Thursday, April 9, 2009

A sum greater than the equal of its parts

Another PLOS One paper, another malaria paper, another paper from Tanzania, another paper on women's health. I might branch out at some point. Or I might not. It's an exciting time for malaria research in Africa, so there's lots of new stuff coming out.

Malaria in pregnancy is a huge public health problem, with tremendous implications for fetal development as well as maternal health, and every bit of knowledge that we can use in its treatment is vital. Like this paper, looking at combo anti-malarials versus monotherapy, where the researchers randomized pregnant women with mild falciparum malaria to four different treatment regimens and looked therapy failure after four weeks. Knowledge of local resistance patterns is crucial in understanding the implications of the study - these lessons can't necessarily be applied in Asia or Central America, for example, or can't necessarily be applied 5-10 years from now in Tanzania itself. That's why we constantly need studies like this, to prove that we're still doing the right thing when treating this constantly adapting illness, trying to stay one step ahead while prevention efforts continue (see prior blog post).

Beyond the main finding of the combination of anti-malarials being effective, while its two components are individually ineffective, the finding of differing efficacy between study subjects and children reinforces the idea of partial immunity being helpful in fighting off the disease. Children likey need completey different, more intensive, typically artemensin-based, regimens compared to adults in the same community, a striking idea that may be unique to malaria treatment in the world of infectious diseases.

Ref: Mutabingwa TK, Muze K, Ord R, BriceƱo M, Greenwood BM, et al. (2009) Randomized Trial of Artesunate+Amodiaquine, Sulfadoxine-Pyrimethamine+Amodiaquine, Chlorproguanal-Dapsone and SP for Malaria in Pregnancy in Tanzania. PLoS ONE 4(4): e5138. doi:10.1371/journal.pone.0005138

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