title: Risk factors for gametocyte carriage in uncomplicated falciparum malaria in children before and after artemisinin-based combination treatments.
abstract: BACKGROUND
  Artemisinin-based combination treatments (ACTs) are the recommended first-line antimalarials globally, but their influence on the risk factors associated with gametocyte carriage has had little evaluation in endemic areas.
  
  
  METHODS
  The risk factors associated with gametocytaemia at presentation and after ACTs were evaluated in 835 children assigned to artesunate, artesunate-amodiaquine, artesunate-mefloquine or artemether-lumefantrine.
  
  
  RESULTS
  Gametocyte carriage at enrolment was 8.4%. During follow-up, 24 patients (2.8%) developed gametocytaemia, which in 83% (20 patients) had developed by day 7 following treatment. In a multiple regression model, 2 factors were independent risk factors for the presence of gametocytaemia at enrolment, namely age <3 years (adjusted odds ratio 2.03, 95% confidence interval 1.01-4.05; p = 0.04) and enrolment before 2009 (adjusted odds ratio 4.2, 95% confidence interval 2.09-8.44; p < 0.001). Haematocrit <25% and parasitaemia <50,000/μl blood were associated with an increased risk of gametocytaemia. Following treatment, 3 factors were independent risk factors for gametocytaemia, namely gametocytaemia at enrolment (adjusted odds ratio 46.39, 95% confidence interval 22.3-96.46; p < 0.0001) and treatment with artesunate (adjusted odds ratio 6.74, 95% confidence interval 1.79-25.27; p = 0.005) or artesunate-mefloquine (adjusted odds ratio 9.66, 95% confidence interval 2.87-32.46; p < 0.0.0001) relative to other ACTs.
  
  
  CONCLUSIONS
  ACTs modified the risk factors associated with gametocyte carriage after use.
authors.affiliation: Department of Pharmacology and Therapeutics, University of Ibadan, Nigeria. akinsowunmi@hotmail.com
authors.forename: Akintunde
authors.initials: A
authors.lastname: Sowunmi
authors.forename: Titilope M
authors.initials: TM
authors.lastname: Okuboyejo
authors.forename: Grace O
authors.initials: GO
authors.lastname: Gbotosho
authors.forename: Christian T
authors.initials: CT
authors.lastname: Happi
mesh_terms: D000293:Adolescent; D000634:Aminoquinolines / Q000008:administration & dosage; D000962:Antimalarials / Q000008:administration & dosage*; D037621:Artemisinins / Q000008:administration & dosage*; D002648:Child; D002675:Child, Preschool; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D016778:Malaria, Falciparum / Q000188:drug therapy* / Q000235:genetics / Q000469:parasitology; D008297:Male; D012307:Risk Factors
chemical_list: D000634:Aminoquinolines; D000962:Antimalarials; D037621:Artemisinins; C055852:tafenoquine; C031327:artemisinin