***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 Artemether-lumefantrine ( AL ) was adopted as first-line treatment for uncomplicated malaria in Kenya in 2006 . Monitoring drug efficacy at regular intervals is essential to prevent unnecessary morbidity and mortality . The efficacy of AL and dihydroartemisinin-piperaquine ( DP ) were evaluated for the treatment of uncomplicated malaria in children aged six to 59 months in western Kenya . Methods From October 2010 to August 2011 , children with fever or history of fever with uncomplicated Plasmodium falciparum mono-infection were enrolled in an in vivo efficacy trial in accordance with World Health Organization ( WHO ) guidelines . The children were r and omized to treatment with a three-day course of AL or DP and efficacy outcomes were measured at 28 and 42 days after treatment initiation . Results A total of 137 children were enrolled in each treatment arm . There were no early treatment failures and all children except one had cleared parasites by day 3 . Polymerase chain reaction (PCR)-uncorrected adequate clinical and parasitological response rate ( ACPR ) was 61 % in the AL arm and 83 % in the DP arm at day 28 ( p = 0.001 ) . PCR-corrected ACPR at day 28 was 97 % in the AL group and 99 % in the DP group , and it was 96 % in both arms at day 42 . Conclusions AL and DP remain efficacious for the treatment of uncomplicated malaria among children in western Kenya . The longer half-life of piperaquine relative to lumefantrine may provide a prophylactic effect , accounting for the lower rate of re-infection in the first 28 days after treatment in the DP arm Background Co-infection with malaria and intestinal parasites such as Ascaris lumbricoides is common . Malaria parasites induce a pro-inflammatory immune response that contributes to the pathogenic sequelae , such as malarial anaemia , that occur in malaria infection . Ascaris is known to create an anti-inflammatory immune environment which could , in theory , counteract the anti-malarial inflammatory immune response , minimizing the severity of malarial anaemia . This study examined whether Ascaris co-infection can minimize the severity of malarial anaemia . Methods Data from a r and omized controlled trial on the effect of antihelminthic treatment in Nigerian preschool-aged ( 6–59 months ) children conducted in 2006–2007 were analysed to examine the effect of malaria and Ascaris co-infection on anaemia severity .  Children were enrolled and tested for malaria , helminths and anaemia at baseline , four , and eight months . Six hundred and ninety subjects were analysed in this study . Generalized linear mixed models were used to assess the relationship between infection status and Ascaris and Plasmodium parasite intensity on severity of anaemia , defined as a haemoglobin less than 11 g/dL. Results Malaria prevalence ranged from 35 - 78 % over the course of this study . Of the malaria-infected children , 55 % were co-infected with Ascaris at baseline , 60 % were co-infected four months later and 48 % were co-infected eight months later , underlining the persistent prevalence of malaria-nematode co-infections in this population . Over the course of the study the percentage of anaemic subjects in the population ranged between 84 % at baseline and 77 % at the eight-month time point . The odds of being anaemic were four to five times higher in children infected with malaria compared to those without malaria . Ascaris infection alone did not increase the odds of being anaemic , indicating that malaria was the main cause of anaemia in this population . There was no significant difference in the severity of anaemia between children singly infected with malaria and co-infected with malaria and Ascaris . Conclusion In this cohort of Nigerian preschool children , malaria infection was the major contributor to anaemia status . Ascaris co-infection neither exacerbated nor ameliorated the severity of malarial anaemia BACKGROUND Antimalarial drug resistance is now well established in both Plasmodium falciparum and Plasmodium vivax . In southern Papua , Indonesia , where both strains of plasmodia coexist , we have been conducting a series of studies to optimize treatment strategies . METHODS We conducted a r and omized trial that compared the efficacy and safety of dihydroartemisinin-piperaquine ( DHP ) with artesunate-amodiaquine ( AAQ ) . The primary end point was the overall cumulative parasitological failure rate at day 42 . RESULTS Of the 334 patients in the evaluable patient population , 185 were infected with P. falciparum , 80 were infected with P. vivax , and 69 were infected with both species . The overall parasitological failure rate at day 42 was 45 % ( 95 % confidence interval [ CI ] , 36%-53 % ) for AAQ and 13 % ( 95 % CI , 7.2%-19 % ) for DHP ( hazard ratio [ HR ] , 4.3 ; 95 % CI , 2.5 - 7.2 ; P<.001 ) . Rates of both recrudescence of P. falciparum infection and recurrence of P. vivax infection were significantly higher after receipt of AAQ than after receipt of DHP ( HR , 3.4 [ 95 % CI , 1.2 - 9.4 ] and 4.3 [ 95 % CI , 2.2 - 8.2 ] , respectively ; P<.001 ) . By the end of the study , AAQ recipients were 2.95-fold ( 95 % CI , 1.2- to 4.9-fold ) more likely to be anemic and 14.5-fold ( 95 % CI , 3.4- to 61-fold ) more likely to have carried P. vivax gametocytes . CONCLUSIONS DHP was more effective and better tolerated than AAQ against multidrug-resistant P. falciparum and P. vivax infections . The prolonged therapeutic effect of piperaquine delayed the time to P. falciparum reinfection , decreased the rate of recurrence of P. vivax infection , and reduced the risk of P. vivax gametocyte carriage and anemia Background Many countries have implemented artemisinin-based combination therapy ( ACT ) for the first-line treatment of malaria . Although many studies have been performed on efficacy and tolerability of the combination arthemeter-lumefantrine ( AL ) or dihydroartemisinin-piperaquine ( DP ) , less is known of the effect of these drugs on gametocyte development , which is an important issue in malaria control . Methods and results In this two-arm r and omized controlled trial , 146 children were treated with either AL or DP .  Both groups received directly observed therapy and were followed for 28 days after treatment . Blood sample s were analysed with microscopy and NASBA . In comparison with microscopy NASBA detected much more gametocyte positive individuals . Moreover , NASBA showed a significant difference in gametocyte clearance in favour of AL compared to DP . The decline of parasitaemia was slower and persistence or development of gametocytes was significantly higher and longer at day 3 , 7 and 14 in the DP group but after 28 days no difference could be observed between both treatment arms . Conclusion Although practical considerations could favour the use of one drug over another , the effect on gametocytogenesis should also be taken into account and studied further using molecular tools like NASBA . This also applies when a new drug is introduced . Trial registration Current controlled trials IS RCT Background Artemisinin combination therapy has become the st and ard of care for uncomplicated malaria in most of Africa . However , there is limited data on the safety and tolerability of these drugs , especially in young children and patients co-infected with HIV . Methods A longitudinal , r and omized controlled trial was conducted in a cohort of HIV-infected and uninfected children aged 4 - 22 months in Tororo , Ug and a. Participants were r and omized to treatment with artemether-lumefantrine ( AL ) or dihydroartemisinin-piperaquine ( DP ) upon diagnosis of their first episode of uncomplicated malaria and received the same regimen for all subsequent episodes . Participants were actively monitored for adverse events for 28 days and then passively for up to 63 days after treatment . This study was registered in Clinical Trials.gov ( registration # NCT00527800 ) . Results A total of 122 children were r and omized to AL and 124 to DP , result ing in 412 and 425 treatments , respectively . Most adverse events were rare , with only cough , diarrhoea , vomiting , and anaemia occurring in more than 1 % of treatments . There were no differences in the risk of these events between treatment groups . Younger age was associated with an increased risk of diarrhoea in both the AL and DP treatment arms . Retreatment for malaria within 17 - 28 days was associated with an increased risk of vomiting in the DP treatment arm ( HR = 6.47 , 95 % CI 2.31 - 18.1 , p < 0.001 ) . There was no increase in the risk of diarrhoea or vomiting for children who were HIV-infected or on concomitant therapy with antiretrovirals or trimethoprim-sulphamethoxazole prophylaxis . Conclusion Both AL and DP were safe and well tolerated for the treatment of uncomplicated malaria in young HIV-infected and uninfected children . Trial Registration Clinical Trials.gov : NCT00527800 ; http:// clinical Background The emergence of artemisinin-resistant P. falciparum malaria in South-East Asia highlights the need for continued global surveillance of the efficacy of artemisinin-based combination therapies . Methods On the Kenyan coast we studied the treatment responses in 474 children 6–59 months old with uncomplicated P. falciparum malaria in a r and omized controlled trial of dihydroartemisinin-piperaquine vs. artemether-lumefantrine from 2005 to 2008 . ( IS RCT N88705995 ) Results The proportion of patients with residual parasitemia on day 1 rose from 55 % in 2005–2006 to 87 % in 2007–2008 ( odds ratio , 5.4 , 95%CI , 2.7–11.1 ; P<0.001 ) and from 81 % to 95 % ( OR , 4.1 , 95%CI , 1.7–9.9 ; P = 0.002 ) in the DHA-PPQ and AM-LM groups , respectively . In parallel , Kaplan-Meier estimated risks of apparent recrudescent infection by day 84 increased from 7 % to 14 % ( P = 0.1 ) and from 6 % to 15 % ( P = 0.05 ) with DHA-PPQ and AM-LM , respectively . Coinciding with decreasing transmission in the study area , clinical tolerance to parasitemia ( defined as absence of fever ) declined between 2005–2006 and 2007–2008 ( OR body temperature > 37.5 ° C , 2.8 , 1.9–4.1 ; P<0.001 ) . Neither in vitro sensitivity of parasites to DHA nor levels of antibodies against parasite extract accounted for parasite clearance rates or changes thereof . Conclusions The significant , albeit small , decline through time of parasitological response rates to treatment with ACTs may be due to the emergence of parasites with reduced drug sensitivity , to the coincident reduction in population -level clinical immunity , or both . Maintaining the efficacy of artemisinin-based therapy in Africa would benefit from a better underst and ing of the mechanisms underlying reduced parasite clearance rates . Trial Registration Controlled-Trials.com IS RCT Background The choice of appropriate artemisinin-based combination therapy depends on several factors ( cost , efficacy , safety , reinfection rate and simplicity of administration ) . To assess whether the combination dihydroartemisinin-piperaquine ( DP ) could be an alternative to artemether-lumefantrine ( AL ) , the efficacy and the tolerability of the two products for the treatment of uncomplicated falciparum malaria in sub-Saharan Africa have been compared . Methods A multicentric open r and omized controlled clinical trial of three-day treatment of DP against AL for the treatment of two parallel groups of patients aged two years and above and suffering from uncomplicated falciparum malaria was carried out in Cameroon , Côte d'Ivoire and Senegal . Within each group , patients were r and omly assigned supervised treatment . DP was given once a day for three days and AL twice a day for three days . Follow-up visits were performed on day 1 to 4 and on day 7 , 14 , 21 , 28 to evaluate clinical and parasitological results . The primary endpoint was the recovery rate by day 28 . Results Of 384 patients enrolled , 197 were assigned DP and 187 AL . The recovery rates adjusted by genotyping , 99.5 % in the DP group and 98.9 % in the AL group , were not statistically different ( p = 0.538 ) . No Early Therapeutic Failure ( ETF 
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The frequency of other adverse events is probably similar with both combinations ( moderate quality evidence ) .
DHA‐P is associated with less nausea , vomiting , dizziness , sleeplessness , and palpitations compared to artesunate plus mefloquine ( moderate quality evidence ) .
DHA‐P was associated with more frequent prolongation of the QTc interval ( low quality evidence ) , but no cardiac arrhythmias were reported .
In Asia , dihydroartemisinin‐piperaquine is as effective as artesunate plus mefloquine , and is better tolerated