Publications

OBJECTIVE

To compare the effectiveness of oral quinine with that of artemether-lumefantrine in treating uncomplicated malaria in children.

DESIGN

Randomised, open label effectiveness study.

SETTING

Outpatient clinic of Uganda's national referral hospital in Kampala.

PARTICIPANTS

175 children aged 6 to 59 months with uncomplicated malaria.

INTERVENTIONS

Participants were randomised to receive oral quinine or artemether-lumefantrine administered by care givers at home.

MAIN OUTCOME MEASURES

Primary outcomes were parasitological cure rates after 28 days of follow-up unadjusted and adjusted by genotyping to distinguish recrudescence from new infections. Secondary outcomes were adherence to study drug, presence of gametocytes, recovery of haemoglobin concentration from baseline at day 28, and safety profiles.

RESULTS

Using survival analysis the cure rate unadjusted by genotyping was 96% for the artemether-lumefantrine group compared with 64% for the quinine group (hazard ratio 10.7, 95% confidence interval 3.3 to 35.5, P=0.001). In the quinine group 69% (18/26) of parasitological failures were due to recrudescence compared with none in the artemether-lumefantrine group. The mean adherence to artemether-lumefantrine was 94.5% compared with 85.4% to quinine (P=0.0008). Having adherence levels of 80% or more was associated with a decreased risk of treatment failure (0.44, 0.19 to 1.02, P=0.06). Adverse events did not differ between the two groups.

CONCLUSIONS

The effectiveness of a seven day course of quinine for the treatment of uncomplicated malaria in Ugandan children was significantly lower than that of artemether-lumefantrine. These findings question the advisability of the recommendation for quinine therapy for uncomplicated malaria in Africa.

TRIAL REGISTRATION

ClinicalTrials.gov NCT00540202.

Infant feeding decisions affect maternal and child health outcomes, worldwide. Even in settings with clean water and good sanitation, infants who are not breast-fed face an increased risk of infectious, as well as non-infectious morbidity and mortality. The decision not to breast-feed can also adversely affect mothers' health by increasing the risk of pre-menopausal breast cancer, ovarian cancer, type II diabetes, hypertension, hyperlipidemia and cardiovascular disease. Clinicians who counsel mothers about the health impact of infant feeding and provide evidence-based care to maximize successful breast-feeding, can improve the short and long-term health of both mothers and infants.