Comprehensive case management of malaria: Operational research informing policy.

In 2013, the Odisha state Vector Borne Disease Control Programme led a five year operational research project, under programmatic conditions, in close collaboration with several partners. This Comprehensive Case Management Project covered a population of 900,000 across paired control and intervention blocks in four districts, each with different transmission intensities. Key gaps in access to malaria services were identified through household surveys and a detailed situation analysis. The interventions included ensuring adequate stocks of rapid diagnostic tests and antimalarial drugs at the village level, the capacity building of health workers and ASHAs, setting up microscopy centres at the primary health care level, and conducting mass screening and treatment in poorly accessible areas. The programme strengthened the routine health system, and improved malaria surveillance as well as the access to and quality of care. Initially, the programme led to increased case reporting due to improved detection, followed by a decline in malaria incidence. Lessons from the project were then scaled up statewide in the form of a new initiative-Durgama Anchalare Malaria Nirakaran (DAMaN).

Optimal dose finding for novel antimalarial combination therapy.

A recent discussion meeting convened by the Medicines for Malaria Venture examined how best to manage the discovery and preclinical pipeline to achieve novel combination therapies which would address the key clinical needs in malaria. It became clear that dose optimisation of components within combination therapy was a key issue in achieving antimalarial efficacy and for preserving that efficacy against parasite resistance emergence. This paper outlines some of the specific issues in malaria that cause dose-ranging and dose-optimisation studies to be particularly challenging and discusses the potential of factorial study design to address such challenges.

Efficacy and safety of artemether in the treatment of severe end complicated malaria in mali.

We compared the efficacy and safety of artemether versus Quinine in 67 children from 3 months to 15 years old hospitalised for severe and complicated in the pediatric service of Gabriel Touré's Hospital Children were randomised to receive artemether or quinine. Artemether was given at 3,2mg/kg in day 1 (two times) and 1; 6mg single dose from day 2 to day5) and quinine was administrated at 20mg/kg (attack dose) followed by 10mg/kg every 8 hours until oral drug administration (10 mg/kg every 8 hours). The treatment for artemether lasted 5 days while quinine treatment lasted 7 day. Thirty tree and 34 children received respectively artemether and quinine. Two groups were comparable with baseline characteristics. Cerebral malaria was most frequent in the two with no statistical difference. Seventy height percent in artemether group compared to 82,4% in quinine group. No statistical difference was found between groups regarding parameters such as : Parasitic clearance, thermal clearances, delay of exit of the coma, upsurge, tolerance, and mortality. Artemether is as efficacious and well safe as quinine for the treatment of sevese and complicated malaria.

[Comparative study of artemether and quinine in severe Plasmodium falciparum malaria in adults and older children in Cameroon]. / Essai comparatif de l'artéméther et de la quinine dans le paludisme grave à Plasmodium falciparum de l'adulte et du grand enfant au Cameroun.

From June 1993 to June 1994, a study was carried out to compare artemether and quinine for management of severe falciparum malaria in adults and adolescents in Cameroon. Artemether was administered intramuscularly at a dose of 3.6 mg/kg on the first day and 1.6 mg/kg for the following 4 days. Quinine was administered intravenously at a dose of 1.6 mg/kg for the first 4 hours and 8 mg every 8 hours for the next 3 days. The files of 84 of the 95 patients recruited were validated for inclusion in the final study. There were 40 patients in the artemether group and 44 in the quinine group. The two groups were comparable with regard to all factors at the time of inclusion. Findings showed that artemether was more effective than quinine with regard to total clearance of parasitemia, 90 p. 100 clearance, and fever control and that it was as effective with regard to 50 p. 100 clearance and recovery of consciousness. In view of its good performance and of the simplicity of its administration by intramuscular injection, artemether would appear to be an excellent alternative for treatment of severe malaria and cerebral malaria in areas with poor medical facilities.