Please select the eligibility criteria that correspond to the clinical trial below.
Title: A Placebo Controlled, Randomised Evaluation of an Eight Week Primaquine Regimen for the Treatment of Vivax Malaria.
Brief Summary: Plasmodium vivax represents a major health problem throughout the tropics. Outside Africa it accounts for over 50% of cases, affecting an estimated 70-80 million people per year. A substantial proportion of clinical cases are not caused by infective bites of Anopheles spp, but by activation of latent hypnozoites in the liver. These relapses may significantly impede development since each illness may result in 5-15 days of absence from work or school.

Primaquine(PQ) is the only drug available that eliminates hypnozoites, though its use is beset by clinical problems; it may precipitate haemolytic anaemia in individuals deficient in the blood enzyme glucose 6 phosphate dehydrogenase (G6PD). Without affordable G6PD testing, primaquine use is precluded. Evidence suggests, however, that a course of 8 weekly doses may be a safe and effective alternative to the traditional 14 day course of the drug. The aim of the proposed study, therefore, is to test whether 8 weekly doses of primaquine is as effective as the 14 day course at preventing relapse malaria, without the risk of hemolysis in G6PD deficient individuals.


Options:
A: Inclusion Criteria:

* ≥ 6 months old
* Microscopic diagnosis of Plasmodium vivax malaria mono-infection
* Participant or parent/guardian is willing and able to give informed consent for participation in the study
* Able (in the Investigators opinion) and willing to comply with all study requirements.

Exclusion Criteria:

* Severe malaria
* History of allergy or adverse reaction to artesunate, piperaquine, chloroquine, or primaquine
* Blood transfusion in the past 3 months
* G6PD deficiency by rapid test
* Hematocrit ≤ 25%
* Pregnancy at the time of screening
* Breastfeeding an infant \< 6 months old
* Presence of any condition which in the judgement of the investigator would place the subject at undue risk or interfere with the results of the study
B: Inclusion Criteria:

1. Positive smear for P. vivax.
2. Parasite density \> 500 and \< 200,000/μl
3. Age: 20-60 years old
4. Willing to sign consent form
5. Willing to be hospitalized for 29 days and remain in a malaria free region for 60 days thereafter for follow-up.
6. A female is eligible to enter and participate in this study if she is of:

a non-childbearing potential (i.e., physiologically incapable of becoming pregnant), including any female who is post-menopausal or, b child-bearing potential, has a negative pregnancy (urine or serum) test at screen, and agrees to comply with recognized contraceptive methods during the treatment stage of the study and for a period of 12 weeks after stopping study drug. Recognized contraceptive methods include, abstinence, implants of levonorgestrel, injectable progestogen, or appropriate double barrier methods using licensed contraceptives such as diaphragm and condom (by the partner) or intrauterine device and condom. The use of oral/patch contraceptives during the study is not considered sufficient contraceptive protection.

Exclusion Criteria:

1. Mixed malaria infections by Field's stain.
2. Female subjects who are pregnant, lactating or unwilling/unable to comply with recognized contraceptive methods during the treatment stage of the study and for a period of 12 weeks after stopping study drug.
3. Symptoms of severe vomiting (no food or inability to take food during the previous 8 hours).
4. Demonstrated glucose-6-phosphate dehydrogenase deficiency.
5. Subject has taken other anti-malarials (mefloquine, primaquine, chloroquine) within the past 30 days by history
6. Clinically significant illness (intercurrent illness e.g. pneumonia, pre-existing condition e.g. renal disease, malignancy or conditions that may affect absorption of study medication e.g. severe diarrhea or any signs of malnutrition as defined clinically).
7. Clinically significant abnormal laboratory values as determined by history, physical examination or routine blood chemistries and hematology values (laboratory guideline values for exclusion are hemoglobin \<7 gm/dL, platelets \< 50,000/μl, White Blood Cell count (WBC) \< 2000/μl, serum creatinine \>2.0mg/dL, or ALT or AST more than 3 times the upper limit of normal for age.
8. History of allergy to chloroquine, mefloquine, tafenoquine, primaquine or any other 8-aminoquinolines.
9. Subject has taken another investigational drug within 30 days or 5 half lives (whichever is longer), of study start.
10. History of previous eye surgery or have evidence of corneal or retinal abnormalities identified in baseline ophthalmological examination.
11. Subjects taking concomitant medications likely to affect renal or ophthalmic function or that are known to be metabolized primarily by the cytochrome P450 isoforms 3A4/5 and 2C9 and whose therapeutic effect occurs within a narrow plasma concentration range (e.g. warfarin, ketoconazole).
12. Subjects whom, after examination by the study ophthalmologist, are judged to be at risk for acute angle closure glaucoma.
13. Females who are pre-menarchal.
C: Inclusion Criteria:

* Patients diagnosed with P. vivax parasitaemia
* Patients over 3 years
* Patients with G6PD deficiency to a safety trial
* Patients without G6PD deficiency to all other groups.

Exclusion Criteria:

* Children under the age of three
* Pregnant / breast feeding women
* Patients with severe clinical anaemia \[Hb\<7g/dl\]
* Patients with P. falciparum
* Patients unavailable for the duration of study.
* Patients who have taken antimalarial drugs in the 2 weeks prior to consultation.
* Patients with concomitant infections or whose general health is considered too poor.
D: Inclusion Criteria:

* Adults and children \> 6 months
* Weight \> 7 kg for children
* Have not had primaquine since last Pv episode
* Participant (or parent/guardian if \< 18 years old) is willing and able to give written informed consent
* Microscopic diagnosis of Plasmodium vivax mono-infection
* Ability (in the investigators opinion) and willingness of patient or parent/guardian to comply with all study requirements

Exclusion Criteria

* Allergy to artesunate, chloroquine or primaquine
* Severe malaria
* Patients with microscopic diagnosis of co-infection with Plasmodium falciparum
* Presence of any condition which in the judgement of the investigator would place the subject at undue risk or interfere with the results of the study
* Inability to tolerate oral medication
* Pregnancy
* Blood transfusion in the last 3 months
* Antimalarial in last 2 months

Answer: C