Kelry Mazurega Oliveira Dinelly1,2,3, Sheila Vitor-Silva2,4, Jose Diego Brito-Sousa1,2, Vanderson Souza Sampaio1,5, Milena Gabriela Oliveira Silva4, André Machado Siqueira6, Cássio Peterka1, Sheila Rodovalho1,7, Aretha Gomes Omena2, Wuelton Marcelo Monteiro1,2, Marcus Vinícius Guimarães Lacerda1,2,8, Gisely Cardoso Melo9,10. 1. Programa de Pós-graduação em Medicina Tropical, Universidade do Estado do Amazonas, Manaus, Brazil. 2. Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil. 3. Faculdade Metropolitana de Manaus-FAMETRO, Manaus, Brazil. 4. Escola de Enfermagem de Manaus, Universidade Federal do Amazonas, Manaus, Brazil. 5. Fundação de Vigilância em Saúde do Amazonas-FVS/AM, Manaus, Brazil. 6. Instituto Nacional de Infectologia Evandro Chagas-INI, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil. 7. Organização Pan Americana da Saúde, Brasília, Brazil. 8. Instituto de Pesquisa Leônidas & Maria Deane, Fundação Oswaldo Cruz, Manaus, Brazil. 9. Programa de Pós-graduação em Medicina Tropical, Universidade do Estado do Amazonas, Manaus, Brazil. cardosogisely@gmail.com. 10. Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil. cardosogisely@gmail.com.
Abstract
BACKGROUND: Relapses 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. METHODS: The 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. RESULTS: Patients 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). CONCLUSIONS: The 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.
BACKGROUND: Relapses 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. METHODS: The 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. RESULTS:Patients 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). CONCLUSIONS: The 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.