Is parasite clearance clinically important after malaria treatment in a high transmission area? A 3-month follow-up of home-based management with herbal medicine or ACT

Willcox, Merlin; Graz, Bertrand; Diakité, Chiaka; Falquet, Jacques; Dackouo, Florent; Sidibé, Oumar; Giani, Sergio; Diallo, Drissa

doi:10.1016/j.trstmh.2010.10.003

Cited by 22 publications

(21 citation statements)

References 13 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The main practical problem was that cultivation was adversely affected by droughts in several areas. In drought-prone areas, drought-resistant anti-malarial plants such as Argemone mexicana would be more suitable[16-18]. Artemisia annua is more suited to highland areas with better rainfall.…”

Section: Discussionmentioning

confidence: 99%

Evaluation and pharmacovigilance of projects promoting cultivation and local use of Artemisia annua for malaria

Willcox

Burton

Oyweka³

et al. 2011

Malar J

View full text Add to dashboard Cite

BackgroundSeveral non-governmental organisations (NGOs) are promoting the use of Artemisia annua teas as a home-based treatment for malaria in situations where conventional treatments are not available. There has been controversy about the effectiveness and safety of this approach, but no pharmacovigilance studies or evaluations have been published to date.MethodA questionnaire about the cultivation of A. annua, treatment of patients, and side-effects observed, was sent to partners of the NGO Anamed in Kenya and Uganda. Some of the respondents were then selected purposively for more in-depth semi-structured interviews.ResultsEighteen partners in Kenya and 21 in Uganda responded. 49% reported difficulties in growing the plant, mainly due to drought. Overall about 3,000 cases of presumed malaria had been treated with A. annua teas in the previous year, of which about 250 were in children and 54 were in women in the first trimester of pregnancy. The commonest problem observed in children was poor compliance due to the bitter taste, which was improved by the addition of sugar or honey. Two miscarriages were reported in pregnant patients. Only four respondents reported side-effects in other patients, the commonest of which was vomiting. 51% of respondents had started using A. annua tea to treat illnesses other than malaria.ConclusionsLocal cultivation and preparation of A. annua are feasible where growing conditions are appropriate. Few adverse events were reported even in children and pregnant women. Where ACT is in short supply, it would make sense to save it for young children, while using A. annua infusions to treat older patients who are at lower risk. An ongoing pharmacovigilance system is needed to facilitate reporting of any adverse events.

show abstract

Section: Discussionmentioning

confidence: 99%

Evaluation and pharmacovigilance of projects promoting cultivation and local use of Artemisia annua for malaria

Willcox

Burton

Oyweka³

et al. 2011

Malar J

View full text Add to dashboard Cite

show abstract

“…It did not differ significantly according to whether the patients received modern or traditional treatment [8]. Sixty-six different traditional herbal medicines were reportedly used for the treatment of malaria in this survey, of which one was selected for clinical trials and yielded promising results [9], [10], [11], [12]. In 2005 the official first-line treatment for malaria changed from chloroquine to ACTs (Artemisinin Combination Therapies: artesunate-amodiaquine and artemether-lumefantrine).…”

Section: Introductionmentioning

confidence: 94%

Pre-Hospital Risk Factors for Inpatient Death from Severe Febrile Illness in Malian Children

et al. 2014

Self Cite

View full text Add to dashboard Cite

BackgroundInpatient case fatality from severe malaria remains high in much of sub-Saharan Africa. The majority of these deaths occur within 24 hours of admission, suggesting that pre-hospital management may have an impact on the risk of case fatality.MethodsProspective cohort study, including questionnaire about pre-hospital treatment, of all 437 patients admitted with severe febrile illness (presumed to be severe malaria) to the paediatric ward in Sikasso Regional Hospital, Mali, in a two-month period.FindingsThe case fatality rate was 17.4%. Coma, hypoglycaemia and respiratory distress at admission were associated with significantly higher mortality. In multiple logistic regression models and in a survival analysis to examine pre-admission risk factors for case fatality, the only consistent and significant risk factor was sex. Girls were twice as likely to die as boys (AOR 2.00, 95% CI 1.08–3.70). There was a wide variety of pre-hospital treatments used, both modern and traditional. None had a consistent impact on the risk of death across different analyses. Reported use of traditional treatments was not associated with post-admission outcome.InterpretationAside from well-recognised markers of severity, the main risk factor for death in this study was female sex, but this study cannot determine the reason why. Differences in pre-hospital treatments were not associated with case fatality.

show abstract

“…Another point he might have added is that, while Western physicians expect the result of antimalarial treatment to be rapid total parasite clearance, in a high-transmission area this may be clinically unimportant (Willcox et al 2011) or actually detrimental, as persistent low-level infection may reduce the risk of significant illness in the likely event of future exposure (Sondén et al 2015). Hence, if a choice between more and less potent traditional medicines were available, the latter might usually be preferable when reduced future illnesses and lesser side effects were considered.…”

Section: Introductionmentioning

confidence: 99%

Antimalarial Use of Malagasy Plants Is Poorly Correlated with Performance in Antimalarial Bioassays

et al. 2017

View full text Add to dashboard Cite

Bioassay screening of plant extracts can identify unique lead compounds for drug development, but the “hit rate” from random screening is very low. Targeted screening of medicinal plants has been repeatedly reported to increase the percentage of samples displaying bioactivity. Contrarily, Maranz (2012) suggested that African antimalarial plants were unsuitable sources of antimalarial drugs because high prevalence of malaria would result in rapid evolution of resistance to active compounds that directly targeted the parasite. As malaria is highly prevalent in much of Madagascar, it was of interest to determine whether Malagasy antimalarial plants would outperform randomly selected plants in conventional antimalarial assays being conducted as part of a discovery program. Of 1294 plant samples screened for antimalarial activity, 39.6% had an IC50 <50 μg/ml and 21.1% had an IC50 <20 μg/ml (the minimum to qualify as a first-pass “hit”). Ethnobotanical uses were coded at both the generic and the species level, as neither samples nor use reports in literature were always identifiable to species level. The 526 samples belonging to genera having reported uses for malaria were slightly more likely than average to display activity (44.3% with IC50 <50 μg/ml, p < .01; 23.2% with IC50 <20 μg/ml). Of these, 67 samples from individual species with documented use were still more likely to be modestly active (49.3% with IC50 <50 μg/ml), yet less likely to be highly active (17.9% with IC50 <20 μg/ml). Thus, in this specific context, ethnobotanically directed screening would not have substantially improved screening efficiency, and would have missed most of the potential hits.

show abstract

Is parasite clearance clinically important after malaria treatment in a high transmission area? A 3-month follow-up of home-based management with herbal medicine or ACT

Cited by 22 publications

References 13 publications

Evaluation and pharmacovigilance of projects promoting cultivation and local use of Artemisia annua for malaria

Evaluation and pharmacovigilance of projects promoting cultivation and local use of Artemisia annua for malaria

Pre-Hospital Risk Factors for Inpatient Death from Severe Febrile Illness in Malian Children

Antimalarial Use of Malagasy Plants Is Poorly Correlated with Performance in Antimalarial Bioassays

Contact Info

Product

Resources

About