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Arena L, Zanamwe M, Halleux CM, Carrara V, Angus BJ, Ariana P, Humphreys GS, Richmond C, Stepniewska K, Guérin PJ, Olliaro PL. Malaria patient spectrum representation in therapeutic clinical trials of uncomplicated malaria: a scoping review of the literature. Malar J 2023; 22:50. [PMID: 36765317 PMCID: PMC9913008 DOI: 10.1186/s12936-023-04441-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 01/03/2023] [Indexed: 02/12/2023] Open
Abstract
BACKGROUND For the results of clinical trials to have external validity, the patients included in the study must be representative of the population presenting in the general clinical settings. A scoping literature review was performed to evaluate how the eligibility criteria used in anti-malarial efficacy and safety trials translate into patient selection. METHODS A search of the WorldWide Antimalarial Resistance Network (WWARN) Clinical Trials Publication Library, MEDLINE, The Cochrane Library, and clinicaltrials.gov was conducted to identify trials investigating anti-malarial efficacy and safety, published between 14th April 2001 and 31st December 2017. An updated search using the WWARN Clinical Trial Publication Library was undertaken to identify eligible publications from 1st January 2018 to 31st July 2021. The review included studies in patients of any age with uncomplicated malaria and any pharmaceutical therapeutic intervention administered. The proportion of trials with malaria-positive patients excluded was calculated and linked to the reported reason for exclusion. A subgroup analysis on eligibility criteria and trial baseline demographics was conducted to assess whether criteria are complied with when recruiting patients. RESULTS Out of 847 studies, 176 (21%) trials were included in the final synthesis, screening a total of 157,516 malaria-positive patients, of whom 56,293 (36%) were enrolled and treated. Across the 176 studies included, 84 different inclusion and exclusion criteria were identified. The reason for exclusion of patients who tested positive for malaria was reported in 144 (82%) studies. Three criteria account for about 70% of malaria-positive patients excluded: mixed-species malaria infections or other specific Plasmodium species, parasite counts outside the set study ranges, and refusal of consent. CONCLUSIONS Nearly two-thirds of the malaria-positive subjects who present to health facilities are systematically excluded from anti-malarial treatment trials. Reasons for exclusions are largely under-reported. Anti-malarial treatment in the general population is informed by studies on a narrow selection of patients who do not fully represent the totality of those seeking antimalarial treatment in routine practice. While entry criteria ensure consistency across trials, pragmatic trials are also necessary to supplement the information currently available and improve the external validity of the findings of malaria clinical trials.
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Affiliation(s)
- Lorenzo Arena
- grid.4991.50000 0004 1936 8948Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK ,WorldWide Antimalarial Resistance Network (WWARN), Oxford, UK ,grid.499581.8Infectious Diseases Data Observatory (IDDO), Oxford, UK
| | - Mazvita Zanamwe
- grid.4991.50000 0004 1936 8948Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Christine M. Halleux
- grid.3575.40000000121633745Special Programme for Research and Training in Tropical Diseases (TDR), World Health Organization (WHO), Geneva, Switzerland
| | - Verena Carrara
- WorldWide Antimalarial Resistance Network (WWARN), Oxford, UK ,grid.499581.8Infectious Diseases Data Observatory (IDDO), Oxford, UK ,grid.8591.50000 0001 2322 4988Institute of Global Health, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Brian J. Angus
- grid.4991.50000 0004 1936 8948Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Proochista Ariana
- grid.4991.50000 0004 1936 8948Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Georgina S. Humphreys
- WorldWide Antimalarial Resistance Network (WWARN), Oxford, UK ,grid.499581.8Infectious Diseases Data Observatory (IDDO), Oxford, UK
| | - Caitlin Richmond
- grid.4991.50000 0004 1936 8948Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK ,WorldWide Antimalarial Resistance Network (WWARN), Oxford, UK ,grid.499581.8Infectious Diseases Data Observatory (IDDO), Oxford, UK
| | - Kasia Stepniewska
- grid.4991.50000 0004 1936 8948Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK ,WorldWide Antimalarial Resistance Network (WWARN), Oxford, UK ,grid.499581.8Infectious Diseases Data Observatory (IDDO), Oxford, UK
| | - Philippe J. Guérin
- grid.4991.50000 0004 1936 8948Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK ,WorldWide Antimalarial Resistance Network (WWARN), Oxford, UK ,grid.499581.8Infectious Diseases Data Observatory (IDDO), Oxford, UK
| | - Piero L. Olliaro
- grid.4991.50000 0004 1936 8948Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK ,grid.4991.50000 0004 1936 8948ISARIC Global Support Centre, International Severe Acute Respiratory and Emerging Infection Consortium, Pandemic Sciences Institute, University of Oxford, Oxford, UK
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Mahano AO, Mahano AZ, Cubaka NH, Kasali FM, Zirirane BB, Namegabe LM, Hamuli PM, Kadima NJ. Pharmaceutical quality of antimalarial drugs: quinine sulfate and Artemether/Lumefantrine tablets sold on Bukavu Market. FUTURE JOURNAL OF PHARMACEUTICAL SCIENCES 2021. [DOI: 10.1186/s43094-021-00290-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Generic antimalarial drugs sold in sub-Saharan Africa require tighter control as counterfeiting has grown more and more out of control. The study aimed to analyze the pharmaceutical quality of quinine sulfate (QS) and Artemether/Lumefantrine(AL) tablets marketed in Bukavu city compared to the current trends in other African cities.
Results
The samples were purchased in community pharmacies or from ambulatory street vendors and analyzed using a set of thirteen simple tests, including visual inspection, UV spectrometry, TLC, and conventional quality control procedures. More than 93% of AL samples had an acceptable global quality score of > 90%. Around 16.6% of QS batches did not satisfy the requirements about hardness, friability, and mass uniformity. Only 33.3% met the disintegration quality; 33.3% did not contain quinine; 8.33% had an active ingredient other than quinine.
Conclusion
The findings strongly alert the circulation of fake antimalarial medicines observed in many countries. Simple TLC procedures may help to detect any low-quality generics to avoid microbial resistance and guarantee the health of the population. Pharmacists and regulatory authorities are alerted to the circulation of low-quality generic quinine preparations in the country.
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3
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Ohmann C, Moher D, Siebert M, Motschall E, Naudet F. Status, use and impact of sharing individual participant data from clinical trials: a scoping review. BMJ Open 2021; 11:e049228. [PMID: 34408052 PMCID: PMC8375721 DOI: 10.1136/bmjopen-2021-049228] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES To explore the impact of data-sharing initiatives on the intent to share data, on actual data sharing, on the use of shared data and on research output and impact of shared data. ELIGIBILITY CRITERIA All studies investigating data-sharing practices for individual participant data (IPD) from clinical trials. SOURCES OF EVIDENCE We searched the Medline database, the Cochrane Library, the Science Citation Index Expanded and the Social Sciences Citation Index via Web of Science, and preprints and proceedings of the International Congress on Peer Review and Scientific Publication. In addition, we inspected major clinical trial data-sharing platforms, contacted major journals/publishers, editorial groups and some funders. CHARTING METHODS Two reviewers independently extracted information on methods and results from resources identified using a standardised questionnaire. A map of the extracted data was constructed and accompanied by a narrative summary for each outcome domain. RESULTS 93 studies identified in the literature search (published between 2001 and 2020, median: 2018) and 5 from additional information sources were included in the scoping review. Most studies were descriptive and focused on early phases of the data-sharing process. While the willingness to share IPD from clinical trials is extremely high, actual data-sharing rates are suboptimal. A survey of journal data suggests poor to moderate enforcement of the policies by publishers. Metrics provided by platforms suggest that a large majority of data remains unrequested. When requested, the purpose of the reuse is more often secondary analyses and meta-analyses, rarely re-analyses. Finally, studies focused on the real impact of data-sharing were rare and used surrogates such as citation metrics. CONCLUSIONS There is currently a gap in the evidence base for the impact of IPD sharing, which entails uncertainties in the implementation of current data-sharing policies. High level evidence is needed to assess whether the value of medical research increases with data-sharing practices.
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Affiliation(s)
- Christian Ohmann
- European Clinical Research Infrastructure Network, Paris, France
| | - David Moher
- Ottawa Methods Centre, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Maximilian Siebert
- CHU Rennes, CIC 1414 (Centre d'Investigation Clinique de Rennes), University Rennes, Rennes, France
| | - Edith Motschall
- Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center - University of Freiburg, Freiburg, Baden-Württemberg, Germany
| | - Florian Naudet
- CHU Rennes, INSERM CIC 1414 (Centre d'Investigation Clinique de Rennes), University Rennes, Rennes, Bretagne, France
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4
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Plucinski MM, Hastings IM, Moriarty LF, Venkatesan M, Felger I, Halsey ES. Variation in Calculating and Reporting Antimalarial Efficacy against Plasmodium falciparum in Sub-Saharan Africa: A Systematic Review of Published Reports. Am J Trop Med Hyg 2021; 104:1820-1829. [PMID: 33724925 PMCID: PMC8103451 DOI: 10.4269/ajtmh.20-1481] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 01/16/2021] [Indexed: 12/11/2022] Open
Abstract
Antimalarials, in particular artemisinin-based combination therapies (ACTs), are critical tools in reducing the global burden of malaria, which is concentrated in sub-Saharan Africa. Performing and reporting antimalarial efficacy studies in a transparent and standardized fashion permit comparison of efficacy outcomes across countries and time periods. This systematic review summarizes study compliance with WHO laboratory and reporting guidance pertaining to antimalarial therapeutic efficacy studies and evaluates how well studies from sub-Saharan Africa adhered to these guidelines. We included all published studies (January 2020 or before) performed in sub-Saharan Africa where ACT efficacy for treatment of uncomplicated Plasmodium falciparum infection was reported. The primary outcome was a composite indicator for study methodology consistent with WHO guidelines for statistical analysis of corrected efficacy, defined as an article presenting a Kaplan-Meier survival analysis of corrected efficacy or reporting a per-protocol analysis where new infections were excluded from the numerator and denominator. Of 581 articles screened, we identified 279 for the review. Molecular correction was used in 83% (232/279) to distinguish new infections from recrudescences in subjects experiencing recurrent parasitemia. Only 45% (99/221) of articles with therapeutic efficacy as a primary outcome and performing molecular correction reported corrected efficacy outcomes calculated in a way consistent with WHO recommendations. These results indicate a widespread lack of compliance with WHO-recommended methods of analysis, which may result in biases in how antimalarial effectiveness is being measured and reported from sub-Saharan Africa.
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Affiliation(s)
- Mateusz M. Plucinski
- Malaria Branch and U.S. President’s Malaria Initiative, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Ian M. Hastings
- Parasitology Department, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Leah F. Moriarty
- Malaria Branch and U.S. President’s Malaria Initiative, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Meera Venkatesan
- U.S. President’s Malaria Initiative, United States Agency for International Development, Washington, District of Columbia
| | - Ingrid Felger
- University of Basel, Basel, Switzerland;,Medical Parasitology and Infection Biology, Swiss Tropical and Public Health Institute, Basel, Switzerland
| | - Eric S. Halsey
- Malaria Branch and U.S. President’s Malaria Initiative, Centers for Disease Control and Prevention, Atlanta, Georgia;,Address correspondence to Eric S. Halsey, Malaria Branch and U.S. President’s Malaria Initiative, Centers for Disease Control and Prevention, 1600 Clifton Rd., Malaria Branch, Atlanta, GA 30333. E-mail:
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5
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Ferreira MU, Nobrega de Sousa T, Rangel GW, Johansen IC, Corder RM, Ladeia-Andrade S, Gil JP. Monitoring Plasmodium vivax resistance to antimalarials: Persisting challenges and future directions. Int J Parasitol Drugs Drug Resist 2021; 15:9-24. [PMID: 33360105 PMCID: PMC7770540 DOI: 10.1016/j.ijpddr.2020.12.001] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 11/27/2020] [Accepted: 12/01/2020] [Indexed: 11/23/2022]
Abstract
Emerging antimalarial drug resistance may undermine current efforts to control and eliminate Plasmodium vivax, the most geographically widespread yet neglected human malaria parasite. Endemic countries are expected to assess regularly the therapeutic efficacy of antimalarial drugs in use in order to adjust their malaria treatment policies, but proper funding and trained human resources are often lacking to execute relatively complex and expensive clinical studies, ideally complemented by ex vivo assays of drug resistance. Here we review the challenges for assessing in vivo P. vivax responses to commonly used antimalarials, especially chloroquine and primaquine, in the presence of confounding factors such as variable drug absorption, metabolism and interaction, and the risk of new infections following successful radical cure. We introduce a simple modeling approach to quantify the relative contribution of relapses and new infections to recurring parasitemias in clinical studies of hypnozoitocides. Finally, we examine recent methodological advances that may render ex vivo assays more practical and widely used to confirm P. vivax drug resistance phenotypes in endemic settings and review current approaches to the development of robust genetic markers for monitoring chloroquine resistance in P. vivax populations.
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Affiliation(s)
- Marcelo U Ferreira
- Department of Parasitology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil; Global Health and Tropical Medicine, Institute of Hygiene and Tropical Medicine, Nova University of Lisbon, Lisbon, Portugal.
| | - Tais Nobrega de Sousa
- Molecular Biology and Malaria Immunology Research Group, René Rachou Institute, Fiocruz, Belo Horizonte, Brazil
| | - Gabriel W Rangel
- Department of Biochemistry and Molecular Biology, Pennsylvania State University, University Park, PA, USA
| | - Igor C Johansen
- Department of Parasitology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil
| | - Rodrigo M Corder
- Department of Parasitology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil
| | - Simone Ladeia-Andrade
- Laboratory of Parasitic Diseases, Oswaldo Cruz Institute, Fiocruz, Rio de Janeiro, Brazil
| | - José Pedro Gil
- Department of Microbiology, Tumor and Cell Biology, Karolinska Institute, Solna, Sweden
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6
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Weiss DJ, Bertozzi-Villa A, Rumisha SF, Amratia P, Arambepola R, Battle KE, Cameron E, Chestnutt E, Gibson HS, Harris J, Keddie S, Millar JJ, Rozier J, Symons TL, Vargas-Ruiz C, Hay SI, Smith DL, Alonso PL, Noor AM, Bhatt S, Gething PW. Indirect effects of the COVID-19 pandemic on malaria intervention coverage, morbidity, and mortality in Africa: a geospatial modelling analysis. THE LANCET. INFECTIOUS DISEASES 2021; 21:59-69. [PMID: 32971006 PMCID: PMC7505634 DOI: 10.1016/s1473-3099(20)30700-3] [Citation(s) in RCA: 118] [Impact Index Per Article: 39.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 08/12/2020] [Accepted: 08/12/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Substantial progress has been made in reducing the burden of malaria in Africa since 2000, but those gains could be jeopardised if the COVID-19 pandemic affects the availability of key malaria control interventions. The aim of this study was to evaluate plausible effects on malaria incidence and mortality under different levels of disruption to malaria control. METHODS Using an established set of spatiotemporal Bayesian geostatistical models, we generated geospatial estimates across malaria-endemic African countries of the clinical case incidence and mortality of malaria, incorporating an updated database of parasite rate surveys, insecticide-treated net (ITN) coverage, and effective treatment rates. We established a baseline estimate for the anticipated malaria burden in Africa in the absence of COVID-19-related disruptions, and repeated the analysis for nine hypothetical scenarios in which effective treatment with an antimalarial drug and distribution of ITNs (both through routine channels and mass campaigns) were reduced to varying extents. FINDINGS We estimated 215·2 (95% uncertainty interval 143·7-311·6) million cases and 386·4 (307·8-497·8) thousand deaths across malaria-endemic African countries in 2020 in our baseline scenario of undisrupted intervention coverage. With greater reductions in access to effective antimalarial drug treatment, our model predicted increasing numbers of cases and deaths: 224·1 (148·7-326·8) million cases and 487·9 (385·3-634·6) thousand deaths with a 25% reduction in antimalarial drug coverage; 233·1 (153·7-342·5) million cases and 597·4 (468·0-784·4) thousand deaths with a 50% reduction; and 242·3 (158·7-358·8) million cases and 715·2 (556·4-947·9) thousand deaths with a 75% reduction. Halting planned 2020 ITN mass distribution campaigns and reducing routine ITN distributions by 25%-75% also increased malaria burden to a total of 230·5 (151·6-343·3) million cases and 411·7 (322·8-545·5) thousand deaths with a 25% reduction; 232·8 (152·3-345·9) million cases and 415·5 (324·3-549·4) thousand deaths with a 50% reduction; and 234·0 (152·9-348·4) million cases and 417·6 (325·5-553·1) thousand deaths with a 75% reduction. When ITN coverage and antimalarial drug coverage were synchronously reduced, malaria burden increased to 240·5 (156·5-358·2) million cases and 520·9 (404·1-691·9) thousand deaths with a 25% reduction; 251·0 (162·2-377·0) million cases and 640·2 (492·0-856·7) thousand deaths with a 50% reduction; and 261·6 (167·7-396·8) million cases and 768·6 (586·1-1038·7) thousand deaths with a 75% reduction. INTERPRETATION Under pessimistic scenarios, COVID-19-related disruption to malaria control in Africa could almost double malaria mortality in 2020, and potentially lead to even greater increases in subsequent years. To avoid a reversal of two decades of progress against malaria, averting this public health disaster must remain an integrated priority alongside the response to COVID-19. FUNDING Bill and Melinda Gates Foundation; Channel 7 Telethon Trust, Western Australia.
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Affiliation(s)
- Daniel J Weiss
- Telethon Kids Institute, Perth Children's Hospital, Perth, WA, Australia; Curtin University, Perth, WA, Australia; Oxford Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Amelia Bertozzi-Villa
- Oxford Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, Nuffield Department of Medicine, University of Oxford, Oxford, UK; Institute for Disease Modeling, Bellevue, WA, USA
| | - Susan F Rumisha
- Oxford Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, Nuffield Department of Medicine, University of Oxford, Oxford, UK; National Institute for Medical Research, Dar es Salaam, Tanzania
| | - Punam Amratia
- Telethon Kids Institute, Perth Children's Hospital, Perth, WA, Australia
| | - Rohan Arambepola
- Oxford Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | | | - Ewan Cameron
- Telethon Kids Institute, Perth Children's Hospital, Perth, WA, Australia; Curtin University, Perth, WA, Australia
| | - Elisabeth Chestnutt
- Oxford Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Harry S Gibson
- Oxford Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Joseph Harris
- Telethon Kids Institute, Perth Children's Hospital, Perth, WA, Australia
| | - Suzanne Keddie
- Telethon Kids Institute, Perth Children's Hospital, Perth, WA, Australia
| | - Justin J Millar
- Oxford Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Jennifer Rozier
- Telethon Kids Institute, Perth Children's Hospital, Perth, WA, Australia
| | - Tasmin L Symons
- Oxford Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Camilo Vargas-Ruiz
- Oxford Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Simon I Hay
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA; Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, USA
| | - David L Smith
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA; Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, USA
| | - Pedro L Alonso
- Global Malaria Programme, World Health Organization, Geneva, Switzerland
| | - Abdisalan M Noor
- Global Malaria Programme, World Health Organization, Geneva, Switzerland
| | - Samir Bhatt
- Department of Infectious Disease Epidemiology, Imperial College London, London, UK
| | - Peter W Gething
- Telethon Kids Institute, Perth Children's Hospital, Perth, WA, Australia; Curtin University, Perth, WA, Australia.
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7
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Das D, Dahal P, Dhorda M, Citarella BW, Kennon K, Stepniewska K, Felger I, Chappuis F, Guerin PJ. A Systematic Literature Review of Microscopy Methods Reported in Malaria Clinical Trials. Am J Trop Med Hyg 2020; 104:836-841. [PMID: 33350371 PMCID: PMC7941839 DOI: 10.4269/ajtmh.20-1219] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 10/21/2020] [Indexed: 12/04/2022] Open
Abstract
Microscopy of stained blood films is essential for the diagnosis of malaria, differentiation of parasite species, and estimation of parasite density performed for assessments of antimalarial drug efficacy. The accuracy and comparability of these measures over time and space are vital to discern the emergence or spread of antimalarial drug resistance. Although evidence-based guidelines for malaria microscopy methods exist, the age-old microscopy techniques for parasitological assessments are subject to considerable methodological variations. The purpose of this review was to explore critically how microscopy methods were reported in published malarial studies between 2013 and 2017 with the focus on outlining the methodological differences and improving reporting standards in practice.
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Affiliation(s)
- Debashish Das
- Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom.,Infectious Diseases Data Observatory (IDDO), Oxford, United Kingdom.,Institute of Global Health, University of Geneva, Geneva, Switzerland
| | - Prabin Dahal
- Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom.,Infectious Diseases Data Observatory (IDDO), Oxford, United Kingdom
| | - Mehul Dhorda
- Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom.,Infectious Diseases Data Observatory (IDDO), Oxford, United Kingdom
| | - Barbara Wanjiru Citarella
- Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom.,Infectious Diseases Data Observatory (IDDO), Oxford, United Kingdom
| | - Kalynn Kennon
- Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom.,Infectious Diseases Data Observatory (IDDO), Oxford, United Kingdom
| | - Kasia Stepniewska
- Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom.,Infectious Diseases Data Observatory (IDDO), Oxford, United Kingdom
| | - Ingrid Felger
- University of Basel, Basel, Switzerland.,Swiss Tropical and Public Health Institute, Basel, Switzerland
| | - François Chappuis
- Division of Tropical and Humanitarian Medicine, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
| | - Philippe J Guerin
- Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom.,Infectious Diseases Data Observatory (IDDO), Oxford, United Kingdom
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8
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Rathmes G, Rumisha SF, Lucas TCD, Twohig KA, Python A, Nguyen M, Nandi AK, Keddie SH, Collins EL, Rozier JA, Gibson HS, Chestnutt EG, Battle KE, Humphreys GS, Amratia P, Arambepola R, Bertozzi-Villa A, Hancock P, Millar JJ, Symons TL, Bhatt S, Cameron E, Guerin PJ, Gething PW, Weiss DJ. Global estimation of anti-malarial drug effectiveness for the treatment of uncomplicated Plasmodium falciparum malaria 1991-2019. Malar J 2020; 19:374. [PMID: 33081784 PMCID: PMC7573874 DOI: 10.1186/s12936-020-03446-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 10/10/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Anti-malarial drugs play a critical role in reducing malaria morbidity and mortality, but their role is mediated by their effectiveness. Effectiveness is defined as the probability that an anti-malarial drug will successfully treat an individual infected with malaria parasites under routine health care delivery system. Anti-malarial drug effectiveness (AmE) is influenced by drug resistance, drug quality, health system quality, and patient adherence to drug use; its influence on malaria burden varies through space and time. METHODS This study uses data from 232 efficacy trials comprised of 86,776 infected individuals to estimate the artemisinin-based and non-artemisinin-based AmE for treating falciparum malaria between 1991 and 2019. Bayesian spatiotemporal models were fitted and used to predict effectiveness at the pixel-level (5 km × 5 km). The median and interquartile ranges (IQR) of AmE are presented for all malaria-endemic countries. RESULTS The global effectiveness of artemisinin-based drugs was 67.4% (IQR: 33.3-75.8), 70.1% (43.6-76.0) and 71.8% (46.9-76.4) for the 1991-2000, 2006-2010, and 2016-2019 periods, respectively. Countries in central Africa, a few in South America, and in the Asian region faced the challenge of lower effectiveness of artemisinin-based anti-malarials. However, improvements were seen after 2016, leaving only a few hotspots in Southeast Asia where resistance to artemisinin and partner drugs is currently problematic and in the central Africa where socio-demographic challenges limit effectiveness. The use of artemisinin-based combination therapy (ACT) with a competent partner drug and having multiple ACT as first-line treatment choice sustained high levels of effectiveness. High levels of access to healthcare, human resource capacity, education, and proximity to cities were associated with increased effectiveness. Effectiveness of non-artemisinin-based drugs was much lower than that of artemisinin-based with no improvement over time: 52.3% (17.9-74.9) for 1991-2000 and 55.5% (27.1-73.4) for 2011-2015. Overall, AmE for artemisinin-based and non-artemisinin-based drugs were, respectively, 29.6 and 36% below clinical efficacy as measured in anti-malarial drug trials. CONCLUSIONS This study provides evidence that health system performance, drug quality and patient adherence influence the effectiveness of anti-malarials used in treating uncomplicated falciparum malaria. These results provide guidance to countries' treatment practises and are critical inputs for malaria prevalence and incidence models used to estimate national level malaria burden.
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Affiliation(s)
- Giulia Rathmes
- Malaria Atlas Project, Big Data Institute, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Susan F Rumisha
- Malaria Atlas Project, Big Data Institute, Nuffield Department of Medicine, University of Oxford, Oxford, UK.
- Telethon Kids Institute, Perth, Australia.
| | - Tim C D Lucas
- Malaria Atlas Project, Big Data Institute, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Katherine A Twohig
- Malaria Atlas Project, Big Data Institute, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Andre Python
- Malaria Atlas Project, Big Data Institute, Nuffield Department of Medicine, University of Oxford, Oxford, UK
- Center for Data Science, Zhejiang University, Hangzhou, 310058, China
| | - Michele Nguyen
- Malaria Atlas Project, Big Data Institute, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Anita K Nandi
- Malaria Atlas Project, Big Data Institute, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Suzanne H Keddie
- Malaria Atlas Project, Big Data Institute, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Emma L Collins
- Malaria Atlas Project, Big Data Institute, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Jennifer A Rozier
- Malaria Atlas Project, Big Data Institute, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Harry S Gibson
- Malaria Atlas Project, Big Data Institute, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Elisabeth G Chestnutt
- Malaria Atlas Project, Big Data Institute, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Katherine E Battle
- Malaria Atlas Project, Big Data Institute, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Georgina S Humphreys
- WorldWide Anti-Malarial Resistance Network (WWARN), Oxford, UK
- Infectious Diseases Data Observatory (IDDO), Oxford, UK
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
| | - Punam Amratia
- Malaria Atlas Project, Big Data Institute, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Rohan Arambepola
- Malaria Atlas Project, Big Data Institute, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Amelia Bertozzi-Villa
- Malaria Atlas Project, Big Data Institute, Nuffield Department of Medicine, University of Oxford, Oxford, UK
- Institute for Disease Modeling, Bellevue, WA, USA
| | - Penelope Hancock
- Malaria Atlas Project, Big Data Institute, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Justin J Millar
- Malaria Atlas Project, Big Data Institute, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Tasmin L Symons
- Malaria Atlas Project, Big Data Institute, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | | | - Ewan Cameron
- Malaria Atlas Project, Big Data Institute, Nuffield Department of Medicine, University of Oxford, Oxford, UK
- Telethon Kids Institute, Perth, Australia
- Curtin University, Perth, Australia
| | - Philippe J Guerin
- WorldWide Anti-Malarial Resistance Network (WWARN), Oxford, UK
- Infectious Diseases Data Observatory (IDDO), Oxford, UK
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
| | - Peter W Gething
- Telethon Kids Institute, Perth, Australia
- Curtin University, Perth, Australia
| | - Daniel J Weiss
- Malaria Atlas Project, Big Data Institute, Nuffield Department of Medicine, University of Oxford, Oxford, UK
- Telethon Kids Institute, Perth, Australia
- Curtin University, Perth, Australia
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