Dataset Information

Optimal Duration of Follow-up for Assessing Antimalarial Efficacy in Pregnancy: A Retrospective Analysis of a Cohort Followed Up Until Delivery on the Thailand-Myanmar Border.

ABSTRACT: Background:Follow-up for 28-42 days is recommended by the World Health Organization to assess antimalarial drug efficacy for nonpregnant populations. This study aimed to determine the optimal duration for pregnant women, as no specific guidance currently exists. Methods:The distributions of time to recrudescence (treatment failure), confirmed by polymerase chain reaction genotyping for different antimalarial drugs in pregnancy, were analyzed by accelerated failure time models using secondary data on microscopically confirmed recurrent falciparum malaria collected in prospective studies on the Thailand-Myanmar border between 1994 and 2010. Results:Of 946 paired isolates from 703 women, the median duration of follow-up for each genotyped recurrence (interquartile range) was 129 (83-174) days, with 429 polymerase chain reaction-confirmed recrudescent. Five different treatments were evaluated, and 382 Plasmodium falciparum recrudescences were identified as eligible. With log-logistic models adjusted for baseline parasitemia, the predicted cumulative proportions of all the recrudescences that were detected by 28 days were 70% (95% confidence interval [CI], 65%-74%) for quinine monotherapy (n = 295), 66% (95% CI, 53%-76%) for artesunate monotherapy (n = 43), 62% (95% CI, 42%-79%) for artemether-lumefantrine (AL; n = 19), 46% (95% CI, 26%-67%) for artesunate with clindamycin (n = 19), and 34% (95% CI, 11%-67%) for dihydroartemisinin-piperaquine (DP; n = 6). Corresponding figures by day 42 were 89% (95% CI, 77%-95%) for AL and 71% (95% CI, 38%-91%) for DP. Follow-up for 63 days was predicted to detect ?95% of all recrudescence, except for DP. Conclusions:In low-transmission settings, antimalarial drug efficacy assessments in pregnancy require longer follow-up than for nonpregnant populations.

SUBMITTER: Saito M

PROVIDER: S-EPMC6602886 | biostudies-literature | 2019 Jul

REPOSITORIES: biostudies-literature

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Optimal Duration of Follow-up for Assessing Antimalarial Efficacy in Pregnancy: A Retrospective Analysis of a Cohort Followed Up Until Delivery on the Thailand-Myanmar Border.

Saito Makoto M Mansoor Rashid R Wiladphaingern Jacher J Paw Moo Kho MK Pimanpanarak Mupawjay M Proux Stephane S Guérin Philippe J PJ White Nicholas J NJ Nosten François F McGready Rose R

Open forum infectious diseases 20190531 7

<h4>Background</h4>Follow-up for 28-42 days is recommended by the World Health Organization to assess antimalarial drug efficacy for nonpregnant populations. This study aimed to determine the optimal duration for pregnant women, as no specific guidance currently exists.<h4>Methods</h4>The distributions of time to recrudescence (treatment failure), confirmed by polymerase chain reaction genotyping for different antimalarial drugs in pregnancy, were analyzed by accelerated failure time models usin ...[more]

PMID: 31281861

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Project description:BackgroundThere is a paucity of data about the susceptibility status of malaria vectors to Public Health insecticides along the Thailand-Myanmar border. This lack of data is a limitation to guide malaria vector-control in this region. The aim of this study was to assess the susceptibility status of malaria vectors to deltamethrin, permethrin and DDT and to validate a simple molecular assay for the detection of knock-down resistance (kdr) mutations in the study area.MethodsAnopheles mosquitoes were collected in four sentinel villages during August and November 2014 and July 2015 using human landing catch and cow bait collection methods. WHO susceptibility tests were carried out to measure the mortality and knock-down rates of female mosquitoes to deltamethrin (0.05%), permethrin (0.75%) and DDT (4%). DNA sequencing of a fragment of the voltage-gated sodium channel gene was carried out to identify knock-down resistance (kdr) mutations at position 1014 in mosquitoes surviving exposure to insecticides.ResultsA total of 6295 Anopheles belonging to ten different species were bioassayed. Resistance or suspected resistance to pyrethroids was detected in An. barbirostris (s.l.) (72 and 84% mortality to deltamethrin (n = 504) and permethrin (n = 493) respectively), An. hyrcanus (s.l.) (33 and 48% mortality to deltamethrin (n = 172) and permethrin (n = 154), respectively), An. jamesii (87% mortality to deltamethrin, n = 111), An. maculatus (s.l.) (85 and 97% mortality to deltamethrin (n = 280) and permethrin (n = 264), respectively), An. minimus (s.l.) (92% mortality, n = 370) and An. vagus (75 and 95% mortality to deltamethrin (n =148) and permethrin (n = 178), respectively). Resistance or suspected resistance to DDT was detected in An. barbirostris (s.l.) (74% mortality, n = 435), An. hyrcanus (s.l.) (57% mortality, n = 91) and An. vagus (97% mortality, n = 133). The L1014S kdr mutation at both heterozygous and homozygous state was detected only in An. peditaeniatus (Hyrcanus Group).ConclusionResistance to pyrethroids is present along the Thailand-Myanmar border, and it represents a threat for malaria vector control. Further investigations are needed to better understand the molecular basis of insecticide resistance in malaria vectors in this area.

Project description:BACKGROUND:Utilization of oral health services has been low among rural populations in Thailand, especially for minority ethnicity populations living along the borders. The aim of this study was to increase understanding of the determinants of the underutilization of oral health services among these populations. METHODS:A qualitative study using in-depth interview and semi-structured interview was conducted among participants of Karen ethnicity living in Mae Tan Sub-district, Thasongyang District, Tak Province, Thailand. The interviews focused on exploring the participants' perceptions of oral health problems, oral health and hygiene, and oral health-seeking behaviors. The verbatim-transcribed interviews were analyzed using thematic analysis. RESULTS:A total of 101 participants (50 adults and 51 children) with a Karen ethnic background took part in the interviews. Most participants could not identify oral health problems and did not perceive dental disease as a problem unless there was severe pain that could not be relieved by painkillers. The Karen ethnic community worked as subsistence farmers, and their busy daily activities consisted of farming, going to the forest to hunt and gather, performing housework, and taking care of their children. Dental health was given a lower priority compared with general health. The perceived value of primary teeth was low, which was identified as an underlying factor resulting in delayed oral health care seeking among this population. The participants had relied on self-care throughout their lifetimes, using either traditional medicines or modern painkillers to relieve toothaches. Fear of dental procedures among children was also described as a barrier to seeking dental health care. CONCLUSIONS:This study found that the lifestyle and traditions of Karen people living in this area influence their oral health care and hygiene activities as well as their health-seeking behaviors. Further research should emphasize how to improve oral health promotion by providing necessary services and health education appropriately to Karen ethnic populations living along the Thai-Myanmar border.

Dataset Information

Optimal Duration of Follow-up for Assessing Antimalarial Efficacy in Pregnancy: A Retrospective Analysis of a Cohort Followed Up Until Delivery on the Thailand-Myanmar Border.

Publications

Optimal Duration of Follow-up for Assessing Antimalarial Efficacy in Pregnancy: A Retrospective Analysis of a Cohort Followed Up Until Delivery on the Thailand-Myanmar Border.

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