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Risk factors for gametocyte carriage in Gambian children
L von Seidlein1, C Drakeley, B Greenwood
1Medical Research Council Laboratories, Fajara, The Gambia. lseidlein@ivi.int
The American Journal of Tropical Medicine and Hygiene
|November 22, 2001
Summary
Reducing Plasmodium falciparum gametocyte prevalence can lower malaria transmission. Effective antimalarial drugs, especially those combining pyrimethamine-sulfadoxine with multiple artesunate doses, significantly suppress gametocyte carriage.
Area of Science:
- Medical Research
- Infectious Diseases
- Parasitology
Background:
- Plasmodium falciparum gametocyte carriage is variable after infection.
- Gametocyte prevalence reduction is key to decreasing malaria transmission.
- Understanding risk factors for gametocytemia is crucial for effective treatment strategies.
Purpose of the Study:
- To analyze risk factors associated with gametocytemia at presentation and 7 days post-treatment.
- To evaluate the impact of different antimalarial drug regimens on gametocyte carriage.
- To determine optimal treatment strategies for suppressing gametocytemia and reducing malaria transmission.
Main Methods:
- Enrollment of 1,198 children in two antimalarial drug trials.
- Assignment to four treatment groups: chloroquine, pyrimethamine-sulfadoxine (PSD) alone, PSD + 1 dose artesunate, PSD + 3 doses artesunate.
- Assessment of gametocytemia at enrollment and 7 days post-treatment.
Main Results:
- At enrollment, 17% of children were gametocyte carriers. Anemia was linked to higher gametocyte prevalence, while fever and high parasite density were linked to lower prevalence.
- Seven days post-treatment, 37% of assessable children carried gametocytes. Pyrimethamine-sulfadoxine (PSD) alone resulted in significantly higher gametocytemia compared to other groups.
- Treatment with PSD + 3 doses of artesunate markedly reduced gametocytemia, with only 10% of children becoming carriers compared to 57% on PSD alone.
Conclusions:
- Early and effective antimalarial therapy is critical for preventing gametocytemia.
- The choice of first-line antimalarial drugs should consider both asexual parasite clearance and gametocyte suppression.
- Combination therapy, particularly PSD with multiple artesunate doses, shows significant potential in reducing gametocyte carriage and malaria transmission.