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Malaria is an
acute febrile, mosquito-borne blood disease caused by a Plasmodium parasite. It
is transmitted to humans through the bite of the female Anopheles mosquito. As
P. falciparum matures the infected erythrocytes adhere to microvascular
endothelium (cytoadherence), they constrain vascular function and reduce
perfusion. The extent to which the vital organs are affected determine the
clinical pattern and outcome of severe falciparum malaria. 1

 

According to
WHO, 216 million cases of malaria were reported globally and caused 445,000
deaths, thus effectively passing as an alarming epidemic. As per the latest
report of WHO-UNICEF, India is third among 15 countries having the highest
cases of malaria and deaths due to the disease.2

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Some
population groups like infants, children under 5 years of age and patients with
HIV/AIDS are at a greater risk of contracting malaria.3

Pregnant
women, especially primigravid women, are up to 10 times more likely to contract
malaria. Gravid women also have a greater tendency to develop severe
malaria.4

 

Malaria is
considered uncomplicated when symptoms are present but there are no clinical or
laboratory signs to indicate severity or dysfunction of organs. Severe
malaria typically occurs as a complication of uncomplicated malaria. P. falciparum can cause severe malaria because it multiples rapidly in
the blood, and can thus cause severe blood loss (anemia).

 

Antimalarial
drugs are used to to curb various symptoms of malaria as well as eradicate the
parasite. Current practice in treating cases of
malaria is based on the concept of combination
therapy (e.g., Coartem). This regimen
offers several advantages, including reduced risk of treatment failure, reduced
risk of developing resistance, enhanced convenience, and reduced
side-effects.5  Parasite clearance rates are chief measures of anti-malarial drug
efficacy. They are particularly important in the assessment of artemisinin
resistance. 6 In the erythrocytic schizogony cycle, artemisinins exert action
on a wide range of stages-from ring forms to early schizonts, thus have the
broadest time window of anitmalarial actions. 7

 

WHO recommends
artemisinin-based combination therapies (ACTs) for the treatment of
uncomplicated malaria caused by the P.
falciparum parasite. By combining 2 active ingredients with different
mechanisms of action. The choice of ACT should be based on the results of
therapeutic efficacy studies against local strains of P. falciparum malaria.

 

Fever is the
most common sign during an acute malarial attack and can be accompanied by
other auxillary symptoms such as headache, diarrhea, abdominal pain, vomiting,
and nausea. 8

The Indian studies
on fever and parasite clearance on patients receiving ACT is inadequate, hence this
study is requisite for establishing a correlation between the drug being
administered and it’s outcome.

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