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Volume 383, No. 9918, p723735, 22 February 2014

Prof Nicholas J White, FRS
Prof Sasithon Pukrittayakamee, DPhil
Prof Tran Tinh Hien, MD
Prof M Abul Faiz, PhD
Prof Olugbenga A Mokuolu, FWACP
Prof Arjen M Dondorp, MD
Published Online: 15 August 2013


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This article can be found in the following collections: Malaria; The Lancet Seminars


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Although global morbidity and mortality have decreased substantially, malaria, a parasite
infection of red blood cells, still kills roughly 2000 people per day, most of whom are
children in Africa. Two factors largely account for these decreases; increased deployment of
insecticide-treated bednets and increased availability of highly effective artemisinin
combination treatments. In large trials, parenteral artesunate (an artemisinin derivative)
reduced severe malaria mortality by 225% in Africa and 347% in Asia compared with
quinine, whereas adjunctive interventions have been uniformly unsuccessful. Rapid tests have
been an important addition to microscopy for malaria diagnosis. Chemopreventive strategies
have been increasingly deployed in Africa, notably intermittent sulfadoxinepyrimethamine
treatment in pregnancy, and monthly amodiaquinesulfadoxinepyrimethamine during the
rainy season months in children aged between 3 months and 5 years across the sub-Sahel.
Enthusiasm for malaria elimination has resurfaced. This ambitious but laudable goal faces
many challenges, including the worldwide economic downturn, difficulties in elimination of
vivax malaria, development of pyrethroid resistance in some anopheline mosquitoes, and the
emergence of artemisinin resistance in Plasmodium falciparum in southeast Asia. We review
the epidemiology, clinical features, pathology, prevention, and treatment of malaria.

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