***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: BACKGROUND Information regarding the safety and efficacy of artemisinin combination treatments for malaria in pregnant women is limited , particularly among women who live in sub-Saharan Africa . METHODS We conducted a multicenter , r and omized , open-label trial of treatments for malaria in pregnant women in four African countries . A total of 3428 pregnant women in the second or third trimester who had falciparum malaria ( at any parasite density and regardless of symptoms ) were treated with artemether-lumefantrine , amodiaquine-artesunate , mefloquine-artesunate , or dihydroartemisinin-piperaquine . The primary end points were the polymerase-chain-reaction (PCR)-adjusted cure rates ( i.e. , cure of the original infection ; new infections during follow-up were not considered to be treatment failures ) at day 63 and safety outcomes . RESULTS The PCR-adjusted cure rates in the per- protocol analysis were 94.8 % in the artemether-lumefantrine group , 98.5 % in the amodiaquine-artesunate group , 99.2 % in the dihydroartemisinin-piperaquine group , and 96.8 % in the mefloquine-artesunate group ; the PCR-adjusted cure rates in the intention-to-treat analysis were 94.2 % , 96.9 % , 98.0 % , and 95.5 % , respectively . There was no significant difference among the amodiaquine-artesunate group , dihydroartemisinin-piperaquine group , and the mefloquine-artesunate group . The cure rate in the artemether-lumefantrine group was significantly lower than that in the other three groups , although the absolute difference was within the 5-percentage-point margin for equivalence . The unadjusted cure rates , used as a measure of the post-treatment prophylactic effect , were significantly lower in the artemether-lumefantrine group ( 52.5 % ) than in groups that received amodiaquine-artesunate ( 82.3 % ) , dihydroartemisinin-piperaquine ( 86.9 % ) , or mefloquine-artesunate ( 73.8 % ) . No significant difference in the rate of serious adverse events and in birth outcomes was found among the treatment groups . Drug-related adverse events such as asthenia , poor appetite , dizziness , nausea , and vomiting occurred significantly more frequently in the mefloquine-artesunate group ( 50.6 % ) and the amodiaquine-artesunate group ( 48.5 % ) than in the dihydroartemisinin-piperaquine group ( 20.6 % ) and the artemether-lumefantrine group ( 11.5 % ) ( P<0.001 for comparison among the four groups ) . CONCLUSIONS Artemether-lumefantrine was associated with the fewest adverse effects and with acceptable cure rates but provided the shortest posttreatment prophylaxis , whereas dihydroartemisinin-piperaquine had the best efficacy and an acceptable safety profile . ( Funded by the European and Developing Countries Clinical Trials Partnership and others ; Clinical Trials.gov number , NCT00852423 . ) BACKGROUND Intermittent treatment with sulfadoxine-pyrimethamine is widely recommended for the prevention of malaria in pregnant women in Africa . However , with the spread of resistance to sulfadoxine-pyrimethamine , new interventions are needed . METHODS We conducted a double-blind , r and omized , controlled trial involving 300 human immunodeficiency virus (HIV)-uninfected pregnant adolescents or women in Ug and a , where sulfadoxine-pyrimethamine resistance is widespread . We r and omly assigned participants to a sulfadoxine-pyrimethamine regimen ( 106 participants ) , a three-dose dihydroartemisinin-piperaquine regimen ( 94 participants ) , or a monthly dihydroartemisinin-piperaquine regimen ( 100 participants ) . The primary outcome was the prevalence of histopathologically confirmed placental malaria . RESULTS The prevalence of histopathologically confirmed placental malaria was significantly higher in the sulfadoxine-pyrimethamine group ( 50.0 % ) than in the three-dose dihydroartemisinin-piperaquine group ( 34.1 % , P=0.03 ) or the monthly dihydroartemisinin-piperaquine group ( 27.1 % , P=0.001 ) . The prevalence of a composite adverse birth outcome was lower in the monthly dihydroartemisinin-piperaquine group ( 9.2 % ) than in the sulfadoxine-pyrimethamine group ( 18.6 % , P=0.05 ) or the three-dose dihydroartemisinin-piperaquine group ( 21.3 % , P=0.02 ) . During pregnancy , the incidence of symptomatic malaria was significantly higher in the sulfadoxine-pyrimethamine group ( 41 episodes over 43.0 person-years at risk ) than in the three-dose dihydroartemisinin-piperaquine group ( 12 episodes over 38.2 person-years at risk , P=0.001 ) or the monthly dihydroartemisinin-piperaquine group ( 0 episodes over 42.3 person-years at risk , P<0.001 ) , as was the prevalence of parasitemia ( 40.5 % in the sulfadoxine-pyrimethamine group vs. 16.6 % in the three-dose dihydroartemisinin-piperaquine group [ P<0.001 ] and 5.2 % in the monthly dihydroartemisinin-piperaquine group [ P<0.001 ] ) . In each treatment group , the risk of vomiting after administration of any dose of the study agents was less than 0.4 % , and there were no significant differences among the groups in the risk of adverse events . CONCLUSIONS The burden of malaria in pregnancy was significantly lower among adolescent girls or women who received intermittent preventive treatment with dihydroartemisinin-piperaquine than among those who received sulfadoxine-pyrimethamine , and monthly treatment with dihydroartemisinin-piperaquine was superior to three-dose dihydroartemisinin-piperaquine with regard to several outcomes . ( Funded by the Eunice Kennedy Shriver National Institute of Child Health and Human Development ; Clinical Trials.gov number , NCT02163447 . ) Background Artemisinin combination therapies ( ACTs ) are currently the preferred option for treating uncomplicated malaria . Dihydroartemisinin-piperaquine ( DHA-PQP ) is a promising fixed-dose ACT with limited information on its safety and efficacy in African children . Methodology /Principal Findings The non-inferiority of DHA-PQP versus artemether-lumefantrine ( AL ) in children 6–59 months old with uncomplicated P. falciparum malaria was tested in five African countries ( Burkina Faso , Kenya , Mozambique , Ug and a and Zambia ) . Patients were r and omised ( 2∶1 ) to receive either DHA-PQP or AL . Non-inferiority was assessed using a margin of −5 % for the lower limit of the one-sided 97.5 % confidence interval on the treatment difference ( DHA-PQP vs. AL ) of the day 28 polymerase chain reaction ( PCR ) corrected cure rate . Efficacy analysis was performed in several population s , and two of them are presented here : intention-to-treat ( ITT ) and enlarged per- protocol ( ePP ) . 1553 children were r and omised , 1039 receiving DHA-PQP and 514 AL  . The PCR-corrected day 28 cure rate was 90.4 % ( ITT ) and 94.7 % ( ePP ) in the DHA-PQP group , and 90.0 % ( ITT ) and 95.3 % ( ePP ) in the AL group . The lower limits of the one-sided 97.5 % CI of the difference between the two treatments were −2.80 % and −2.96 % , in the ITT and ePP population s , respectively . In the ITT population , the Kaplan-Meier estimate of the proportion of new infections up to Day 42 was 13.55 % ( 95 % CI : 11.35%–15.76 % ) for DHA-PQP vs 24.00 % ( 95 % CI : 20.11%–27.88 % ) for AL ( p<0.0001 ) . Conclusions / Significance DHA-PQP is as efficacious as AL in treating uncomplicated malaria in African children from different endemicity setting s , and shows a comparable safety profile . The occurrence of new infections within the 42-day follow up was significantly lower in the DHA-PQP group , indicating a longer post-treatment prophylactic effect . Trial Registration Controlled-trials.com IS RCT BACKGROUND Artemisinin-based combinations are judged the best treatments for multidrug-resistant Plasmodium falciparum malaria . Artesunate-mefloquine is widely recommended in southeast Asia , but its high cost and tolerability profile remain obstacles to widespread deployment . To assess whether dihydroartemisinin-piperaquine is a suitable alternative to artesunate-mefloquine , we compared the safety , tolerability , efficacy , and effectiveness of the two regimens for the treatment of uncomplicated falciparum in western Myanmar ( Burma ) . METHODS We did an open r and omised comparison of 3-day regimens of artesunate-mefloquine ( 12/25 mg/kg ) versus dihydroartemisinin-piperaquine ( 6.3/50 mg/kg ) for the treatment of children aged 1 year or older and in adults with uncomplicated falciparum malaria in Rakhine State , western Myanmar . Within each group , patients were r and omly assigned supervised or non-supervised treatment . The primary endpoint was the PCR-confirmed parasitological failure rate by day 42 . Failure rates at day 42 were estimated by Kaplan-Meier survival analysis . This study is registered as an International St and ard R and omised Controlled Trial , number IS RCT N27914471 . FINDINGS Of 652 patients enrolled , 327 were assigned dihydroartemisinin-piperaquine ( 156 supervised and 171 not supervised ) , and 325 artesunate-mefloquine ( 162 and 163 , respectively ) . 16 patients were lost to follow-up , and one patient died 22 days after receiving dihydroartemisinin-piperaquine .  Recrudescent parasitaemias were confirmed in only two patients ; the day 42 failure rate was 0.6 % ( 95 % CI 0.2 - 2.5 ) for dihydroartemisinin-piperaquine and 0 ( 0 - 1.2 ) for artesunate-mefloquine .  Whole-blood piperaquine concentrations at day 7 were similar for patients with observed and non-observed dihydroartemisinin-piperaquine treatment . Gametocytaemia developed more frequently in patients who had received dihydroartemisinin-piperaquine than in those on artesunate-mefloquine : day 7 , 18 ( 10 % ) of 188 versus five ( 2 % ) of 218 ; relative risk 4.2 ( 1.6 - 11.0 ) p=0.011 . INTERPRETATION Dihydroartemisinin-piperaquine is a highly efficacious and inexpensive treatment of multidrug-resistant falciparum malaria and is well tolerated by all age groups . The effectiveness of the unsupervised treatment , as in the usual context of use , equalled its supervised efficacy , indicating good adherence without supervision .  Dihydroartemisinin-piperaquine  is a good alternative to artesunate-mefloquine Background In Africa , most plasmodium infections during pregnancy remain asymptomatic , yet are associated with maternal anemia and low birthweight . WHO recommends intermittent preventive therapy in pregnancy with sulfadoxine-pyrimethamine ( IPTp-SP ) . However , sulfadoxine-pyrimethamine ( SP ) efficacy is threatened by high-level parasite resistance . We conducted a trial to evaluate the efficacy and safety of scheduled intermittent screening with malaria rapid diagnostic tests ( RDTs ) and treatment of RDT-positive women with dihydroartemisinin-piperaquine ( DP ) as an alternative strategy to IPTp-SP . Methods and Findings This was an open-label , two-arm individually r and omized superiority trial among HIV-seronegative women at three sites in Malawi with high SP resistance . The intervention consisted of three or four scheduled visits in the second and third trimester , 4 to 6 wk apart . Women in the IPTp-SP arm received SP at each visit . Women in the intermittent 
    Output:
    
Compared with IPT-SP , moderate certainty evidence indicated that women who received IPT-DP had significantly lower risks of clinical malaria during pregnancy .
High certainty evidence showed intermittent screening and treatment with DP  did not reduce placental malaria or maternal parasitemia at delivery .
Effect of DP on low birth weight and adverse birth outcomes was minimal .
Moderate certainty evidence suggests that IPT-DP may reduce maternal and placental malaria compared with IPT-SP , and monthly DP is more effective than SP in reducing placental malaria .