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Background: Wide-spread implementation of treatment regimens for the radical cure of vivax malaria is hindered by a range of factors. This has resulted in an increase in the relative proportion of vivax malaria and is an important obstacle in the achievement of global malaria elimination by 2030. The main objective of this study was to explore the current policies guiding the treatment plans on vivax malaria, and the factors affecting the implementation of radical cure in South/South East Asian and Asian Pacific countries., Methods: This was a qualitative study among respondents who represented national malaria control programmes (NMCPs) or had a role and influence in the national malaria policies. 33 respondents from 17 countries in South/South East Asia and Asia Pacific participated in interviews between October 15 and December 15, 2020. Semi-structured interviews were conducted virtually except for two face to face interviews and audio-recorded. Transcribed audio-records underwent thematic analysis using QSR NVivo., Results: Policies against vivax malaria were underprioritized, compared with the focus on falciparum malaria and, in particular, drug resistant Plasmodium falciparum strains. Despite the familiarity with primaquine (PQ) as the essential treatment to achieve the radical cure, the respondents contested the need for G6PD testing. Optional G6PD testing was reported to have poor adherence. The fear of adverse events led health workers to hesitate prescribing PQ. In countries where G6PD was mandatory, respondents experienced frequent stockouts of G6PD rapid diagnostic kits in peripheral health facilities, which was compounded by a short shelf life of these tests. These challenges were echoed across participating countries to various degrees. Most respondents agreed that a shorter treatment regimen, such as single dose tafenoquine could resolve these problems but mandatory G6PD testing will be needed. The recommendation of shorter regimens including tafenoquine or high dose PQ requires operational evidence demonstrating the robust performance of point of care G6PD tests (biosensors)., Conclusion: There was sparse implementation and low adherence to the radical cure in South/South East Asian and Asian pacific countries. Shorter treatment regimens with appropriate point of care quantitative G6PD tests may resolve the current challenges. Operational evidence on point of care quantitative G6PD tests that includes the feasibility of integrating such tests into the radical cure regimen are critical to ensure its implementation.

Background:Plasmodium vivax malaria accounts for more than half of all malaria cases in Asia and Latin America. Despite the high prevalence of disease caused by this parasite, research into its effects (especially its renal effect) has lagged disproportionately. To investigate predictors of vivax malaria-induced nephropathy, we analyzed the cases of vivax malaria-induced nephropathy in young Korean men. Methods: This was a retrospective analysis of P. vivax patients with acute nephropathy (all males, n = 75), defined by an absolute increase in serum creatinine of 0.3 mg/dl or more (equal to an estimated glomerular filtration rate (eGFR) <80 ml/min) (group 1, n = 31) or proteinuria (group 2, n = 44), between January 2004 and December 2007. The eGFR was calculated using a simplified Modification of Renal Disease (MDRD) equation. None of the patients had a history of traveling abroad, drug abuse or blood transfusion. The clinical manifestations, laboratory abnormalities and predictors of nephropathy were reviewed. Results: Out of 398 cases of vivax malaria, 75 patients (all males) suffered from to vivax malaria-induced acute nephropathy. The mean age of the patients who were divided into two groups was 22.8 ± 3.7 and 21.6 ± 1.8 years, respectively (p = 0.089). In group 1, the total serum bilirubin significantly correlated with serum creatinine and eGFR (p = 0.004 and 0.035, correlation coefficient = 0.508 and –0.387, respectively). In group 2, 24-hour proteinuria significantly correlated with hemoglobin (p = 0.004, correlation coefficient = –0.424). Conclusion: Total serum bilirubin (group 1, an absolute increase in serum creatinine of 0.3 mg/dl or more (equal to an eGFR <80 ml/min)) and hemoglobin (group 2, proteinuria) are useful to predict vivax-induced nephropathy. Copyright © 2008 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]