BACKGROUND: @entity507 -resistant @entity3964 has emerged in the Greater Mekong sub-region and poses a major global public health threat. Slow parasite clearance is a key clinical manifestation of reduced susceptibility to @entity507 . This study was designed to establish the baseline values for clearance in @entity1 from Sub-Saharan African countries with uncomplicated @entity311 treated with @entity507 -based combination therapies (ACTs). METHODS: A literature review in PubMed was conducted in March 2013 to identify all prospective clinical trials (uncontrolled trials, controlled trials and randomized controlled trials), including ACTs conducted in Sub-Saharan Africa, between 1960 and 2012. Individual @entity1 data from these studies were shared with the WorldWide Antimalarial Resistance Network (WWARN) and pooled using an a priori statistical analytical plan. Factors affecting early parasitological response were investigated using logistic regression with study sites fitted as a random effect. The risk of bias in included studies was evaluated based on study design, methodology and missing data. RESULTS: In total, 29,493 @entity1 from 84 clinical trials were included in the analysis, treated with @entity15280 - @entity15281 (n   =   13,664), @entity506 - @entity16944 (n   =   11,337) and @entity8185 - @entity26716 (n   =   4,492). The overall parasite clearance rate was rapid. The parasite positivity rate (PPR) decreased from 59.7  % (95  % CI: 54.5-64.9) on day 1 to 6.7  % (95  % CI: 4.8-8.7) on day 2 and 0.9  % (95  % CI: 0.5-1.2) on day 3. The 95th percentile of observed day 3 PPR was 5.3  %. Independent risk factors predictive of day 3 positivity were: high baseline parasitaemia (adjusted odds ratio (AOR)   =   1.16 (95  % CI: 1.08-1.25); per 2-fold increase in parasite density, P <0.001); fever (>37.5    C) (AOR   =   1.50 (95  % CI: 1.06-2.13), P   =   0.022); severe @entity417 (AOR   =   2.04 (95  % CI: 1.21-3.44), P   =   0.008); areas of low/moderate transmission setting (AOR   =   2.71 (95  % CI: 1.38-5.36), P   =   0.004); and treatment with the loose formulation of @entity506 - @entity16944 (AOR   =   2.27 (95  % CI: 1.14-4.51), P   =   0.020, compared to @entity8185 - @entity26716 ). CONCLUSIONS: The three ACTs assessed in this analysis continue to achieve rapid early parasitological clearance across the sites assessed in Sub-Saharan Africa. A threshold of 5  %  day 3 parasite positivity from a minimum sample size of 50 @entity1 provides a more sensitive benchmark in Sub-Saharan Africa compared to the current recommended threshold of 10  % to trigger further investigation of @entity507 susceptibility.

Clinical determinants of early parasitological response to ACTs in African XXXX with uncomplicated falciparum malaria: a literature review and meta-analysis of individual @entity1 data.

@entity1 :: ('9606', 'Species') :: ['patients', 'patient'] @entity15281 :: ('MESH:C102070', 'Chemical') :: ['lumefantrine'] @entity417 :: ('MESH:D000740', 'Disease') :: ['anaemia'] @entity26716 :: ('MESH:C034759', 'Chemical') :: ['piperaquine'] @entity8185 :: ('MESH:C039060', 'Chemical') :: ['dihydroartemisinin'] @entity16944 :: ('MESH:D000655', 'Chemical') :: ['amodiaquine'] @entity15280 :: ('MESH:C032942', 'Chemical') :: ['artemether'] @entity507 :: ('MESH:C031327', 'Chemical') :: ['Artemisinin', 'artemisinin'] @entity3964 :: ('5833', 'Species') :: ['Plasmodium falciparum'] @entity506 :: ('MESH:C039726', 'Chemical') :: ['artesunate'] @entity311 :: ('MESH:D008288', 'Disease') :: ['malaria']
@entity1 :: (9606,Species) :: ['patients']
