Malaria study leads WHO to revise treatment guidelines

Artesunate reduces mortality by more than 20% compared with the standard treatment of quinine

The results of the largest ever clinical trial among patients hospitalised with severe malaria – the Wellcome Trust-funded AQUAMAT study – have led the World Health Organisation (WHO) to revise its guidelines for the treatment of the disease in African children.

AQUAMAT ('African quinine versus artesunate malaria trial') involved researchers across Africa, working in collaboration with scientists in Thailand and the UK. The randomised, controlled trial enrolled 5,425 children hospitalised with severe malaria across nine African countries. It showed a 22.5% reduction in mortality among patients treated with artesunate compared with those given the standard treatment of quinine.

In line with these findings, the WHO has now changed its treatment guidelines to recommend parenteral artesunate as first-line treatment in the management of severe malaria in African children. The disease remains a major killer, with these patients accounting for 90% of the one million malaria deaths that occur annually. Changing the first-line treatment from quinine to artesunate has the potential to save hundreds of thousands of children's lives across Africa each year.

Professor Nick White of Oxford University, who led the study, says: ‘The AQUAMAT trial is a very important step in reducing preventable childhood death in the tropics. It is very gratifying for the many investigators to see their research findings being turned into a globally influential policy. If implemented this will save hundreds of thousands of young lives.’

The AQUAMAT team has been shortlisted as one of the three finalists in the category of Research Paper of the Year in the British Medical Journal Awards.

‘This is clearly an immensely important piece of work by Nick White and colleagues and an excellent example of how multicentre research can be conducted across many countries and even continents,’ said Dr Jimmy Whitworth, head of international activities at the Wellcome Trust. ‘This has provided the rigorous evidence necessary to inform the WHO's revised guidelines and we hope this will have a dramatic effect on the lives of children across the African continent.’

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