The online version of this article (doi:10.1186/1475-2875-11-286) contains supplementary material, which is available to authorized users.
The authors declare that they have no competing interests.
ACS coordinated the study and contributed to the writing of the manuscript; IR designed and coordinated the study and contributed to the writing of the manuscript; AD participated in coordinating and conducting the study and contributed to the writing of the manuscript, MB contributed to the study conception and design; PM participated in the study design and coordination and helped draft the manuscript; RLC participated in study design and coordination; MBFL conducted the study and helped draft the manuscript; IM conducted the study, and helped to draft the manuscript; APL conducted the statistical analysis and drafted the manuscript; WJ conducted the statistical analysis and drafted the manuscript, and discussed the study results; JLBL coordinated the study and helped draft the manuscript. All authors read and approved the final manuscript.
Studies in South-East Asia have suggested that early diagnosis and treatment with artesunate (AS) and mefloquine (MQ) combination therapy may reduce the transmission of Plasmodium falciparum malaria and the progression of MQ resistance.
The effectiveness of a fixed-dose combination of AS and MQ (ASMQ) in reducing malaria transmission was tested in isolated communities of the Juruá valley in the Amazon region.
Priority municipalities within the Brazilian Legal Amazon area were selected according to pre-specified criteria. Routine national malaria control programmatic procedures were followed. Existing health structures were reinforced and health care workers were trained to treat with ASMQ all confirmed falciparum malaria cases that match inclusion criteria. A local pharmacovigilance structure was implemented. Incidence of malaria and hospitalizations were recorded two years before, during, and after the fixed-dose ASMQ intervention. In total, between July 2006 and December 2008, 23,845 patients received ASMQ. Two statistical modelling approaches were applied to monthly time series of P. falciparum malaria incidence rates, P. falciparum/Plasmodium vivax infection ratio, and malaria hospital admissions rates. All the time series ranged from January 2004 to December 2008, whilst the intervention period span from July 2006 to December 2008.
The ASMQ intervention had a highly significant impact on the mean level of each time series, adjusted for trend and season, of 0.34 (95%CI 0.20 – 0.58) for the P. falciparum malaria incidence rates, 0.67 (95%CI 0.50 – 0.89) for the P. falciparum/P. vivax infection ratio, and 0.53 (95%CI 0.41 – 0.69) for the hospital admission rates. There was also a significant change in the seasonal (or monthly) pattern of the time series before and after intervention, with the elimination of the malaria seasonal peak in the rainy months of the years following the introduction of ASMQ. No serious adverse events relating to the use of fixed-dose ASMQ were reported.
In the remote region of the Juruá valley, the early detection of malaria by health care workers and treatment with fixed-dose ASMQ was feasible and efficacious, and significantly reduced the incidence and morbidity of P. falciparum malaria.
Additional file 1: Effect estimates and 95%CI for the indicator variables of years (trend), months (seasonality), and intervention (ASMQ) on three outcomes: P. falciparum Malaria Incidence Rates, P. falciparum-P.vivax Ratio, and Malaria Hospital Admission Rates in Vale do Juruá, Acre, Brazil, from January 2004 to December 2008. Interaction effects between months and intervention are presented on every second column. Significant effects are highlighted. (XLSX 14 KB)12936_2012_2227_MOESM1_ESM.xlsx
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- Effect of artesunate-mefloquine fixed-dose combination in malaria transmission in amazon basin communities
Ana C Santelli
Paola B Marchesini
Roseli La Corte dos Santos
Marize BF Lucena
Antonio P Leon
José LB Ladislau
- BioMed Central
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