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              Guidelines for the treatment of malaria – 2
              Guidelines for the treatment of malaria – 2  edition edition
                          importance  CRITICAL  IMPORTANT  CRITICAL  IMPORTANT  IMPORTANT  IMPORTANT  IMPORTANT





                          Quality  HIGH  HIGH   VERY LOW  MODERATE  HIGH
              Is DHA+PPQ an alternative to AS+MQ for treating uncomplicated P. falciparum malaria in Asia and South America?
                                                                        LOW   LOW
                               28 fewer per 1000   (from 10 fewer    41 fewer per 1000   (from 3 fewer    Not estimable  47 more per 1000   (from 4 more    26 more per 1000   (from 5 more   1 fewer per 1000 (from   4 fewer to 8 more)  15 fewer per 1000   (from 38 fewer


                        Absolute  to 37 fewer)  to 69 fewer)  to 237 more)  to 73 more)  to 16 more)




                     effect  Relative risk   (95% CI)  RR 0.39   (0.19–0.79)  RR 0.73   (0.54–0.98)  RR 9.55   (0.52–176.35)  RR 6.19   (1.4–27.35)  RR 3.01   (1.37–6.63)  RR 0.9   (0.38–2.15)  RR 0.87   (0.66–1.14)


                  summary of findings  no. of patients  AS + MQ  DHA + PPQ  21/458    10/604   (4.6%)  (1.7%)  78/515   73/667   (15.1%)  (10.9%)  0/224    4/211    (0%)  (1.9%)  2/226    12/219   (0.9%)  (5.5%)  8/635    29/814   (1.3%)  (3.6%)  8/1152    12/1465   (0.7%)  (0.8%)  88/785   74/833   (11.2%)  (8.9%)







                          considerations

                        Other    None  None     None   None    None     None  None


                        Imprecision  No serious   imprecision 6  No serious   imprecision 6  Very serious 10  No serious   imprecision 11  No serious   imprecision 11  Very serious 14  Serious 16



                        Indirectness  No serious   indirectness 5  No serious   indirectness 5  Serious 9  Serious 9  No serious   indirectness 12  No serious   indirectness  No serious   indirectness



                        Inconsistency  No serious   inconsistency 4  No serious   inconsistency 4  Not applicable  Not applicable  No serious   inconsistency 4  No serious   inconsistency 4  No serious   inconsistency 4



                        Limitations EFFICACy: total failure (P . falciparum) day 63 PCR adjusted – Asia 1  No serious   limitations 3 EFFICACy: total failure (P. falciparum) day 63 PCR unadjusted – Asia 1  No serious   limitations 3 EFFICACy: total failure (P . falciparum) day 63 PCR adjusted – South America  No serious   limitations 8 EFFICACy: total failur

            GRADE Table A7.3.1    Quality assessment  Design  Randomized   trial 2  Randomized   trial 2  Randomized   trial 7  Randomized   trial 7  Randomized   trial  HARMS: serious adverse events (including deaths)  Randomized   trial  HARMS: early vomiting  Randomized   trial










   146                  No. of   studies  3  3  1      1       4        8     5
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