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Flickr, Cristhian Alama, Red Mundial
Artemisinin-based combination therapy is the first-line antimalarial treatment for uncomplicated falciparum malaria in most endemic countries but can suppress the bone marrow response and also contribute to haemolysis.
This individual patient data pooled analysis quantifies the underlying haematological response following P. falciparum infection to better understand the comparative benefits and risks of different antimalarial treatments.
The publication 'Haematological consequences of acute uncomplicated falciparum malaria: a WorldWide Antimalarial Resistance Network pooled analysis of individual patient data', involved data from 70,226 patients, from 200 studies conducted between 1991 and 2013, with 72.4% enrolled in Africa, 26.3% in Asia and 1.3% in South America.
The paper determined the main factors associated with haematological fall and recovery following uncomplicated malaria and its treatment. The study highlights patients at greatest risk of severe anaemia who would warrant closer follow up and also whether some treatment regimens offer advantages over others with regard to fast recovery and prevention of anaemia.
WWARN researchers highlighted five main findings:
- A haemoglobin of <7 g/dL is present in 8.4% of people from Africa, 3.3% of people from Asia-Pacific and 0.1% of people from South America
- The majority of patients with uncomplicated falciparum malaria have a modest fall in haemoglobin following treatment before subsequently improving with recovery
- Young children are at a particularly high risk of developing malarial anaemia
- The risk of anaemia during recovery is exacerbated with a slower parasite clearance
- In Asia, people treated with an artemisinin-based regimen are at a greater risk of anaemia during recovery compared with those treated with a non-artemisinin-based regimen.