***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 Afghanistan 's national guidelines recommend chloroquine for the treatment of Plasmodium vivax infection , the parasite responsible for the majority of its malaria burden . Chloroquine resistance in P. vivax is emerging in Asia . Therapeutic responses across Afghanistan have not been evaluated in detail . Methods Between July 2007 and February 2009 , an open-label , r and omized controlled trial of chloroquine and dihydroartemisinin-piperaquine in patients aged three months and over with slide-confirmed P. vivax mono-infections was conducted . Consistent with current national guidelines , primaquine was not administered . Subjects were followed up daily during the acute phase of illness ( days 0 - 3 ) and weekly until day 56 . The primary endpoint was the overall cumulative parasitological failure rate at day 56 after the start of treatment , with the hypothesis being that dihydroartemisinin-piperaquine was non-inferior compared to chloroquine ( Δ = 5 % difference in proportion of failures ) . Results Of 2,182 individuals with positive blood films for P. vivax , 536 were enrolled in the trial . The day 28 cure rate was 100 % in both treatment groups . Parasite clearance was more rapid with dihydroartemisinin-piperaquine than chloroquine . At day 56 , there were more recurrent infections in the chloroquine arm ( 8.9 % , 95 % CI 6.0 - 13.1 % ) than the dihydroartemisinin-piperaquine arm ( 2.8 % , 95 % CI 1.4 - 5.8 % ) , a difference in cumulative recurrence rate of 6.1 % ( 2-sided 90%CI + 2.6 to + 9.7 % ) . The log-rank test comparing the survival curves confirmed the superiority of dihydroartemisinin-piperaquine over chloroquine ( p = 0.003 ) . Multivariate analysis showed that a lower initial haemoglobin concentration was also independently associated with recurrence . Both regimens were well tolerated and no serious adverse events were reported . Conclusions Chloroquine remains an efficacious treatment for the treatment of vivax malaria in Afghanistan . In a setting where radical therapy can not be administered , dihydroartemisinin-piperaquine provides additional benefit in terms of post-treatment prophylaxis , reducing the incidence of recurrence from 4 - 8 weeks after treatment . Trial Registration The trial was registered at Clinical Trials.gov under identifier NCT00682578 Background There is general international agreement that the importance of vivax malaria has been neglected , and there is a need for new treatment approaches in an effort to progress towards control and elimination in Latin America . This open label r and omized clinical trial evaluated the efficacy and safety of three treatment regimens using either one of two fixed dose artemisinin-based combinations or chloroquine in combination with a short course of primaquine ( 7–9 days : total dose 3–4.2 mg/kg ) in Brazil . The primary objective was establishing whether cure rates above 90 % could be achieved in each arm . Results A total of 264 patients were followed up to day 63 . The cure rate of all three treatment arms was greater than 90 % at 28 and 42 days . Cure rates were below 90 % in all three treatment groups at day 63 , although the 95 % confidence interval included 90 % for all three treatments . Most of the adverse events were mild in all treatment arms . Only one of the three serious adverse events was related to the treatment and significant drops in haemoglobin were rare . Conclusion This study demonstrated the efficacy and safety of all three regimens that were tested with 42-day cure rates that meet World Health Organization criteria . The efficacy and safety of artemisinin-based combination therapy regimens in this population offers the opportunity to treat all species of malaria with the same regimen , simplifying protocol s for malaria control programmes and potentially contributing to elimination of both vivax and falciparum malaria . Trial registration 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 The Bangladeshi national treatment guidelines for uncomplicated malaria follow WHO recommendations but without G6PD testing prior to primaquine administration . A prospect i ve observational study was conducted to assess the efficacy of the current antimalarial policy . Methods Patients with uncomplicated malaria , confirmed by microscopy , attending a health care facility in the Chittagong Hill Tracts , Bangladesh , were treated with artemether-lumefantrine ( days 0–2 ) plus single dose primaquine ( 0.75mg/kg on day2 ) for P. falciparum infections , or with chloroquine ( days 0–2 ) plus 14 days primaquine ( 3.5mg/kg total over 14 days ) for P. vivax infections . Hb was measured on days 0 , 2 and 9 in all patients and also on days 16 and 30 in patients with P. vivax infection . Participants were followed for 30 days . The study was registered with the clinical trials website ( NCT02389374 ) . Results Between September 2014 and February 2015 a total of 181 patients were enrolled ( 64 % P. falciparum , 30 % P. vivax and 6 % mixed infections ) . Median parasite clearance times were 22.0 ( Interquartile Range , IQR : 15.2–27.3 ) hours for P. falciparum , 20.0 ( IQR : 9.5–22.7 ) hours for P. vivax and 16.6 ( IQR : 10.0–46.0 ) hours for mixed infections . All participants were afebrile within 48 hours , two patients with P. falciparum infection remained parasitemic at 48 hours . No patient had recurrent parasitaemia within 30 days . Adjusted male median G6PD activity was 7.82U/gHb . One male participant ( 1/174 ) had severe G6PD deficiency ( < 10 % activity ) , five participants ( 5/174 ) had mild G6PD deficiency ( 10–60 % activity ) . The Hb nadir occurred on day 2 prior to primaquine treatment in P. falciparum and P. vivax infected patients ; mean fractional fall in Hb was -8.8 % ( 95%CI -6.7 % to -11.0 % ) and -7.4 % ( 95%CI : -4.5 to -10.4 % ) respectively . Conclusion The current antimalarial policy remains effective . The prevalence of G6PD deficiency was low . Main contribution to haemolysis in G6PD normal individuals was attributable to acute malaria rather than primaquine administration . Trial Registration Clinical Trials.gov Background Recent efforts in malaria control have result ed in great gains in reducing the burden of Plasmodium falciparum , but P. vivax has been more refractory . Its ability to form dormant liver stages confounds control and elimination efforts . To compare the efficacy and safety of primaquine regimens for radical cure , we undertook a r and omized controlled trial in Ethiopia . Methods and findings Patients with normal glucose-6-phosphate dehydrogenase status with symptomatic P. vivax mono-infection were enrolled and r and omly assigned to receive either chloroquine ( CQ ) or artemether-lumefantrine ( AL ) , alone or in combination with 14 d of semi-supervised primaquine ( PQ ) ( 3.5 mg/kg total ) . A total of 398 patients ( n = 104 in the CQ arm , n = 100 in the AL arm , n = 102 in the CQ+PQ arm , and n = 92 in the AL+PQ arm ) were followed for 1 y , and recurrent episodes were treated with the same treatment allocated at enrolment . The primary endpoints were the risk of P. vivax recurrence at day 28 and at day 42 . The risk of recurrent P. vivax infection at day 28 was 4.0 % ( 95 % CI 1.5%–10.4 % ) after CQ treatment and 0 % ( 95 % CI 0%–4.0 % ) after CQ+PQ . The corresponding risks were 12.0 % ( 95 % CI 6.8%–20.6 % ) following AL alone and 2.3 % ( 95 % CI 0.6%–9.0 % ) following AL+PQ . On day 42 , the risk was 18.7 % ( 95 % CI 12.2%–28.0 % ) after CQ , 1.2 % ( 95 % CI 0.2%–8.0 % ) after CQ+PQ , 29.9 % ( 95 % CI 21.6%–40.5 % ) after AL , and 5.9 % ( 95 % CI 2.4%–13.5 % ) after AL+PQ ( overall p < 0.001 ) . In those not prescribed PQ , the risk of recurrence by day 42 appeared greater following AL treatment than CQ treatment ( HR = 1.8 [ 95 % CI 1.0–3.2 ] ; p = 0.059 ) . At the end of follow-up , the incidence rate of P. vivax was 2.2 episodes/person-year for patients treated with CQ compared to 0.4 for patients treated with CQ+PQ ( rate ratio : 5.1 [ 95 % CI 2.9–9.1 ] ; p < 0.001 ) and 2.3 episodes/person-year for AL compared to 0.5 for AL+PQ ( rate ratio : 6.4 [ 95 % CI 3.6–11.3 ] ; p < 0.001 ) . There was no difference in the occurrence of adverse events between treatment arms . The main limitations of the study were the early termination of the trial and the omission of haemoglobin measurement after day 42 , result ing in an inability to estimate the cumulative risk of anaemia . Conclusions Despite evidence of CQ-resistant P. vivax , the risk of recurrence in this study was greater following treatment with AL unless it was combined with a supervised course of PQ . PQ combined with either CQ or AL was well tolerated and reduced recurrence of vivax malaria by 5-fold at 1 y. Trial registration Clinical Trials.gov The efficacy of chloroquine in the treatment of Plasmodium vivax malaria is declining on the Northwestern border of Thail and . This r and omized controlled trial in 500 adults and children shows that dihydroartemisinin-piperaquine is a safe and effective alternative treatment BACKGROUND Plasmodium knowlesi commonly causes severe malaria in Malaysian Borneo , with high case-fatality rates reported . We compared risk , spectrum , and outcome of severe disease from P. knowlesi , Plasmodium falciparum , and Plasmodium vivax and outcomes following introduction of protocol s for early referral and intravenous artesunate for all severe malaria . METHODS From September 2010 to October 2011 we prospect ively assessed nonpregnant patients aged ≥12 years admitted to Queen Elizabeth Hospital ( QEH ) , Sabah , with polymerase chain reaction-confirmed Plasmodium monoinfection . 
    Output:
    
In this study , we observed the risk of P. vivax recurrence at day 42 to be significantly lower following treatment with DP compared with AL , reflecting the longer period of post-treatment prophylaxis ; this risk was reduced substantially by coadministration with PQ .
We found that delaying P. vivax recurrence was associated with a small but significant improvement in haemoglobin .
These results highlight the benefits of PQ radical cure and also the provision of blood-stage antimalarial agents with prolonged post-treatment prophylaxis