Background
Methods
Data
Study & country | Treatment | N | Parasitology follow up days (bold = transmission experiment) | Mean age (years) | Mean asexual parasite density/μl | Mean slide- positive gametocyte prevalence (%) | Mean gametocyte density/μl |
---|---|---|---|---|---|---|---|
1. Gambia Targett 2001 [22] | CQ | 135 | 4, 7,14,28 | 5.9 | 80,886 | 2.5 | 33 |
SP | 277 | 6.0 | 73,742 | 5.6 | 13 | ||
SP-AS1 | 113 | 6.2 | 23,147 | 10.7 | 10 | ||
SP-AS3 | 74 | 6.3 | 26,567 | 13.4 | 88 | ||
all
|
599
|
6.0
|
59,581
|
6.9
|
26
| ||
2. Gambia Targett 2001 [22] | SP | 101 | 7,14 | 4.4 | 28,684 | 6.0 | 31 |
SP-AS3 | 404 | 4.8 | 27,738 | 8.0 | 127 | ||
all
|
505
|
4.7
|
27,927
|
7.6
|
107
| ||
3. Gambia Drakeley 2004 [20] | CQ | 129 | 3, 7,14,28 | 4.7 | 64,329 | 20.2 | 10 |
CQ-AS | 386 | 4.8 | 66,593 | 20.2 | 22 | ||
all
|
515
|
4.8
|
66,026
|
20.2
|
19
| ||
4. Gambia Hallett 2006 [13] | CQ | 125 | 3, 7, 10, 14,28 | 4.5 | 63,640 | 21.6 | 30 |
SP | 180 | 4.5 | 58,128 | 23.2 | 47 | ||
CQ-SP | 193 | 4.6 | 79,900 | 19.2 | 37 | ||
all
|
498
|
4.6
|
68,009
|
21.2
|
39
| ||
5. Gambia Sutherland 2005 [21] | CQ-SP | 89 | 7,14,28 | 4.3 | 56,444 | 4.5 | 5 |
AL | 400 | 4.4 | 57,550 | 6.3 | 9 | ||
(Coartem) | |||||||
all
|
489
|
4.3
|
57,347
|
6.0
|
9
| ||
6. Kenya Bousema 2006 [19] | SP | 152 | 3,7, 14,28 | 3.4 | 19,044 | 20.9 | 7 |
SP-AQ | 127 | 2.9 | 20,578 | 22.3 | 8 | ||
SP-AS3 | 174 | 3.2 | 21,620 | 24.4 | 8 | ||
AL (Coartem) | 75 | 4.0 | 21,178 | 24.6 | 6 | ||
all
|
528
|
3.3
|
20,565
|
22.9
|
7
|
Statistical methods
Results
Gametocytaemia during follow-up and transmission to mosquitoes
Study & country | Treatment | Parasitological treatment failure (%) | Mean AUC per day | % gametocyte slide-positive at transmission experiment | N transmission experiments (patients) | % mosquitoes infected* | Mean oocyst density |
---|---|---|---|---|---|---|---|
1. Gambia Targett 2001 [22] | CQ | 59.3 | 67.4 | 17.4 | 21 | 13.4 | 3.1 |
SP | 12.9 | 117.6 | 37.8 | 57 | 5.5 | 0.5 | |
SP-AS1 | 3.8 | 3.4 | 16.3 | 22 | 8.7 | 0.5 | |
SP-AS3 | 0 | 11.9 | 25.4 | 12 | 18.8 | 5.2 | |
all
|
23.9
|
66.2
|
27.6
|
112
|
9.0
|
1.6
| |
2. Gambia Targett 2001 [22] | SP | -† | -† | 64.0 | 20 | 10.7 | 1.5 |
SP-AS3 | 13.4 | 20 | 6.1 | 0.3 | |||
all
|
23.3
|
40
|
8.4
|
0.9
| |||
3. Gambia Drakeley 2004 [20] | CQ | 73.5 | 58.7 | 49.5 | 35 | 13.1 | 3.9 |
CQ-AS | 54.7 | 36.4 | 26.5 | 32 | 5.2 | 0.4 | |
all
|
59.6
|
42.0
|
32.1
|
67
|
9.3
|
2.1
| |
4. Gambia Hallett 2006 [13] | CQ | 73.5 | 81.1 | 54.2 | 17 | 5.5 | 0.8 |
SP | 57.4 | 216.2 | 89.6 | 30 | 2.7 | 0.2 | |
CQ-SP | 19.4 | 134.8 | 61.3 | 20 | 4.6 | 1.1 | |
all
|
46.0
|
147.7
|
64.8
|
67
|
4.0
|
0.6
| |
5. Gambia Sutherland 2005 [21] | CQ-SP | 19.0 | 44.6 | 41.7 | 22 | 3.0 | 0.1 |
AL | 15.0 | 2.9 | 5.8 | 39 | 0.1 | 0.0 | |
(Coartem) | |||||||
all
|
15.7
|
9.9
|
12.2
|
61
|
1.2
|
0.1
| |
6. Kenya Bousema 2006 [19] | SP | 54.1 | 19.2 | 37.2 | 71 | 7.0 | -‡ |
SP-AQ | 13.4 | 11.2 | 31.6 | 41 | 4.7 | ||
SP-AS3 | 17.9 | 3.9 | 9.6 | 41 | 2.6 | ||
AL | 4.1 | 2.3 | 6.8 | 29 | 4.1 | ||
(Coartem) | |||||||
all
|
25
|
9.1
|
21.7
|
182
|
5.0
|
Patient-level outcomes (gametocytaemia) | ||||||
---|---|---|---|---|---|---|
Variable | N patients | Univariate AUC Ratio of arithmetic means (95% CI) | P value | N patients | Univariate OR slide- positive gametocytaemia on day of feeding (95% CI) | P value |
Antimalarial
| ||||||
CQ (non-artemisinin) | 240 | 1 | <0.00 | 337 | 1 | <0.00 |
SP (non-artemisinin) | 325 | 1.56 (1.27–1.93) | 1 | 520 | 3.11 (2.19–4.40) | 1 |
CQ-SP (non-artemisinin) | 198 | 1.03 (0.81–1.32) | 227 | 1.33 (0.86–2.06) | ||
CQ-AS (ACT) | 291 | 0.72 (0.57–0.91) | 344 | 0.42 (0.28–0.62) | ||
SP-AS3 (ACT) | 187 | 0.62 (0.47–0.83) | 581 | 0.50 (0.32–0.78) | ||
AL (Coartem) (ACT) | 407 | 0.18 (0.13–0.25) | 404 | 0.15 (0.08–0.29) | ||
ACT
| ||||||
non-artemisinin | 872 | 1 | <0.00 | 1201 | 1 | <0.00 |
ACT | 885 | 0.35 (0.31–0.41) | 1 | 1329 | 0.20 (0.16–0.26) | 1 |
ACT by pre-treatment gametocytaemia
| ||||||
day 0 slide-negative
| † | † | ||||
non-artemisinin | 727 | 1 | <0.00 | 994 | 1 | <0.00 |
ACT | 745 | 0.23 (0.19–0.28) | 1 | 1125 | 0.13 (0.10–0.17) | 1 |
day 0 slide-positive
| ||||||
non-artemisinin | 145 | 1 | 0.054 | 164 | 1 | |
ACT | 140 | 0.80 (0.64–1.00) | 183 | 0.41 (0.25–0.67) | <0.00 | |
ACT by parasitological treatment failure
| ||||||
No failure
| † | |||||
non-artemisinin | 459 | 1 | <0.00 | 468 | 1 | <0.00 |
ACT | 605 | 0.31 (0.25–0.37) | 615 | 0.28 (0.20–0.38) | 1 | |
Failure
| 1 | |||||
non-artemisinin | 269 | 1 | <0.00 | 303 | <0.00 | |
ACT | 218 | 0.51 (0.40–0.65) | 1 | 233 | 0.33 (0.22–0.49) | 1 |
Mosquito-level outcomes
| ||||||
Variable | N mosquito es | Adjusted OR mosquito infection (95% CI)* | P value | N mosquito es | Adjusted OR oocyst count per midgut in highest 50% of positive counts (4) (95% CI)* | P value |
Antimalarial
| ||||||
CQ (non-artemisinin) | 2194 | 1 | 0.002 | 2194 | 1 | <0.00 |
SP (non-artemisinin) | 6762 | 0.42 (0.20–0.87) | 4079 | 0.25 (0.09–0.75) | 1 | |
CQ-SP (non-artemisinin) | 1277 | 1.28 (0.43–3.85) | 1146 | 0.12 (0.03–0.58) | ||
CQ-AS (ACT) | 974 | 0.28 (0.11–0.71) | 974 | 0.25 (0.05–1.21) | ||
SP-AS3 (ACT) | 2793 | 0.29 (0.12–0.69) | 1439 | 0.39 (0.09–1.8) | ||
AL (Coartem) (ACT) | 2299 | 0.22 (0.08–0.61) | 292 | - ‡ | ||
ACT
| ||||||
non-artemisinin | 11653 | 1 | 0.029 | 7419 | 1 | 0.165 |
ACT | 6066 | 0.49 (0.33–0.73) | 2705 | 0.45 (0.14–1.39) | ||
ACT by pre-treatment gametocytaemia
| ||||||
day 0 slide-negative
| ||||||
non-artemisinin | 8811 | 1 | 0.002 | 5700 | 1 | 0.008 |
ACT | 4039 | 0.49 (0.31–0.77) | 1419 | 0.11 (0.02–0.56) | ||
day 0 slide-positive
| ||||||
non-artemisinin | 2277 | 1 | <0.00 | 1326 | 1 | 0.102 |
ACT | 1870 | 0.30 (0.16–0.55) | 1 | 1129 | 0.28 (0.06–1.29) | |
ACT by parasitological treatment failure
| ||||||
No failure
| ||||||
non-artemisinin | 4773 | 1 | 0.003 | 2037 | 1 | 0.486 |
ACT | 3496 | 0.46 (0.28–0.76) | 740 | 0.49 (0.07–3.62) | ||
Failure
| ||||||
non-artemisinin | 3027 | 1 | 0.021 | 1574 | 1 | 0.294 |
ACT | 897 | 0.37 (0.16–0.86) | 572 | 0.33 (0.04–2.59) |