A JAMA THEME ISSUE
Edited by Gianna Zuccotti, MD, MPH, and Catherine D. DeAngelis, MD, MPH
When Plasmodium falciparum and Plasmodium vivax coexist and species-specific malaria diagnosis is difficult, treatment that is efficacious against both species is desirable. Leslie and colleagues conducted a randomized trial testing the relative efficacy and safety of 2 antifolate therapies vs chloroquine for P vivax malaria in Pakistan and Afghanistan. They found that although chloroquine is the drug of choice, all 3 therapies effectively cleared parasites by day 14 and were well tolerated.
In a randomized trial involving Ugandan children with first-episode uncomplicated falciparum malaria, Dorsey and colleagues compared the efficacy and safety of 3 combination regimens and found that artemether-lumefantrine was associated with the lowest 28-day risk of parasitological failure.
In a case-control study involving children with severe falciparum malaria, May and colleagues found that the hemoglobin S carrier state was negatively associated with all major manifestations of severe disease, whereas the hemoglobin C and α+-thalassemia carrier states were negatively associated with cerebral malaria and severe anemia, respectively.
Among patients with fever seen at Zambian health facilities having either microscopy or malaria rapid diagnostic testing capabilities, Hamer and colleagues found that only 27.8% of patients had diagnostic testing performed, and patients with negative test results were often prescribed antimalarial agents.
Idro and colleagues reviewed patient records for Kenyan children younger than 14 years who were admitted to the hospital with acute falciparum malaria and found that almost half had neurological involvement, most often seizures or impaired consciousness or coma, and with an associated higher risk of mortality or neurological sequelae.
In an analysis of survey data reflecting the availability of insecticide-treated nets (ITNs) in 43 African countries, Miller and colleagues estimated that 16.7 million ITNs were available in households at risk in 2003. They calculate that between 130 million and 264 million ITNs will be required in 2007 to reach an 80% coverage target for young children and pregnant women in these countries.
Griffith and colleagues report results of a systematic literature review of diagnostic modalities and available pharmacotherapies to guide the rapid diagnosis and appropriate treatment of malaria in patients in the United States.
“Fighting diseases such as malaria in Africa requires opening the space for dialogue, not just at the political and governmental levels, but within communities.” From “Don't Sleep With Your Chickens.”
Malaria researchers are seeking better drugs and ways to control the parasite's mosquito vectors.
Controversies and misconceptions reflected in national chemoprophylaxis guidelines.
Make global surveillance to detect artemisin resistance a priority.
Strong leadership, effective management, and sufficient funding could make global malaria control a reality.
The issue editors discuss progress and challenges in malaria control.
Epidemics revisited for today's readers.
For your patients: Information about malaria.
This Week in JAMA . JAMA. 2007;297(20):2167. doi:10.1001/jama.297.20.2167