Malaria Branch, Malaria Branch, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA.
BMC Public Health. 2011 Apr 13;11 Suppl 3(Suppl 3):S14. doi: 10.1186/1471-2458-11-S3-S14.
The Lives Saved Tool (LiST) model was developed to estimate the impact of the scale-up of child survival interventions on child mortality. New advances in antimalarials have improved their efficacy of treating uncomplicated and severe malaria. Artemisinin-based combination therapies (ACTs) for uncomplicated Plasmodium falciparum malaria and parenteral or rectal artemisinin or quinine for severe malaria syndromes have been shown to be very effective for the treatment of malaria in children. These interventions are now being considered for inclusion in the LiST model. However, for obvious ethical reasons, their protective efficacy (PE) compared to placebo is unknown and their impact on reducing malaria-attributable mortality has not been quantified.
We performed systematic literature reviews of published studies in P. falciparum endemic settings to determine the protective efficacy (PE) of ACT treatment against malaria deaths among children with uncomplicated malaria, as well as the PE of effective case management including parenteral quinine against malaria deaths among all hospitalized children. As no randomized placebo-controlled trials of malaria treatment have been conducted, we used multiple data sources to ascertain estimates of PE, including a previously performed Delphi estimate for treatment of uncomplicated malaria.
Based on multiple data sources, we estimate the PE of ACT treatment of uncomplicated P. falciparum malaria on reducing malaria mortality in children 1-23 months to be 99% (range: 94-100%), and in children 24-59 months to be 97% (range: 86-99%). We estimate the PE of treatment of severe P. falciparum malaria with effective case management including intravenous quinine on reducing malaria mortality in children 1-59 months to be 82% (range: 63-94%) compared to no treatment.
This systematic review quantifies the PE of ACT used for treating uncomplicated malaria and effective case management including parenteral quinine for treating severe P. falciparum malaria for preventing malaria mortality in children <5. These data will be used in the Lives Saved Tool (LiST) model for estimating the impact of scaling-up these interventions against malaria. However, in order to estimate the reduction in child mortality due to scale-up of these interventions, it is imperative to develop standardized indicators to measure population coverage of these interventions.
生命挽救工具（LiST）模型旨在评估儿童生存干预措施扩大规模对儿童死亡率的影响。抗疟药的新进展提高了其治疗无并发症和严重疟疾的疗效。无并发症恶性疟原虫疟疾的青蒿素类复方疗法（ACT）和治疗严重疟疾综合征的注射用青蒿琥酯或直肠青蒿琥酯或奎宁，已被证明对儿童疟疾的治疗非常有效。这些干预措施目前正在考虑纳入 LiST 模型。然而，由于明显的伦理原因，它们与安慰剂相比的保护效果（PE）是未知的，它们对降低疟疾相关死亡率的影响也没有被量化。
我们对恶性疟原虫流行地区已发表的研究进行了系统的文献回顾，以确定 ACT 治疗对无并发症疟疾儿童疟疾死亡的保护效果（PE），以及包括注射用奎宁在内的有效病例管理对所有住院儿童疟疾死亡的保护效果（PE）。由于没有进行过抗疟治疗的随机安慰剂对照试验，我们使用了多种数据源来确定 PE 的估计值，包括之前对无并发症疟疾治疗进行的德尔菲估计。
基于多种数据源，我们估计 ACT 治疗无并发症恶性疟原虫疟疾对降低 1-23 个月儿童疟疾死亡率的保护效果为 99%（范围：94-100%），对 24-59 个月儿童的保护效果为 97%（范围：86-99%）。我们估计，包括静脉注射奎宁在内的有效病例管理治疗严重恶性疟原虫疟疾，对 1-59 个月儿童疟疾死亡率的保护效果为 82%（范围：63-94%），而不治疗的保护效果为 0。
本系统综述量化了 ACT 治疗无并发症疟疾和包括注射用奎宁在内的有效病例管理治疗严重恶性疟原虫疟疾的保护效果（PE），以预防 5 岁以下儿童疟疾死亡。这些数据将用于 LiST 模型，以评估扩大这些干预措施对抗疟疾的影响。然而，为了估计这些干预措施扩大规模对儿童死亡率的降低，制定衡量这些干预措施的人口覆盖率的标准化指标至关重要。
