Severe Malaria Clinical Trial
— MATIASOfficial title:
Treatment of Severe Malaria - An Operational Comparative Study Between Quinine and Artesunate for the Treatment of Severe Malaria in Hospitals and Health Centers of Kinshasa and Lower Congo
The MATIAS study aims to demonstrate through limited scope implementation studies how injectable artesunate may be progressively rolled out nationwide in the Democratic Republic of the Congo as the preferred treatment for severe malaria.
Status | Completed |
Enrollment | 350 |
Est. completion date | June 2013 |
Est. primary completion date | June 2013 |
Accepts healthy volunteers | No |
Gender | Both |
Age group | 2 Months and older |
Eligibility |
Inclusion Criteria: Patients (= 2 months old) admitted to one of the study sites and treated for severe malaria with IV quinine in the first part of the study and patients treated with IV/IM artesunate in the second part of the study will be included. Patients need to fulfill the WHO criteria for severe malaria and must be unable to take oral treatment (WHO, 2010, WHO, 2011). In addition all participants need to give their informed consent Conditions: Positive rapid diagnostic test (RDT) for Plasmodium falciparum HRP2 or lactate dehydrogenase and/or a positive blood slide (thick smear). Patient will be considered to be positive if one of the two tests is positive. In case of negative result of both tests, the patient will not be enrolled in the study and will receive care according to the usual routine practice in the hospital/health center in question. Definition of severe malaria according to WHO (WHO, 2010): In a patient with P. falciparum asexual parasitaemia and no other obvious cause for the symptoms, the presence of one or more of the following clinical or laboratory features classifies the patient as suffering from severe malaria: Clinical features (hospitals and health centers): - impaired consciousness or unrousable coma - prostration, i.e. generalized weakness so that the patient is unable walk or sit up without assistance - failure to feed - multiple convulsions - more than two episodes in 24 h - deep breathing, respiratory distress (acidotic breathing) - circulatory collapse or shock, systolic blood pressure < 70 mm Hg in adults and < 50 mm Hg in children - clinical jaundice plus evidence of other vital organ dysfunction Complementary Laboratory findings (hospitals only) - severe anaemia (Hb < 5g/dl, packed cell volume < 15%) - hypoglycemia (blood glucose < 2.2 mmol/l or < 40 mg/dl) - metabolic acidosis (plasma bicarbonate < 15 mmol/l) - serum creatinine > 265 ìmol/l suggesting renal impairment Exclusion Criteria: Patients with known serious adverse reactions to quinine and artemisinin derivatives or patients who have received adequate antimalarial treatment 24 hours before admission will not be included in the study. Women with known or suspected pregnancy in all trimesters will not be included in the study and will be treated with quinine infusions according to the new national DRC guidelines (Programme Nationale de Lutte contre le Paludisme, 2012). According to current routine procedures determination of pregnancy will be done by medical anamnesis and/ or by a positive pregnancy test. |
Time Perspective: Prospective
Country | Name | City | State |
---|---|---|---|
Congo, The Democratic Republic o | Centre de Santé CECO | Kimpese | Bas Congo |
Congo, The Democratic Republic o | Centre de Santé la Famille | Kimpese | Bas Congo |
Congo, The Democratic Republic o | Hôpital Général de Référence IME | Kimpese | Bas Congo |
Congo, The Democratic Republic o | Centre Hospitalier Roi Baudoin 1er Masina | Kinshasa | |
Congo, The Democratic Republic o | Centre de Santé Ngeba | Kisantu | Bas Congo |
Congo, The Democratic Republic o | Hôpital Saint Luc de Kisantu | Kisantu | Bas Congo |
Congo, The Democratic Republic o | Centre de Santé Bita | Maluku | Kinshasa |
Congo, The Democratic Republic o | Centre de Santé Menkao | Maluku | Kinshasa |
Congo, The Democratic Republic o | Centre Hospitalier d'État de Maluku | Maluku | Kinshasa |
Lead Sponsor | Collaborator |
---|---|
Swiss Tropical & Public Health Institute | Medicines for Malaria Venture |
Congo, The Democratic Republic of the,
Centers for Disease Control and Prevention (CDC). Published reports of delayed hemolytic anemia after treatment with artesunate for severe malaria--worldwide, 2010-2012. MMWR Morb Mortal Wkly Rep. 2013 Jan 11;62(1):5-8. — View Citation
Dondorp A, Nosten F, Stepniewska K, Day N, White N; South East Asian Quinine Artesunate Malaria Trial (SEAQUAMAT) group. Artesunate versus quinine for treatment of severe falciparum malaria: a randomised trial. Lancet. 2005 Aug 27-Sep 2;366(9487):717-25. — View Citation
Dondorp AM, Fanello CI, Hendriksen IC, Gomes E, Seni A, Chhaganlal KD, Bojang K, Olaosebikan R, Anunobi N, Maitland K, Kivaya E, Agbenyega T, Nguah SB, Evans J, Gesase S, Kahabuka C, Mtove G, Nadjm B, Deen J, Mwanga-Amumpaire J, Nansumba M, Karema C, Umulisa N, Uwimana A, Mokuolu OA, Adedoyin OT, Johnson WB, Tshefu AK, Onyamboko MA, Sakulthaew T, Ngum WP, Silamut K, Stepniewska K, Woodrow CJ, Bethell D, Wills B, Oneko M, Peto TE, von Seidlein L, Day NP, White NJ; AQUAMAT group. Artesunate versus quinine in the treatment of severe falciparum malaria in African children (AQUAMAT): an open-label, randomised trial. Lancet. 2010 Nov 13;376(9753):1647-57. doi: 10.1016/S0140-6736(10)61924-1. Epub 2010 Nov 7. Erratum in: Lancet. 2011 Jan 8;377(9760):126. — View Citation
Lubell Y, Riewpaiboon A, Dondorp AM, von Seidlein L, Mokuolu OA, Nansumba M, Gesase S, Kent A, Mtove G, Olaosebikan R, Ngum WP, Fanello CI, Hendriksen I, Day NP, White NJ, Yeung S. Cost-effectiveness of parenteral artesunate for treating children with severe malaria in sub-Saharan Africa. Bull World Health Organ. 2011 Jul 1;89(7):504-12. doi: 10.2471/BLT.11.085878. Epub 2011 Apr 28. — View Citation
Type | Measure | Description | Time frame | Safety issue |
---|---|---|---|---|
Other | Clinical assessment | Time from start of IV/IM treatment to initiation of oral treatment Parasite clearance time Clinical status at discharge Signs for tiredness and breathlessness at follow up |
28 days | No |
Other | Laboratory assessment (exploratory - (see explanation in 1.1.4) | - Hemoglobin nadir during follow up period of 28 days | 28 days | No |
Other | Time and motion study | - Cumulative staff time required for all steps of patient management, including drug administration | 28 days | No |
Other | Feasibility and acceptability study | Perceived feasibility of patient management (as assessed and graded by provider questionnaire) Perceived ease of application of drug treatment (as assessed and graded by provider questionnaire) Perceived quality of case management (including perceived adverse effects) by patient / caretaker (as assessed through patient / caretaker questionnaire) |
28 days | No |
Other | Analysis of financial cost | - Total financial cost of patient management including treatment | 28 days | No |
Primary | Duration of hospitalization (from registration to discharge) | 3-7 days | No |
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