***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: OBJECTIVE To examine the extent to which district health teams could reduce the burden of malaria , a continuing major cause of mortality and morbidity , in a situation where severe re source constraints existed and integrated care was provided . METHODS Antimalarial drugs were prepackaged into unit doses in an attempt to improve compliance with full courses of chemotherapy . FINDINGS Compliance improved by approximately 20 % in both adults and children . There were 50 % reductions in cost to patients , waiting time at dispensaries and drug wastage at facilities . The intervention , which tended to improve both case and drug management at facilities , was well accepted by health staff and did not involve them in additional working time . CONCLUSION The prepackaging of antimalarials at the district level offers the prospect of improved compliance and a reduction in the spread of resistance A r and omized , controlled , malaria-clinic-based field trial was conducted to compare compliance with a 7-day quinine + tetracycline regimen and a 5-day 700-mg artesunate regimen for the treatment of uncomplicated falciparum malaria in a community in Thail and . Of 137 patients , aged 15 - 60 years attending a malaria clinic , 77 received artesunate  and 60 received quinine + tetracycline .  Compliance and cure rates were evaluated on days 5 ( artesunate ) and 7 ( quinine + tetracycline ) using patient interview/residual pill counts and peripheral blood smear , respectively . Data were analysed using the intention-to-treat approach , and the reasons for compliance and noncompliance were investigated . Compliance was significantly higher ( 98.4 % ) with artesunate than with quinine + tetracycline ( 71.7 % ) ( relative risk adjusted for sex ( aRR ) = 1.39 ( 95 % C.I. = 1.15 - 1.68 ) ; referent : quinine + tetracycline ) . Cure rate ( 100 % ) was higher in those receiving artesunate than quinine + tetracycline ( 77.4 % ) ( aRR = 1.32 ( 95 % C.I. = 1.12 - 1.55 ) ) . Reasons for compliance included the desire to be cured and to follow the advice of malaria staff/employer , and the simple dosing regimen . Noncompliance was mostly due to adverse reactions and forgetting to take the drugs . These results can serve as a baseline for design ing and evaluating new interventions to improve compliance , as well as for study ing cost-effectiveness to help drug policy decision-making . We recommend a strategy which integrates a short-course , once-a-day regimen ( with minimal adverse reactions ) , a better delivery system for antimalarial drugs and health education , and an enhanced advisory role of malaria staff . Considering the higher compliance rate and curative effectiveness of artesunate , we recommend its use instead of quinine + tetracycline for the treatment of uncomplicated malaria in clinics in Thail and Background Plasmodium vivax has a dormant hepatic stage , called the hypnozoite , which can cause relapse months after the initial attack . For 50 years , primaquine has been used as a hypnozoitocide to radically cure P. vivax infection , but major concerns remain regarding the side-effects of the drug and adherence to the 14-day regimen . This study examined the effectiveness of using the directly-observed therapy ( DOT ) method for the radical treatment of P. vivax malaria infection , to prevent reappearance of the parasite within the 90-day follow-up period . Other potential risk factors for the reappearance of P. vivax were also explored . Methods A r and omized trial was conducted from May 2007 to January 2009 in a low malaria transmission area along the Thai-Myanmar border . Patients aged ≥ 3 years diagnosed with P. vivax by microscopy , were recruited . All patients were treated with the national st and ard regimen of chloroquine for three days followed by primaquine for 14 days . Patients were r and omized to receive DOT or self-administered therapy ( SAT ) . All patients were followed for three months to check for any reappearance of P. vivax . Results Of the 216 patients enrolled , 109 were r and omized to DOT and 107 to SAT . All patients recovered without serious adverse effects . The vivax reappearance rate was significantly lower in the DOT group than the SAT group ( 3.4/10,000 person-days vs. 13.5/10,000 person-days , p = 0.021 ) . Factors related to the reappearance of vivax malaria included inadequate total primaquine dosage received ( < 2.75 mg/kg ) , duration of fever ≤ 2 days before initiation of treatment , parasite count on admission ≥ 10,000/µl , multiple P. vivax-genotype infection , and presence of P. falciparum infection during the follow-up period . Conclusions Adherence to the 14-day primaquine regimen is important for the radical cure of P. vivax malaria infection . Implementation of DOT reduces the reappearance rate of the parasite , and may subsequently decrease P. vivax transmission in the area We investigated the impact of pre-packaging antimalarial drugs and counselling on compliance with treatment of malaria at the Adult Outpatient Department of Port Moresby General Hospital . Adult patients who were prescribed st and ard antimalarial drugs following clinical and microscopic diagnosis of malaria were r and omly assigned to one of three groups : an intervention group , where pre-packaging and counselling instructions were applied ; control group A , with counselling but no pre-packaging ; and control group B , with neither counselling nor pre-packaging . Patients were interviewed on two occasions , day 1 of treatment and day 4 post treatment . Of a total of 436 patients , 322 patients ( 179 males and 143 females ) completed the study . Our data indicate an increase of 18 % in compliance with treatment in the intervention group and 16 % in control group A , when compared with control group B. While compliance with treatment was gender independent , the language spoken and used for giving instructions and counselling may have influenced patients ' behaviour on prescribed medication . The results of our study indicate that a simple pre-packaging system and proper counselling could improve compliance with antimalarial drug treatment . As an additional beneficial observation , pre-packaging is likely to eliminate errors and possible contamination of the products during dispensing Background Chlorproguanil-dapsone ( Lapdap ) , developed as a low-cost antimalarial , was withdrawn in 2008 after concerns about safety in G6PD deficient patients . This trial was conducted in 2004 to evaluate the safety and effectiveness of CD and comparison with artemether-lumefantrine ( AL ) under conditions of routine use in G6PD normal and G6PD deficient patients with uncomplicated malaria in The Gambia . We also examined the effects of a common genetic variant that affects chlorproguanil metabolism on risk of treatment failure . Methods 1238 children aged 6 months to 10 years with uncomplicated malaria were r and omized to receive CD or artemether-lumefantrine ( AL ) and followed for 28 days . The first dose was supervised , subsequent doses given unsupervised at home . G6PD genotype was determined to assess the interaction between treatment and G6PD status in their effects on anaemia . The main endpoints were clinical treatment failure by day 28 , incidence of severe anaemia ( Hb<5 g/dL ) , and haemoglobin concentration on day 3 . Findings One third of patients treated with AL , and 6 % of patients treated with CD , did not complete their course of medication . 18 % ( 109/595 ) of children treated with CD and 6.1 % ( 36/587 ) with AL required rescue medication within 4 weeks , risk difference 12 % ( 95%CI 8.9%–16 % ) . 23 children developed severe anaemia ( 17 ( 2.9 % ) treated with CD and 6 ( 1.0 % ) with AL , risk difference 1.8 % , 95%CI 0.3%–3.4 % , P = 0.02 ) . Haemoglobin concentration on day 3 was lower among children treated with CD than AL ( difference 0.43 g/dL , 95 % CI 0.24 to 0.62 ) , and within the CD group was lower among those children who had higher parasite density at enrolment . Only 17 out of 1069 children who were typed were G6PD A- deficient , of these 2/9 treated with CD and 1/8 treated with AL developed severe anaemia . 5/9 treated with CD had a fall of 2 g/dL or more in haemoglobin concentration by day 3 . Interpretation AL was well tolerated and highly effective and when given under operational conditions despite poor adherence to the six-dose regimen . There were more cases of severe malaria and anaemia after CD treatment although G6PD deficiency was uncommon . Trial Registration Clinical trials.gov Overwhelming evidence shows the quality of reporting of r and omised controlled trials ( RCTs ) is not optimal . Without transparent reporting , readers can not judge the reliability and validity of trial findings nor extract information for systematic review s. Recent method ological analyses indicate that inadequate reporting and design are associated with biased estimates of treatment effects . Such systematic error is seriously damaging to RCTs , which are considered the gold st and ard for evaluating interventions because of their ability to minimise or avoid bias . A group of scientists and editors developed the CONSORT ( Consoli date d St and ards of Reporting Trials ) statement to improve the quality of reporting of RCTs . It was first published in 1996 and up date d in 2001 . The statement consists of a checklist and flow diagram that authors can use for reporting an RCT . Many leading medical journals and major international editorial groups have endorsed the CONSORT statement . The statement facilitates critical appraisal and interpretation of RCTs . During the 2001 CONSORT revision , it became clear that explanation and elaboration of the principles underlying the CONSORT statement would help investigators and others to write or appraise trial reports . A CONSORT explanation and elaboration article was published in 2001 alongside the 2001 version of the CONSORT statement . After an expert meeting in January 2007 , the CONSORT statement has been further revised and is published as the CONSORT 2010 Statement . This up date improves the wording and clarity of the previous checklist and incorporates recommendations related to topics that have only recently received recognition , such as selective outcome reporting bias . This explanatory and elaboration document-intended to enhance the use , underst and ing , and dissemination of the CONSORT statement-has also been extensively revised . It presents the meaning and rationale for each new and up date d checklist item providing examples of good reporting and , where possible , references to relevant empirical studies . Several examples of flow diagrams are included . The CONSORT 2010 Statement , this revised explanatory and elaboration document , and the associated website ( www.consort-statement.org ) should be helpful re sources to improve reporting of r and omised trials Objective To compare the effectiveness of oral quinine with that of artemether-lumefantrine in treating uncomplicated malaria in children . Design R and omised , open label effectiveness study . Setting Outpatient clinic of Ug and a ’s national referral hospital in Kampala . Participants 175 children aged 6 to 59 months with uncomplicated malaria . Interventions Participants were r and omised to receive oral quinine or artemether-lumefantrine administered by care givers at home . Main outcome measures Primary outcomes were parasitological cure rates after 28 days of follow-up unadjusted and adjusted by genotyping to distinguish recrudescence from new infections . Secondary outcomes were adherence to study drug , presence of gametocytes , recovery of haemoglobin concentration from baseline at day 28 , and safety profiles . Results Using survival analysis the cure rate unadjusted by genotyping was 96 % for the artemether-lumefantrine group compared with 64 % for the quinine group ( hazard ratio 10.7 , 95 % confidence interval 3.3 to 35.5 , P=0.001 ) . In the quinine group 69 % ( 18/26 ) of parasitological failures were due to recrudescence compared with none in the artemether-lumefantrine group . The mean adherence to artemether-lumefantrine  was 94.5 % compared with 85.4 % to quinine ( P=0.0008 ) . Having adherence levels of 80 % or more was associated with a decreased risk of treatment failure ( 0.44 , 0.19 to 1.02 , P=0.06 ) . Adverse events did not differ between the two groups . Conclusions The effectiveness of a seven day course of quinine for the treatment of uncomplicated malaria in Ug and an children was significantly lower than that of artemether-lumefantrine . These findings question the advisability of the recommendation for quinine therapy for uncomplicated malaria in Africa . Trial registration Clinical Trials.gov NCT00540202 Background Controlled clinical trials have shown that a six-dose regimen of artemether-lumefantrine ( AL ) therapy for uncomplicated Plasmodium falciparum malaria results in cure rates > 95 % with good tolerability . Material s and methods A prospect i ve study was carried out to document the adherence to and acceptability 
    Output:
    
Although a most effective intervention did not emerge , community education and visual media/verbal information combinations may well have most potential to improve adherence to antimalarial medication .
The current underst and ing on improved adherence would facilitate to contain outbreaks of malaria cost effectively