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Optimised dosing of antimalarials to support malaria elimination in Africa and the Greater Mekong sub region

Principal Investigator :  Bob Taylor

Project Status : Completed

Project Summary

Efforts to reduce the global malaria burden have been successfully, but to completely get the disease under control, multiple approaches must be taken. While the efforts in rapid diagnosis and treatment have broadly worked, there is now a growing appreciation for the need to also combat asymptomatic reservoirs that also contribute to malaria transmission. When Plasmodium vivax infection also create additional reservoirs of hypnozoites, silent p. vivax parasites that form in the liver. These hypnozoites can reactivate periodically causing another blood stage infection. This is known as relapse and can cause significant morbidity and mortality. Currently the standard treatment for killing P. Vivax hypnozoites is treatment with primaquine. However, the current WHO recommended dosing is based only on mg/KG, and none exist for weight or aged based dosing. This creates several issues in areas where malaria is most problematic. The most concerning of which is the impracticality of weighing everyone who is administered does of the primaquine. Often there is no formal health system, and weights aren’t closely tracked. Moreover the drugs are given out from community health posts and local pharmacies which often do not have scales. When given en masse, its clear to see that dosing by weight is challenging and wasteful. While dosing by age is a much more practical solution. This strategy has had previous success, it was used to for the dosing of artesunate amodiaquine (ASAQ) MDA during the Ebola crisis.