Abstract
BackgroundRelapses in vivax malaria have posed great challenges for malaria control, and they also account for a great proportion of reported cases. Knowing the real effectiveness of a 7-day primaquine (PQ) scheme is crucial in order to evaluate not only the cost-effectiveness of implementing new anti-hypnozoite drugs, but also how health education strategies can guarantee better compliance and be reinforced. This study aimed to evaluate the effect of daily treatment with chloroquine and PQ supervised by health workers versus prescription without supervision.MethodsThe outcome was the passive detection of new positive thick blood smears up to 180 days, based on the official data records from the National Malaria Control Programme. The recurrences seen in the real life were, therefore, used as a surrogate for true relapses.ResultsPatients under supervised treatment had a lower risk of recurrence up to day 180 when compared to the unsupervised treatment (17.9% vs. 36.1%; p = 0.027).ConclusionsThe lack of supervision in the non-supervised group (which followed standard of care in the real life) enabled proper comparison, as consent itself would have lead to greater compliance in this group. Future studies should scale such an analysis to different settings in the Brazilian Amazon.
Highlights
Relapses in vivax malaria have posed great challenges for malaria control, and they account for a great proportion of reported cases
This study evaluated the impact supervised treatment has on recurrences of vivax malaria in a municipality in the Brazilian Amazon
Survival analysis showed a higher risk of recurrence in the unsupervised treatment group [Hazard Ratio 2.44, p=0.019 (95%CI 1.15–5.15)] when compared to supervised treatment (Fig. 1)
Summary
Relapses in vivax malaria have posed great challenges for malaria control, and they account for a great proportion of reported cases. This study aimed to evaluate the effect of daily treatment with chloroquine and PQ supervised by health workers versus prescription without supervision. The development of latent hepatic forms known as hypnozoites, which are responsible for relapses months or years after an episode of vivax malaria, contribute to the maintenance of the transmission cycle [2]. Some studies indicate that after the first doses of anti-malarials, patients infected with P. vivax become asymptomatic and tend to interrupt treatment with PQ, which is the essential drug for radical cure [10]. In a rural area in the Western Brazilian Amazon, P. vivax relapse episodes were observed in 29.4% of the individuals during 90 days of follow-up [12].
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