@article{Henriques2013-ee,

title = {Artemisinin resistance in rodent malaria--mutation in the AP2 

 adaptor $mu$-chain suggests involvement of endocytosis and 

 membrane protein trafficking},

author = {Gisela Henriques and Axel Martinelli and Louise Rodrigues and Katarzyna Modrzynska and Richard Fawcett and Douglas R Houston and Sofia T Borges and Umberto d'Alessandro and Halidou Tinto and Corine Karema and Paul Hunt and Pedro Cravo},

year  = {2013},

date = {2013-04-01},

journal = {Malar. J.},

volume = {12},

number = {1},

pages = {118},

publisher = {Springer Nature},

abstract = {BACKGROUND: The control of malaria, caused by Plasmodium 

 falciparum, is hampered by the relentless evolution of drug 

 resistance. Because artemisinin derivatives are now used in the 

 most effective anti-malarial therapy, resistance to artemisinin 

 would be catastrophic. Indeed, studies suggest that artemisinin 

 resistance has already appeared in natural infections. 

 Understanding the mechanisms of resistance would help to prolong 

 the effective lifetime of these drugs. Genetic markers of 

 resistance are therefore required urgently. Previously, a 

 mutation in a de-ubiquitinating enzyme was shown to confer 

 artemisinin resistance in the rodent malaria parasite Plasmodium 

 chabaudi. METHODS: Here, for a mutant P. chabaudi malaria 

 parasite and its immediate progenitor, the in vivo artemisinin 

 resistance phenotypes and the mutations arising using Illumina 

 whole-genome re-sequencing were compared. RESULTS: An increased 

 artemisinin resistance phenotype is accompanied by one 

 non-synonymous substitution. The mutated gene encodes the 

 $mu$-chain of the AP2 adaptor complex, a component of the 

 endocytic machinery. Homology models indicate that the mutated 

 residue interacts with a cargo recognition sequence. In natural 

 infections of the human malaria parasite P. falciparum, 12 

 polymorphisms (nine SNPs and three indels) were identified in 

 the orthologous gene. CONCLUSION: An increased 

 artemisinin-resistant phenotype occurs along with a mutation in 

 a functional element of the AP2 adaptor protein complex. This 

 suggests that endocytosis and trafficking of membrane proteins 

 may be involved, generating new insights into possible 

 mechanisms of resistance. The genotypes of this adaptor protein 

 can be evaluated for its role in artemisinin responses in human 

 infections of P. falciparum.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{Tinto2013-rv,

title = {Good clinical practice in resource-limited settings: translating 

 theory into practice},

author = {Halidou Tinto and Ramadhani A Noor and Charles L Wanga and Innocent Valea and Maimouna Ndour Mbaye and Umberto D'Alessandro and Raffaella M Ravinetto},

year  = {2013},

date = {2013-04-01},

journal = {Am. J. Trop. Med. Hyg.},

volume = {88},

number = {4},

pages = {608--613},

publisher = {American Society of Tropical Medicine and Hygiene},

abstract = {A Good Clinical Practices (GCPs) course, based on the 

 combination of theoretical modules with a practical training in 

 real-life conditions, was held in 2010 in Burkina Faso. It was 

 attended by 15 trainees from nine African, Asian, and Latin 

 American countries. There were some discrepancies between the 

 average good results at the end of the theoretical phase and the 

 GCP application during the first days of the practical phase, 

 underlying the difficulties of translating theoretical knowledge 

 into good practices. Most of the findings were not unexpected 

 and reflected the challenges commonly faced by clinical 

 investigators in resource-poor contexts (i.e., the high workload 

 at peripheral health facilities, the need to conciliate routine 

 clinical activities with clinical research, and the risk of 

 creating a double standard among patients attending the same 

 health facility [free care for recruited patients versus user 

 fees for non-recruited patients with the same medical 

 condition]). Even if limited in number and time, these 

 observations suggest that a theoretical training alone may not 

 be sufficient to prepare trainees for the challenges of medical 

 research in real-life settings. Conversely, when a practical 

 phase immediately follows a theoretical one, trainees can 

 immediately experience what the research methodology implicates 

 in terms of work organization and relationship with recruited 

 and non-recruited patients. This initial experience shows the 

 complexity of translating GCP into practice and suggests the 

 need to rethink the current conception of GCP training.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{Bamba2013-ua,

title = {Traitement pr\'{e}ventif intermittent `a la sulfadoxine -- 

 pyrim\'{e}thamine du paludisme chez les femmes enceintes: 

 efficacit\'{e} et observance dans deux h^opitaux urbains du 

 Burkina Faso},

author = {Sanata Bamba and Adama S\'{e}r\'{e} and Rodrigues Niki\'{e}ma and Tinto Halidou and Blandine Thi\'{e}ba and Blami Dao and Robert Tinga Guiguemd\'{e}},

year  = {2013},

date = {2013-03-01},

journal = {Pan Afr. Med. J.},

volume = {14},

pages = {105},

publisher = {Pan African Medical Journal},

keywords = {Burkina Faso; Grossesse; Intermittent Preventive Treatment;   Malaria; effectiveness; observance; pyrimethamine; sulfadoxine;   woman},

pubstate = {published},

tppubtype = {article}

}

@article{Bisoffi2013-bz,

title = {Should malaria treatment be guided by a point of care rapid 

 test? A threshold approach to malaria management in rural 

 Burkina Faso},

author = {Zeno Bisoffi and Halidou Tinto and Bienvenu Sodiomon Sirima and Federico Gobbi and Andrea Angheben and Dora Buonfrate and Jef Van den Ende},

year  = {2013},

date = {2013-03-01},

journal = {PLoS One},

volume = {8},

number = {3},

pages = {e58019},

publisher = {Public Library of Science (PLoS)},

abstract = {BACKGROUND: In Burkina Faso, rapid diagnostic tests for malaria 

 have been made recently available. Previously, malaria was 

 managed clinically. This study aims at assessing which is the 

 best management option of a febrile patient in a hyperendemic 

 setting. Three alternatives are: treating presumptively, 

 testing, or refraining from both test and treatment. The test 

 threshold is the tradeoff between refraining and testing, the 

 test-treatment threshold is the tradeoff between testing and 

 treating. Only if the disease probability lies between the two 

 should the test be used. METHODS AND FINDINGS: Data for this 

 analysis was obtained from previous studies on malaria rapid 

 tests, involving 5220 patients. The thresholds were calculated, 

 based on disease risk, treatment risk and cost, test accuracy 

 and cost. The thresholds were then matched against the disease 

 probability. For a febrile child under 5 in the dry season, the 

 pre-test probability of clinical malaria (3.2%), was just above 

 the test/treatment threshold. In the rainy season, that 

 probability was 63%, largely above the test/treatment 

 threshold. For febrile children >5 years and adults in the dry 

 season, the probability was 1.7%, below the test threshold, 

 while in the rainy season it was higher (25.1%), and situated 

 between the two thresholds (3% and 60.9%), only if costs were 

 not considered. If they were, neither testing nor treating with 

 artemisinin combination treatments (ACT) would be recommended. 

 CONCLUSIONS: A febrile child under 5 should be treated 

 presumptively. In the dry season, the probability of clinical 

 malaria in adults is so low, that neither testing nor treating 

 with any regimen should be recommended. In the rainy season, if 

 costs are considered, a febrile adult should not be tested, nor 

 treated with ACT, but a possible alternative would be a 

 presumptive treatment with amodiaquine plus 

 sulfadoxine-pyrimethamine. If costs were not considered, testing 

 would be recommended.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{Ravinetto2013-hg,

title = {Challenges of non-commercial multicentre North-South 

 collaborative clinical trials},

author = {Raffaella M Ravinetto and Ambrose Talisuna and Maaike De Crop and Harry Loen and Joris Menten and Chantal Van Overmeir and Halidou Tinto and Raquel Gonzalez and Martin Meremikwu and Carolyn Nabasuma and Ghyslain M Ngoma and Corine Karema and Yeka Adoke and Mike Chaponda and Jean-Pierre Van Geertruyden and Umberto D'Alessandro},

year  = {2013},

date = {2013-02-01},

journal = {Trop. Med. Int. Health},

volume = {18},

number = {2},

pages = {237--241},

publisher = {Wiley},

abstract = {The last decade has witnessed a substantial increase of 

 multi-centre, public health-oriented clinical trials in poor 

 countries. However, non-commercial research groups have less 

 staff and financial resources than traditional commercial 

 sponsors, so the trial teams have to be creative to comply with 

 Good Clinical Practices (GCP) requirements. According to the 

 recent experience of a large multicentre trial on antimalarials, 

 major challenges result from the complexity of multiple ethical 

 review, the costs of in-depth monitoring at several sites, 

 setting up an adequate Good Clinical Laboratory Practices (GCLP) 

 framework, lack of insurers in host countries, and lack of 

 adequate non-commercial data management software. Public 

 research funding agencies need to consider these challenges in 

 their funding policies. They also could support common spaces 

 where North-South collaborative research groups may share 

 critical information, such as on research insurance and 

 open-source, GCP-compliant software. WHO should update its GCP 

 guidelines, which date back to 1995, to incorporate the 

 perspectives and needs of non-commercial clinical research.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{Ye2013-vs,

title = {Malaria mortality estimates: need for agreeable approach},

author = {Yazoume Ye and Catherine Kyobutungi and Bernhards Ogutu and Leopoldo Villegas and Diadier Diallo and Halidou Tinto and Abraham Oduro and Osman Sankoh},

year  = {2013},

date = {2013-02-01},

journal = {Trop. Med. Int. Health},

volume = {18},

number = {2},

pages = {219--221},

publisher = {Wiley},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{RTSS_Clinical_Trials_Partnership2012-am,

title = {A phase 3 trial of RTS,S/AS01 malaria vaccine in African 

 infants},

author = {S Clinical Trials Partnership RTS and Selidji Todagbe Agnandji and Bertrand Lell and Jos\'{e} Francisco Fernandes and B\'{e}atrice Peggy Abossolo and Barbara Gaelle Nfono Ondo Methogo and Anita Lumeka Kabwende and Ayola Akim Adegnika and Benjamin Mordm\"{u}ller and Saadou Issifou and Peter Gottfried Kremsner and Jahit Sacarlal and Pedro Aide and Miguel Lanaspa and John J Aponte and Sonia Machevo and Sozinho Acacio and Helder Bulo and Betuel Sigauque and Eus\'{e}bio Macete and Pedro Alonso and Salim Abdulla and Nahya Salim and Rose Minja and Maxmillian Mpina and Saumu Ahmed and Ali Mohammed Ali and Ali Takadir Mtoro and Ali Said Hamad and Paul Mutani and Marcel Tanner and Halidou Tinto and Umberto D'Alessandro and Hermann Sorgho and Innocent Valea and Bi\'{e}bo Bihoun and Issa Guiraud and Berenger Kabor\'{e} and Olivier Sombi\'{e} and Robert Tinga Guiguemd\'{e} and Jean Bosco Ou\'{e}draogo and Mary J Hamel and Simon Kariuki and Martina Oneko and Chris Odero and Kephas Otieno and Norbert Awino and Meredith McMorrow and Vincent Muturi-Kioi and Kayla F Laserson and Laurence Slutsker and Walter Otieno and Lucas Otieno and Nekoye Otsyula and Stacey Gondi and Allan Otieno and Victorine Owira and Esther Oguk and George Odongo and Jon Ben Woods and Bernhards Ogutu and Patricia Njuguna and Roma Chilengi and Pauline Akoo and Christine Kerubo and Charity Maingi and Trudie Lang and Ally Olotu and Philip Bejon and Kevin Marsh and Gabriel Mwambingu and Seth Owusu-Agyei and Kwaku Poku Asante and Kingsley Osei-Kwakye and Owusu Boahen and David Dosoo and Isaac Asante and George Adjei and Evans Kwara and Daniel Chandramohan and Brian Greenwood and John Lusingu and Samwel Gesase and Anangisye Malabeja and Omari Abdul and Coline Mahende and Edwin Liheluka and Lincoln Malle and Martha Lemnge and Thor G Theander and Chris Drakeley and Daniel Ansong and Tsiri Agbenyega and Samuel Adjei and Harry Owusu Boateng and Theresa Rettig and John Bawa and Justice Sylverken and David Sambian and Anima Sarfo and Alex Agyekum and Francis Martinson and Irving Hoffman and Tisungane Mvalo and Portia Kamthunzi and Rutendo Nkomo and Tapiwa Tembo and Gerald Tegha and Mercy Tsidya and Jane Kilembe and Chimwemwe Chawinga and W Ripley Ballou and Joe Cohen and Yolanda Guerra and Erik Jongert and Didier Lapierre and Amanda Leach and Marc Lievens and Opokua Ofori-Anyinam and Aur\'{e}lie Olivier and Johan Vekemans and Terrell Carter and David Kaslow and Didier Leboulleux and Christian Loucq and Afiya Radford and Barbara Savarese and David Schellenberg and Marla Sillman and Preeti Vansadia},

year  = {2012},

date = {2012-12-01},

journal = {N. Engl. J. Med.},

volume = {367},

number = {24},

pages = {2284--2295},

abstract = {BACKGROUND: The candidate malaria vaccine RTS,S/AS01 reduced 

 episodes of both clinical and severe malaria in children 5 to 17 

 months of age by approximately 50% in an ongoing phase 3 trial. 

 We studied infants 6 to 12 weeks of age recruited for the same 

 trial. METHODS: We administered RTS,S/AS01 or a comparator 

 vaccine to 6537 infants who were 6 to 12 weeks of age at the time 

 of the first vaccination in conjunction with Expanded Program on 

 Immunization (EPI) vaccines in a three-dose monthly schedule. 

 Vaccine efficacy against the first or only episode of clinical 

 malaria during the 12 months after vaccination, a coprimary end 

 point, was analyzed with the use of Cox regression. Vaccine 

 efficacy against all malaria episodes, vaccine efficacy against 

 severe malaria, safety, and immunogenicity were also assessed. 

 RESULTS: The incidence of the first or only episode of clinical 

 malaria in the intention-to-treat population during the 14 months 

 after the first dose of vaccine was 0.31 per person-year in the 

 RTS,S/AS01 group and 0.40 per person-year in the control group, 

 for a vaccine efficacy of 30.1% (95% confidence interval [CI], 

 23.6 to 36.1). Vaccine efficacy in the per-protocol population 

 was 31.3% (97.5% CI, 23.6 to 38.3). Vaccine efficacy against 

 severe malaria was 26.0% (95% CI, -7.4 to 48.6) in the 

 intention-to-treat population and 36.6% (95% CI, 4.6 to 57.7) 

 in the per-protocol population. Serious adverse events occurred 

 with a similar frequency in the two study groups. One month after 

 administration of the third dose of RTS,S/AS01, 99.7% of 

 children were positive for anti-circumsporozoite antibodies, with 

 a geometric mean titer of 209 EU per milliliter (95% CI, 197 to 

 222). CONCLUSIONS: The RTS,S/AS01 vaccine coadministered with EPI 

 vaccines provided modest protection against both clinical and 

 severe malaria in young infants. (Funded by GlaxoSmithKline 

 Biologicals and the PATH Malaria Vaccine Initiative; RTS,S 

 ClinicalTrials.gov number, NCT00866619.).},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{Derra2012-bz,

title = {Profile: Nanoro Health and Demographic Surveillance System},

author = {Karim Derra and Eli Rouamba and Adama Kazienga and Sayouba Ouedraogo and Marc C Tahita and Hermann Sorgho and Innocent Valea and Halidou Tinto},

year  = {2012},

date = {2012-10-01},

journal = {Int. J. Epidemiol.},

volume = {41},

number = {5},

pages = {1293--1301},

publisher = {Oxford University Press (OUP)},

abstract = {The Nanoro Health and Demographic Surveillance System (HDSS), 

 located in the rural centre of Burkina Faso, was established in 

 2009 by the Clinical Research Unit of Nanoro with the aim of 

 providing a core framework for clinical trials and also to 

 support the Burkina Faso health authorities in generating 

 epidemiological data that can contribute to the setup and 

 assessment of health interventions. In the baseline of initial 

 census, 54 781 individuals were recorded of whom 56.1% are 

 female. After the initial census, vital events such as 

 pregnancies, births, migrations and deaths have been monitored, 

 and data on individuals and household characteristics are 

 updated during regular 4-monthly household visits. The available 

 data are categorized into demographic, cultural, socio-economic 

 and health information, and are used for monitoring and 

 evaluation of population development issues. As a young site, 

 our objective has been to strengthen our skills and knowledge 

 and share new scientific experiences with INDEPTH and HDSS sites 

 in Burkina Faso. In addition, all data produced by the Nanoro 

 HDSS will be made publicly available through the INDEPTH data 

 sharing system.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{Kattenberg2012-oz,

title = {Evaluation of antigen detection tests, microscopy, and 

 polymerase chain reaction for diagnosis of malaria in peripheral 

 blood in asymptomatic pregnant women in Nanoro, Burkina Faso},

author = {Johanna H Kattenberg and Christian M Tahita and Inge A J Versteeg and Halidou Tinto and Maminata Traor\'{e} Coulibaly and Umberto D'Alessandro and Henk D F H Schallig and Petra F Mens},

year  = {2012},

date = {2012-08-01},

journal = {Am. J. Trop. Med. Hyg.},

volume = {87},

number = {2},

pages = {251--256},

publisher = {American Society of Tropical Medicine and Hygiene},

abstract = {Rapid diagnostics tests (RDTs) detect malaria specific 

 antigen(s) in the circulation, even when parasites are 

 sequestered in the placenta and not visible by microscopy. 

 However, research on their diagnostic accuracy during pregnancy is limited. Pregnant women (n = 418) were screened for malaria 

 during routine antenatal care by using two RDTs that detect 

 histidine-rich protein 2 (HRP2) or Plasmodium lactate 

 dehydrogenase, and enzyme-linked immunosorbent assays with 

 antibodies that detect dihydrofolate reductase-thymidylate 

 synthase or heme-detoxification protein, and compared with 

 real-time polymerase chain reaction (RT-PCR) and microscopy for 

 evaluation of their diagnostic accuracy. Prevalence of malaria 

 infection was high (53% by PCR). The RT-PCR and the HRP2 RDT 

 detected most cases of malaria during pregnancy, whereas 

 microscopy, the Plasmodium lactate dehydrogenase RDT, and 

 enzyme-linked immunosorbent assays for dihydrofolate 

 reductase-thymidylate synthase and heme-detoxification protein 

 antibodies did not detect several low-density infections. 

 Therefore, the HRP2 RDT could be a useful tool in 

 high-transmission areas for diagnosis of malaria in asymptomatic 

 pregnant women.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{Kattenberg2012-hg,

title = {Antigen persistence of rapid diagnostic tests in pregnant women 

 in Nanoro, Burkina Faso, and the implications for the diagnosis 

 of malaria in pregnancy},

author = {Johanna H Kattenberg and Christian M Tahita and Inge A J Versteeg and Halidou Tinto and Maminata Traor\'{e}-Coulibaly and Henk D F H Schallig and Petra F Mens},

year  = {2012},

date = {2012-05-01},

journal = {Trop. Med. Int. Health},

volume = {17},

number = {5},

pages = {550--557},

publisher = {Wiley},

abstract = {OBJECTIVES: To evaluate persistence of several Plasmodium 

 antigens in pregnant women after treatment and compare 

 diagnostics during treatment follow-up. METHODS: Thirty-two pregnant women (N = 32) with confirmed malaria infection by a 

 histidine-rich protein 2 (HRP2)-based rapid diagnostic test 

 (RDT) and microscopy were followed for 28 days after 

 artemisinin-based combination therapy (ACT). A Plasmodium 

 lactate dehydrogenase (pLDH)-based RDT and two ELISAs based on 

 the detection of dihydrofolate reductase-thymidylate synthase 

 (DHFR-TS) and haeme detoxification protein (HDP) were compared 

 with each other and to RT-PCR at each visit. RESULTS: The mean 

 visit number (95% confidence interval) on which the HRP2-based 

 RDT was still positive after treatment was 3.4 (2.7-4.1) visits 

 with some patients still positive at day 28. This is 

 significantly later than the pLDH-based RDT [0.84 (0.55-1.1)], 

 microscopy (median 1, range 1-3), DHFR-TS-ELISA [1.7 (1.1-2.3)] 

 and RT-PCR (median 2, range 1-5) (P < 0.05), but not 

 significantly later than HDP-ELISA [2.1 (1.6-2.7)]. Lower 

 gravidity and higher parasite density at day 0 resulted in 

 significantly longer positive results with most tests (P < 

 0.05). CONCLUSIONS: HRP2 can persist up to 28 days after ACT 

 treatment; therefore, this test is not suitable for treatment 

 follow-up in pregnant women and can generate problems when using 

 this test during intermittent preventive treatment (IPTp). 

 DHFR-TS is less persistent than HRP2, making it a potentially 

 interesting target for diagnosis.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{Rueangweerayut2012-is,

title = {Pyronaridine-artesunate versus mefloquine plus artesunate for 

 malaria},

author = {Ronnatrai Rueangweerayut and Aung Pyae Phyo and Chirapong Uthaisin and Yi Poravuth and Tran Quang Binh and Halidou Tinto and Louis K P\'{e}nali and Neena Valecha and Nong Thi Tien and Salim Abdulla and Isabelle Borghini-Fuhrer and Stephan Duparc and Chang-Sik Shin and Lawrence Fleckenstein and Pyronaridine-Artesunate Study Team},

year  = {2012},

date = {2012-04-01},

journal = {N. Engl. J. Med.},

volume = {366},

number = {14},

pages = {1298--1309},

abstract = {BACKGROUND: Pyronaridine-artesunate is an artemisinin-based 

 combination therapy under evaluation for the treatment of 

 Plasmodium falciparum and P. vivax malaria. METHODS: We conducted 

 a phase 3, open-label, multicenter, noninferiority trial that 

 included 1271 patients between 3 and 60 years of age from Asia 

 (81.3%) or Africa (18.7%) with microscopically confirmed, 

 uncomplicated P. falciparum malaria. Patients underwent 

 randomization for treatment with a fixed-dose combination of 180 

 mg of pyronaridine and 60 mg of artesunate or with 250 mg of 

 mefloquine plus 100 mg of artesunate. Doses were calculated 

 according to body weight and administered once daily for 3 days. 

 RESULTS: Pyronaridine-artesunate was noninferior to mefloquine 

 plus artesunate for the primary outcome: adequate clinical and 

 parasitologic response in the per-protocol population on day 28, 

 corrected for reinfection with the use of 

 polymerase-chain-reaction (PCR) genotyping. For this outcome, 

 efficacy in the group receiving pyronaridine-artesunate was 

 99.2% (743 of 749 patients; 95% confidence interval [CI], 98.3 

 to 99.7) and that in the group receiving mefloquine plus 

 artesunate was 97.8% (360 of 368 patients; 95% CI, 95.8 to 

 99.1), with a treatment difference of 1.4 percentage points (95% CI, 0.0 to 3.5; P=0.05). In the intention-to-treat population, 

 efficacy on day 42 in the group receiving pyronaridine-artesunate 

 was 83.1% (705 of 848 patients; 95% CI, 80.4 to 85.6) and that 

 in the group receiving mefloquine plus artesunate was 83.9% (355 

 of 423 patients; 95% CI, 80.1 to 87.3). In Cambodia, where there 

 were 211 study patients, the median parasite clearance time was 

 prolonged for both treatments: 64 hours versus 16.0 to 38.9 hours 

 in other countries (P<0.001, on the basis of Kaplan-Meier 

 estimates). Kaplan-Meier estimates of the recrudescence rate in 

 the intention-to-treat population in Cambodia until day 42 were 

 higher with pyronaridine-artesunate than with mefloquine plus artesunate (10.2% [95% CI, 5.4 to 18.6] vs. 0%; P=0.04 as 

 calculated with the log-rank test), but similar for the other 

 countries combined (4.7% [95% CI, 3.3 to 6.7] and 2.8% [95% CI, 1.5 to 5.3], respectively; P=0.24). Elevated levels of 

 aminotransferases were observed in those receiving 

 pyronaridine-artesunate. Two patients receiving mefloquine plus 

 artesunate had seizures. CONCLUSIONS: Fixed-dose 

 pyronaridine-artesunate was efficacious in the treatment of 

 uncomplicated P. falciparum malaria. In Cambodia, extended 

 parasite clearance times were suggestive of in vivo resistance to 

 artemisinin. (Funded by Shin Poong Pharmaceutical Company and the 

 Medicines for Malaria Venture; ClinicalTrials.gov number, 

 NCT00403260.).},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{Valea2012-pp,

title = {An analysis of timing and frequency of malaria infection during 

 pregnancy in relation to the risk of low birth weight, anaemia 

 and perinatal mortality in Burkina Faso},

author = {Innocent Valea and Halidou Tinto and Maxime K Drabo and Lieven Huybregts and Hermann Sorgho and Jean-Bosco Ouedraogo and Robert T Guiguemde and Jean Pierre Geertruyden and Patrick Kolsteren and Umberto D'Alessandro and FSP/MISAME Group},

year  = {2012},

date = {2012-03-01},

journal = {Malar. J.},

volume = {11},

number = {1},

pages = {71},

publisher = {Springer Nature},

abstract = {BACKGROUND: A prospective study aiming at assessing the effect 

 of adding a third dose sulphadoxine-pyrimethamine (SP) to the 

 standard two-dose intermittent preventive treatment for pregnant 

 women was carried out in Hounde, Burkina Faso, between March 

 2006 and July 2008. Pregnant women were identified as earlier as 

 possible during pregnancy through a network of home visitors, 

 referred to the health facilities for inclusion and followed up 

 until delivery. METHODS: Study participants were enrolled at 

 antenatal care (ANC) visits and randomized to receive either two 

 or three doses of SP at the appropriate time. Women were visited 

 daily and a blood slide was collected when there was fever (body 

 temperature > 37.5°C) or history of fever. Women were encouraged 

 to attend ANC and deliver in the health centre, where the 

 new-born was examined and weighed. The timing and frequency of 

 malaria infection was analysed in relation to the risk of low 

 birth weight, maternal anaemia and perinatal mortality. RESULTS: 

 Data on birth weight and haemoglobin were available for 1,034 

 women. The incidence of malaria infections was significantly 

 lower in women having received three instead of two doses of SP. 

 Occurrence of first malaria infection during the first or second 

 trimester was associated with a higher risk of low birth weight: incidence rate ratios of 3.56 (p < 0.001) and 1.72 (p = 0.034), 

 respectively. After adjusting for possible confounding factors, 

 the risk remained significantly higher for the infection in the first trimester of pregnancy (adjusted incidence rate ratio = 2.0},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{RTSS_Clinical_Trials_Partnership2011-gv,

title = {First results of phase 3 trial of RTS,S/AS01 malaria vaccine 

 in African children},

author = {S Clinical Trials Partnership RTS and Selidji Todagbe Agnandji and Bertrand Lell and Solange Solmeheim Soulanoudjingar and Jos\'{e} Francisco Fernandes and B\'{e}atrice Peggy Abossolo and Cornelia Conzelmann and Barbara Gaelle Nfono Ondo Methogo and Yannick Doucka and Arnaud Flamen and Benjamin Mordm\"{u}ller and Saadou Issifou and Peter Gottfried Kremsner and Jahit Sacarlal and Pedro Aide and Miguel Lanaspa and John J Aponte and Arlindo Nhamuave and Diana Quelhas and Quique Bassat and Sofia Mandjate and Eus\'{e}bio Macete and Pedro Alonso and Salim Abdulla and Nahya Salim and Omar Juma and Mwanajaa Shomari and Kafuruki Shubis and Francisca Machera and Ali Said Hamad and Rose Minja and Ali Mtoro and Alma Sykes and Saumu Ahmed and Alwisa Martin Urassa and Ali Mohammed Ali and Grace Mwangoka and Marcel Tanner and Halidou Tinto and Umberto D'Alessandro and Hermann Sorgho and Innocent Valea and Marc Christian Tahita and William Kabor\'{e} and Sayouba Ou\'{e}draogo and Yara Sandrine and Robert Tinga Guiguemd\'{e} and Jean Bosco Ou\'{e}draogo and Mary J Hamel and Simon Kariuki and Chris Odero and Martina Oneko and Kephas Otieno and Norbert Awino and Jackton Omoto and John Williamson and Vincent Muturi-Kioi and Kayla F Laserson and Laurence Slutsker and Walter Otieno and Lucas Otieno and Otsyula Nekoye and Stacey Gondi and Allan Otieno and Bernhards Ogutu and Ruth Wasuna and Victorine Owira and David Jones and Agnes Akoth Onyango and Patricia Njuguna and Roma Chilengi and Pauline Akoo and Christine Kerubo and Jesse Gitaka and Charity Maingi and Trudie Lang and Ally Olotu and Benjamin Tsofa and Philip Bejon and Norbert Peshu and Kevin Marsh and Seth Owusu-Agyei and Kwaku Poku Asante and Kingsley Osei-Kwakye and Owusu Boahen and Samuel Ayamba and Kingsley Kayan and Ruth Owusu-Ofori and David Dosoo and Isaac Asante and George Adjei and George Adjei and Daniel Chandramohan and Brian Greenwood and John Lusingu and Samwel Gesase and Anangisye Malabeja and Omari Abdul and Hassan Kilavo and Coline Mahende and Edwin Liheluka and Martha Lemnge and Thor Theander and Chris Drakeley and Daniel Ansong and Tsiri Agbenyega and Samuel Adjei and Harry Owusu Boateng and Theresa Rettig and John Bawa and Justice Sylverken and David Sambian and Alex Agyekum and Larko Owusu and Francis Martinson and Irving Hoffman and Tisungane Mvalo and Portia Kamthunzi and Ruthendo Nkomo and Albans Msika and Allan Jumbe and Nelecy Chome and Dalitso Nyakuipa and Joseph Chintedza and W Ripley Ballou and Myriam Bruls and Joe Cohen and Yolanda Guerra and Erik Jongert and Didier Lapierre and Amanda Leach and Marc Lievens and Opokua Ofori-Anyinam and Johan Vekemans and Terrell Carter and Didier Leboulleux and Christian Loucq and Afiya Radford and Barbara Savarese and David Schellenberg and Marla Sillman and Preeti Vansadia},

year  = {2011},

date = {2011-11-01},

journal = {N. Engl. J. Med.},

volume = {365},

number = {20},

pages = {1863--1875},

publisher = {New England Journal of Medicine (NEJM/MMS)},

abstract = {BACKGROUND: An ongoing phase 3 study of the efficacy, safety, 

 and immunogenicity of candidate malaria vaccine RTS,S/AS01 is 

 being conducted in seven African countries. METHODS: From March 

 2009 through January 2011, we enrolled 15,460 children in two 

 age categories--6 to 12 weeks of age and 5 to 17 months of 

 age--for vaccination with either RTS,S/AS01 or a non-malaria 

 comparator vaccine. The primary end point of the analysis was 

 vaccine efficacy against clinical malaria during the 12 months 

 after vaccination in the first 6000 children 5 to 17 months of 

 age at enrollment who received all three doses of vaccine 

 according to protocol. After 250 children had an episode of 

 severe malaria, we evaluated vaccine efficacy against severe 

 malaria in both age categories. RESULTS: In the 14 months after 

 the first dose of vaccine, the incidence of first episodes of 

 clinical malaria in the first 6000 children in the older age 

 category was 0.32 episodes per person-year in the RTS,S/AS01 

 group and 0.55 episodes per person-year in the control group, 

 for an efficacy of 50.4% (95% confidence interval [CI], 45.8 

 to 54.6) in the intention-to-treat population and 55.8% (97.5% 

 CI, 50.6 to 60.4) in the per-protocol population. Vaccine 

 efficacy against severe malaria was 45.1% (95% CI, 23.8 to 

 60.5) in the intention-to-treat population and 47.3% (95% CI, 

 22.4 to 64.2) in the per-protocol population. Vaccine efficacy 

 against severe malaria in the combined age categories was 34.8% 

 (95% CI, 16.2 to 49.2) in the per-protocol population during an 

 average follow-up of 11 months. Serious adverse events occurred 

 with a similar frequency in the two study groups. Among children 

 in the older age category, the rate of generalized convulsive 

 seizures after RTS,S/AS01 vaccination was 1.04 per 1000 doses 

 (95% CI, 0.62 to 1.64). CONCLUSIONS: The RTS,S/AS01 vaccine 

 provided protection against both clinical and severe malaria in 

 African children. (Funded by GlaxoSmithKline Biologicals and the 

 PATH Malaria Vaccine Initiative; RTS,S ClinicalTrials.gov 

 number, NCT00866619 .).},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{Bisoffi2011-dn,

title = {Strict adherence to malaria rapid test results might lead to a 

 neglect of other dangerous diseases: a cost benefit analysis 

 from Burkina Faso},

author = {Zeno Bisoffi and Sodiomon B Sirima and Filip Meheus and Claudia Lodesani and Federico Gobbi and Andrea Angheben and Halidou Tinto and Bouma Neya and Klara Van den Ende and Annalisa Romeo and Jef Van den Ende},

year  = {2011},

date = {2011-08-01},

journal = {Malar. J.},

volume = {10},

number = {1},

pages = {226},

publisher = {Springer Nature},

abstract = {BACKGROUND: Malaria rapid diagnostic tests (RDTs) have generally 

 been found reliable and cost-effective. In Burkina Faso, the 

 adherence of prescribers to the negative test result was found 

 to be poor. Moreover, the test accuracy for malaria-attributable 

 fever (MAF) is not the same as for malaria infection. This paper 

 aims at determining the costs and benefits of two competing 

 strategies for the management of MAF: presumptive treatment for 

 all or use of RDTs. METHODS: A cost benefit analysis was carried 

 out using a decision tree, based on data previously obtained, 

 including a randomized controlled trial (RCT) recruiting 852 

 febrile patients during the dry season and 1,317 in the rainy 

 season. Cost and benefit were calculated using both the real 

 adherence found by the RCT and assuming an ideal adherence of 

 90% with the negative result. The main parameters were 

 submitted to sensitivity analysis. RESULTS AND DISCUSSION: At 

 real adherence, the test-based strategy was dominated. Assuming 

 ideal adherence, at the value of 525 € for a death averted, the 

 total cost of managing 1,000 febrile children was 1,747 vs. 

 1,862 € in the dry season and 1,372 vs. 2,138 in the rainy 

 season for the presumptive vs. the test-based strategy. For 

 adults it was 2,728 vs. 1,983 and 2,604 vs. 2,225, respectively. 

 At the subsidized policy adopted locally, assuming ideal 

 adherence, the RDT would be the winning strategy for adults in 

 both seasons and for children in the dry season.At sensitivity 

 analysis, the factors most influencing the choice of the better 

 strategy were the value assigned to a death averted and the 

 proportion of potentially severe NMFI treated with antibiotics 

 in patients with false positive RDT results. The test-based 

 strategy appears advantageous for adults if a satisfactory 

 adherence could be achieved. For children the presumptive 

 strategy remains the best choice for a wide range of scenarios. 

 CONCLUSIONS: For RDTs to be preferred, a positive result should 

 not influence the decision to treat a potentially severe NMFI 

 with antibiotics. In the rainy season the presumptive strategy 

 always remains the better choice for children.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{Swysen2011-lr,

title = {Development of standardized laboratory methods and quality 

 processes for a phase III study of the RTS, S/AS01 

 candidate malaria vaccine},

author = {Christine Swysen and Johan Vekemans and Myriam Bruls and Sunny Oyakhirome and Chris Drakeley and Peter Kremsner and Brian Greenwood and Opokua Ofori-Anyinam and Brenda Okech and Tonya Villafana and Terrell Carter and Barbara Savarese and Adriano Duse and Andrea Reijman and Charlotte Ingram and John Frean and Bernhards Ogutu and Clinical Trials Partnership Committee},

year  = {2011},

date = {2011-08-01},

journal = {Malar. J.},

volume = {10},

number = {1},

pages = {223},

publisher = {Springer Nature},

abstract = {BACKGROUND: A pivotal phase III study of the RTS,S/AS01 malaria 

 candidate vaccine is ongoing in several research centres across 

 Africa. The development and establishment of quality systems was 

 a requirement for trial conduct to meet international regulatory 

 standards, as well as providing an important capacity 

 strengthening opportunity for study centres. METHODS: 

 Standardized laboratory methods and quality assurance processes 

 were implemented at each of the study centres, facilitated by 

 funding partners. RESULTS: A robust protocol for determination 

 of parasite density based on actual blood cell counts was set up 

 in accordance with World Health Organization recommendations. 

 Automated equipment including haematology and biochemistry 

 analyzers were put in place with standard methods for bedside 

 testing of glycaemia, base excess and lactacidaemia. Facilities 

 for X-rays and basic microbiology testing were also provided or 

 upgraded alongside health care infrastructure in some centres. 

 External quality assurance assessment of all major laboratory 

 methods was established and method qualification by each 

 laboratory demonstrated. The resulting capacity strengthening 

 has ensured laboratory evaluations are conducted locally to the 

 high standards required in clinical trials. CONCLUSION: Major 

 efforts by study centres, together with support from 

 collaborating parties, have allowed standardized methods and 

 robust quality assurance processes to be put in place for the 

 phase III evaluation of the RTS, S/AS01 malaria candidate 

 vaccine. Extensive training programmes, coupled with continuous 

 commitment from research centre staff, have been the key 

 elements behind the successful implementation of quality 

 processes. It is expected these activities will culminate in 

 healthcare benefits for the subjects and communities 

 participating in these trials. TRIAL REGISTRATION: 

 Clinicaltrials.gov NCT00866619.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{Ravinetto2011-tb,

title = {Double ethical review of North-South collaborative clinical 

 research: hidden paternalism or real partnership?},

author = {Raffaella Ravinetto and Anne Buv\'{e} and Tinto Halidou and Pascal Lutumba and Ambrose Talisuna and Mohammad Juffrie and Umberto D'Alessandro and Marleen Boelaert},

year  = {2011},

date = {2011-04-01},

journal = {Trop. Med. Int. Health},

volume = {16},

number = {4},

pages = {527--530},

publisher = {Wiley},

abstract = {Despite their universal character, the ethical principles 

 governing clinical research need to be translated into 

 procedures and practices, which will vary among countries and 

 regions because of differences in local cultural norms and in 

 the available resources. Double ethical review, by which a 

 research protocol is submitted for ethical clearance both in the 

 country or countries where the research takes place and in the 

 country of the sponsor or funding agency, will then help ensure 

 that all relevant perspectives are taken into account. In 

 addition, a geographically and culturally close ethics committee 

 can do a much better informed and comprehensive assessment of 

 the respective skills of the clinical sites and of the sponsor. 

 But the practical implementation of double ethical review can 

 bring significant difficulties and delays, especially in 

 multi-site and multi-country researches. Currently, most ethics 

 committees do not proactively seek communication with others 

 evaluating the same research protocol in different 

 socio-economical and cultural contexts, so in practice there is 

 no mutual learning process. Proactive communication would help 

 to build collaborative partnership among ethical bodies, 

 promoting common practices and resolving conflicting opinions.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{Valea2010-af,

title = {Intermittent preventive treatment of malaria with 

 sulphadoxine-pyrimethamine during pregnancy in Burkina Faso: 

 effect of adding a third dose to the standard two-dose regimen 

 on low birth weight, anaemia and pregnancy outcomes},

author = {Innocent Valea and Halidou Tinto and Maxime K Drabo and Lieven Huybregts and Marie-Claire Henry and Dominique Roberfroid and Robert T Guiguemde and Patrick Kolsteren and Umberto D'Alessandro and FSP/MISAME Group},

year  = {2010},

date = {2010-11-01},

journal = {Malar. J.},

volume = {9},

number = {1},

pages = {324},

publisher = {Springer Nature},

abstract = {BACKGROUND: Intermittent preventive treatment with 

 sulphadoxine-pyrimethamine (IPTp-SP) is being implemented in 

 most malaria endemic countries as a standard two-doses regimen 

 as it reduces the risk of low birth weight (LBW) and the 

 prevalence of maternal anaemia. Nevertheless, where the risk of 

 infection close to delivery is high because of intense 

 transmission, a third IPTp-SP dose may further reduce the 

 negative effects of malaria on pregnancy outcome. METHODS: 

 Pregnant women in the 2nd or 3rd trimester were randomized to 

 receive either 2 (SP2) or 3 doses (SP3) of SP. Trained field 

 workers paid home visits to the women for drug administration 

 according to a predefined drug delivery schedule. Women were 

 encouraged to attend their scheduled ANC visits and to deliver 

 at the health facilities where the new-born was weighed. The 

 prevalence of LBW (<2500 g), severe anaemia (Hb < 8 g/dL) and 

 premature birth was analysed using intention-to-treat (ITT) and 

 per-protocol (PP) analysis. RESULTS: Data from 1274 singleton 

 pregnancies were analysed (641 in the SP3 and 633 in the SP2 

 group). The uptake of the intervention appeared to be low. 

 Though the prevalence of LBW in both intervention groups was similar (adjusted Incident Rate Rati},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{Bisoffi2010-jd,

title = {Accuracy of a rapid diagnostic test on the diagnosis of malaria 

 infection and of malaria-attributable fever during low and high 

 transmission season in Burkina Faso},

author = {Zeno Bisoffi and Sodiomon B Sirima and Joris Menten and Cristian Pattaro and Andrea Angheben and Federico Gobbi and Halidou Tinto and Claudia Lodesani and Bouma Neya and Maria Gobbo and Jef Van den Ende},

year  = {2010},

date = {2010-07-01},

journal = {Malar. J.},

volume = {9},

number = {1},

pages = {192},

publisher = {Springer Nature},

abstract = {BACKGROUND: Malaria management policies currently recommend that 

 the treatment should only be administered after laboratory 

 confirmation. Where microscopy is not available, rapid 

 diagnostic tests (RDTs) are the usual alternative. Conclusive 

 evidence is still lacking on the safety of a test-based strategy 

 for children. Moreover, no formal attempt has been made to 

 estimate RDTs accuracy on malaria-attributable fever. This study 

 aims at estimating the accuracy of a RDT for the diagnosis of 

 both malaria infection and malaria - attributable fever, in a 

 region of Burkina Faso with a typically seasonal malaria 

 transmission pattern. METHODS: Cross-sectional study. SUBJECTS: 

 all patients aged > 6 months consulting during the study 

 periods. Gold standard for the diagnosis of malaria infection 

 was microscopy. Gold standard for malaria-attributable fever was 

 the number of fevers attributable to malaria, estimated by 

 comparing parasite densities of febrile versus non-febrile 

 subjects. EXCLUSION CRITERIA: severe clinical condition needing 

 urgent care. RESULTS: In the dry season, 186/852 patients with 

 fever (22%) and 213/1,382 patients without fever (15%) had a 

 Plasmodium falciparum infection. In the rainy season, this 

 proportion was 841/1,317 (64%) and 623/1,669 (37%), 

 respectively. The attributable fraction of fever to malaria was 

 11% and 69%, respectively. The RDT was positive in 113/400 

 (28.3%) fever cases in the dry season, and in 443/650 (68.2%) 

 in the rainy season. In the dry season, the RDT sensitivity and 

 specificity for malaria infection were 86% and 90% 

 respectively. In the rainy season they were 94% and 78% 

 respectively. In the dry season, the RDT sensitivity and 

 specificity for malaria-attributable fever were 94% and 75%, 

 the positive predictive value (PPV) was 9% and the negative 

 predictive value (NPV) was 99.8%. In the rainy season the test 

 sensitivity for malaria-attributable fever was 97% and 

 specificity was 55%. The PPV ranged from 38% for adults to 

 82% for infants, while the NPV ranged from 84% for infants to 

 over 99% for adults. CONCLUSIONS: In the dry season the RDT has 

 a low positive predictive value, but a very high negative 

 predictive value for malaria-attributable fever. In the rainy 

 season the negative test safely excludes malaria in adults but 

 not in children.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{Bassat2009-xq,

title = {Dihydroartemisinin-piperaquine and artemether-lumefantrine for 

 treating uncomplicated malaria in African children: a 

 randomised, non-inferiority trial},

author = {Quique Bassat and Modest Mulenga and Halidou Tinto and Patrice Piola and Steffen Borrmann and Clara Men\'{e}ndez and Michael Nambozi and Innocent Val\'{e}a and Carolyn Nabasumba and Philip Sasi and Antonella Bacchieri and Marco Corsi and David Ubben and Ambrose Talisuna and Umberto D'Alessandro},

year  = {2009},

date = {2009-11-01},

journal = {PLoS One},

volume = {4},

number = {11},

pages = {e7871},

publisher = {Public Library of Science (PLoS)},

abstract = {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, Uganda and Zambia). Patients were 

 randomised (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 populations, and two of them are presented 

 here: intention-to-treat (ITT) and enlarged per-protocol (ePP). 

 1553 children were randomised, 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 populations, 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 settings, 

 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 

 ISRCTN16263443.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{Bisoffi2009-zh,

title = {Rapid malaria diagnostic tests vs. clinical management of 

 malaria in rural Burkina Faso: safety and effect on clinical 

 decisions. A randomized trial},

author = {Zeno Bisoffi and Bienvenu Sodiomon Sirima and Andrea Angheben and Claudia Lodesani and Federico Gobbi and Halidou Tinto and Jef Van den Ende},

year  = {2009},

date = {2009-05-01},

journal = {Trop. Med. Int. Health},

volume = {14},

number = {5},

pages = {491--498},

publisher = {Wiley},

abstract = {OBJECTIVES: To assess if the clinical outcome of patients 

 treated after performing a Rapid Diagnostic Test for malaria 

 (RDT) is at least equivalent to that of controls (treated 

 presumptively without test) and to determine the impact of the 

 introduction of a malaria RDT on clinical decisions. METHODS: 

 Randomized, multi-centre, open clinical trial in two arms in 

 2006 at the end of the dry and of the rainy season in 10 

 peripheral health centres in Burkina Faso: one arm with use of 

 RDT before treatment decision, one arm managed clinically. 

 Primary endpoint: persistence of fever at day 4. Secondary 

 endpoints: frequency of malaria treatment and of antibiotic 

 treatment. RESULTS: A total of 852 febrile patients were 

 recruited in the dry season and 1317 febrile patients in the 

 rainy season, and randomized either to be submitted to RDT 

 (P_RTD) or to be managed presumptively (P_CLIN). In both 

 seasons, no significant difference was found between the two 

 randomized groups in the frequency of antimalarial treatment, 

 nor of antibiotic prescription. In the dry season, 80.8% and 

 79.8% of patients with a negative RDT were nevertheless 

 diagnosed and treated for malaria, and so were 85.0% and 82.6% 

 negative patients in the rainy season. In the rainy season only, 

 both diagnosis and treatment of other conditions were 

 significantly less frequent in RDT positive vs. negative patients (48.3% vs. 61.4% and 46.2% vs. 59.9},

keywords = {},

pubstate = {published},

tppubtype = {article}

}