Example of mobile phones common in rural Africa.

<p>Example of mobile phones common in rural Africa.</p

Studies reporting use of text messaging for malaria control in Africa.

<p>ACT, artemisinin-based combination therapy; HF, health facility; RDT, rapid diagnostic test.</p

Potential applications of text messaging for routine malaria health service delivery.

<p>Blue arrows, dominant SMS communication targeting control managers; red arrows, dominant SMS communication targeting health workers and patients; green boxes, areas of intervention.</p

The study design.

<p>The study design.</p

Estimates of comparative efficacy.

*<p>episodes with no outcomes and recurrent parasitemia/malaria caused by non-falciparum species censored.</p>†<p>episodes with no outcomes, recurrent parasitemia/malaria caused by non-falciparum species, and new <i>P. falciparum</i> infections Censored.</p

Secondary outcomes.

*<p>Subjective fever over previous 24 hours or temperature ≥37^.5°C.</p>†<p>Change in Hb from day 0 to day 28 or day of clinical failure.</p>a<p>Patients with gametocytes present on day 0 not included.</p>±<p>Quinine vs AL, p<0^.05.</p>∥<p>Quinine vs DHAPQ, p<0^.05.</p>§<p>AL vs DHAPQ, p<0^.05.</p

Cumulative risk of recurrent parasitaemia.

<p>Cumulative risk of recurrent parasitaemia.</p

Trial profile.

<p>Trial profile.</p

PCR-corrected ACPR rates.

<p>Shown is the percent of children in the ASAQ and AL groups with PCR-corrected ACPR on day 28 by month, ITT Population.</p

Efficacy and Safety of Fixed-Dose Artesunate-Amodiaquine vs. Artemether-Lumefantrine for Repeated Treatment of Uncomplicated Malaria in Ugandan Children

<div><p></p><p>The safety and efficacy of the two most widely used fixed-dose artemisinin-based combination therapies (ACT), artesunate-amodiaquine (ASAQ) and artemether-lumefantrine (AL) are well established for single episodes of uncomplicated <i>Plasmodium falciparum</i> malaria, but the effects of repeated, long-term use are not well documented. We conducted a 2-year randomized, open-label, longitudinal, phase IV clinical trial comparing the efficacy and safety of fixed-dose ASAQ and AL for repeated treatment of uncomplicated malaria in children under 5 years at Nagongera Health Centre, Uganda. Participants were randomized to ASAQ or AL and all subsequent malaria episodes were treated with the same regimen. 413 children were enrolled and experienced a total of 6027 malaria episodes (mean 15; range, 1–26). For the first malaria episode, the PCR-corrected-cure rate for ASAQ (97.5%) was non-inferior to that for AL (97.0%; 95% CI [−0.028; 0.037]). PCR-corrected cure rates for subsequent malaria episodes that had over 100 cases (episodes 2–18), ranged from 88.1% to 98.9% per episode, with no clear difference between the treatment arms. Parasites were completely cleared by day 3 for all malaria episodes and gametocyte carriage was less than 1% by day 21. Fever clearance was faster in the ASAQ group for the first episode. Treatment compliance for subsequent episodes (only first dose administration observed) was close to 100%. Adverse events though common were similar between treatment arms and mostly related to the disease. Serious adverse events were uncommon, comparable between treatment arms and resolved spontaneously. Anemia and neutropenia occurred in <0.5% of cases per episode, abnormal liver function tests occurred in 0.3% to 1.4% of cases. Both regimens were safe and effective for repeated treatment of malaria.</p><p>Trial Registration</p><p>Current Controlled Trials <a href="http://www.controlled-trials.com/mrct/trial/452497/NCT00699920" target="_blank">NCT00699920</a></p></div