through March 2013). From 1,813 potential papers identified, 16 studies met the selection criteria comprising 9,247 patients. Interventions were classified as packaging aids, visual media, combined visual media and verbal information, community education, medication supervision, and convenient regimen. These interventions were shown to increase adherence to antimalarial drugs (median relative risk = 1.4, interquartile range 1.2-2.0). Although a most effective intervention did not emerge, community education and visual media/verbal information combinations may well have most potential to improve adherence to antimalarial medication. These interventions should be implemented in combination to optimize their beneficial effects. The current understanding on improved adherence would facilitate to contain outbreaks of malaria cost effectively.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Intervention to Promote Patients' Adherence to Antimalarial Medication: A Systematic Review

Fuangchan

Dhippayom

Kongkaew³

2014

The American Journal of Tropical Medicine and Hygiene

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“…1 To date, resistance to QN remains particularly patchy and rare, [2][3][4][5][6][7][8][9][10][11][12] and only few cases of clinical failure have been reported in Asia and South America. The mechanism underlying QN resistance is not well-understood, and it is probably complex and multigenic.…”

mentioning

confidence: 99%

Plasmodium falciparum Na+/H+ Exchanger (pfnhe-1) Genetic Polymorphism in Indian Ocean Malaria-Endemic Areas

Andriantsoanirina

Khim²,

Ratsimbasoa³

et al. 2013

The American Journal of Tropical Medicine and Hygiene

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Abstract. To date, 11 studies conducted in different countries to test the association between Plasmodium falciparum Na + /H + exchanger gene ( pfnhe-1; PF13_0019) polymorphisms and in vitro susceptibility to quinine have generated conflicting data. In this context and to extend our knowledge of the genetic polymorphism of Pfnhe gene, we have sequenced the ms4760 locus from 595 isolates collected in the Comoros (N = 250; an area with a high prevalence of chloroquine and sulfadoxine-pyrimethamine resistance) and Madagascar (N = 345; a low drug-resistance area). Among them, 29 different alleles were observed, including 8 (27%) alleles not previously described. Isolates from the Comoros showed more repeats in block II (DNNND), which some studies have found to be positively associated with in vitro resistance to quinine, compared with isolates from Madagascar. Additional studies are required to better define the mechanisms underlying quinine resistance, which involve multiple gene interactions.Quinine (QN), a natural quinoline derivative compound found in Cinchona bark, has been used for centuries in malaria-endemic regions.1 To date, resistance to QN remains particularly patchy and rare, 2-12 and only few cases of clinical failure have been reported in Asia and South America. The mechanism underlying QN resistance is not well-understood, and it is probably complex and multigenic. Since the seminal work by Ferdig and others 13 in 2004, 11 studies have been conducted in different countries to evaluate implication of ms4760 polymorphisms in QN resistance, [14][15][16][17][18][19][20][21][22][23][24] and conflicting data have been reported, likely because of the different geographical origin of parasites (implying different genetic backgrounds), the type of parasites used (fresh isolates, culture-adapted strains, and reference lines), and the method used to assess in vitro QN susceptibility. 21,25 In this context and to extend our previous work regarding ms4760 polymorphisms in Plasmodium falciparum parasites circulating in malaria-endemic areas in the Indian Ocean, Parasite DNA was extracted from blood spots with Instagene matrix (Bio-Rad, Marnes la Coquette, France) according to the manufacturer's instructions or directly from 100 μL infected blood by the phenol-chloroform method. 26The parasite species was confirmed by real-time polymerase chain reaction (PCR) as described in the work by Mangold and others.27 Amplification and sequencing of the ms4760 locus in the P. falciparum Na + /H + exchanger gene (pfnhe-1) was performed in accordance with the protocol described earlier.14 pfnhe-1 ms4760 alleles were constructed from a full sequence presenting an unambiguous single-allele signal at all positions and used P. falciparum 3D7 (sodium/hydrogen exchanger, Na + , H + antiporter, PF13_0019, XM_001349726) as the reference.Genetic diversity was assessed by Nei's unbiased expected heterozygosity (H e ) from haploid data and calculated as H e = [n/(n -1)][1 − p i ] (n = the number of isolates sampled; p i = the frequency o...

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“…Majority of the patients with uncomplicated malaria were prescribed an Artemesinin based Combination Therapy (ACT), precisely Artemether Lumefantrine (AL), which is the recommended first line therapy for uncomplicated malaria in Uganda [10]. This is an encouraging finding given the high burden of malaria in many parts of the country and the efficacy of ACTs for uncomplicated malaria [13]- [16].…”

Section: Discussionmentioning

confidence: 90%

Anti-Malarial Targeting and Dosing Practices among Health Workers at Lower Level Health Facilities in Uganda

Kakeeto¹,

Wanzira²,

Karyeija³

et al. 2014

Health

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Background: Health worker shortages remain a significant challenge to delivery of health care services globally. Moving tasks, where appropriate, to less specialized health workers is recommended by the World Health Organization as a strategy to address this challenge. However, this concept is feared to raise specific quality concerns. This research aimed at assessing the performance of health workers to correctly prescribe (target) appropriate antimalarial treatment. Methods: We conducted a cross sectional study at three public health centre IVs in Uganda, with varying malaria transmission intensities (Kihihi-low, Kasambya-medium and Nagongera-high). We categorized prescribers into two groups: specialized prescribers (doctors and clinical officers) and less specialized prescribers (nurses and midwives). At each site, 100 records of patients seen between September and November 2011 and prescribed an antimalarial were retrieved for each group of prescribers. Correctness of the antimalarial drug prescribed and dose given were assessed for each group and compared to the 2005 Uganda national malaria treatment guidelines which recommend Artemether Lumefantrine (AL) for treatment of uncomplicated malaria and Quinine for complicated malaria. Results: Findings of the study showed that specialized health workers were more likely to target correctly as compared to the less specialized health workers [OR = 1.49 (1.00 -2.22), p = 0.046]. Appropriateness of dosing was higher among specialized prescribers compared to less specialized prescribers however this was not significant [OR = 1.58

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Effectiveness of quinine versus artemether-lumefantrine for treating uncomplicated falciparum malaria in Ugandan children: randomised trial

Cited by 84 publications

References 33 publications

Intervention to Promote Patients' Adherence to Antimalarial Medication: A Systematic Review

Intervention to Promote Patients' Adherence to Antimalarial Medication: A Systematic Review

Plasmodium falciparum Na+/H+ Exchanger (pfnhe-1) Genetic Polymorphism in Indian Ocean Malaria-Endemic Areas

Anti-Malarial Targeting and Dosing Practices among Health Workers at Lower Level Health Facilities in Uganda

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