{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T19:36:37Z","timestamp":1791488197031,"version":"4.3.4"},"reference-count":20,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2026,4,25]],"date-time":"2026-04-25T00:00:00Z","timestamp":1777075200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,4,25]],"date-time":"2026-04-25T00:00:00Z","timestamp":1777075200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/501100000969","name":"Australian Academy of Science","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000969","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000865","name":"Bill and Melinda Gates Foundation","doi-asserted-by":"publisher","award":["OPP1164105\/INV\u2010010504"],"award-info":[{"award-number":["OPP1164105\/INV\u2010010504"]}],"id":[{"id":"10.13039\/100000865","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000925","name":"National Health and Medical Research Council","doi-asserted-by":"publisher","award":["GNT1132975"],"award-info":[{"award-number":["GNT1132975"]}],"id":[{"id":"10.13039\/501100000925","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000925","name":"National Health and Medical Research Council","doi-asserted-by":"publisher","award":["GNT2033264"],"award-info":[{"award-number":["GNT2033264"]}],"id":[{"id":"10.13039\/501100000925","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000925","name":"National Health and Medical Research Council","doi-asserted-by":"publisher","award":["2008501"],"award-info":[{"award-number":["2008501"]}],"id":[{"id":"10.13039\/501100000925","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000925","name":"National Health and Medical Research Council","doi-asserted-by":"publisher","award":["1196068"],"award-info":[{"award-number":["1196068"]}],"id":[{"id":"10.13039\/501100000925","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000925","name":"National Health and Medical Research Council","doi-asserted-by":"publisher","award":["GNT2018654"],"award-info":[{"award-number":["GNT2018654"]}],"id":[{"id":"10.13039\/501100000925","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000925","name":"National Health and Medical Research Council","doi-asserted-by":"publisher","award":["GNT2024622"],"award-info":[{"award-number":["GNT2024622"]}],"id":[{"id":"10.13039\/501100000925","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Tropical Med Int Health"],"published-print":{"date-parts":[[2026,8]]},"abstract":"ABSTRACT<\/jats:title>\n \n Background<\/jats:title>\n \n Plasmodium vivax<\/jats:italic>\n remains a challenge for malaria elimination in Nepal due to its ability to relapse. Radical cure with primaquine is effective but limited by poor adherence to the standard 14\u2010day low\u2010dose regimen. In 2022, the WHO recommended administering the same total dose (3.5\u2009mg\/kg) over 7\u2009days to improve adherence. This study aimed to evaluate the 7\u2010day low\u2010dose primaquine regimen in G6PD\u2010normal patients with uncomplicated\n \n P. vivax<\/jats:italic>\n <\/jats:styled-content>\n and\/or\n P. falciparum<\/jats:italic>\n malaria in the pre\u2010elimination context of Nepal.\n <\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n \n A randomised study was conducted in south\u2010west Nepal. Adult patients with microscopically confirmed\n \n P. vivax<\/jats:italic>\n <\/jats:styled-content>\n and\/or\n P. falciparum<\/jats:italic>\n malaria and glucose\u20106\u2010phosphate dehydrogenase (G6PD) activity \u2265\u200930% were randomised 1:1 to receive either a 7\u2010day low\u2010dose primaquine regimen (0.5\u2009mg\/kg\/day; total 3.5\u2009mg\/kg) or standard of care (14\u2010day primaquine [0.25\u2009mg\/kg\/day; total 3.5\u2009mg\/kg] for patients with\n \n P. vivax<\/jats:italic>\n <\/jats:styled-content>\n malaria and single\u2010dose primaquine for\n P. falciparum<\/jats:italic>\n malaria patients) in addition to their schizonticidal treatment. All treatment was directly observed, and patients were followed for 6 months. The primary outcome was the risk of\n \n P. vivax<\/jats:italic>\n <\/jats:styled-content>\n recurrence at 6\u2009months. Safety outcomes included adverse events, gastrointestinal symptoms and haematological parameters.\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Of 5842 individuals screened, 27 eligible participants were enrolled. Among these, 21 had\n \n P. vivax<\/jats:italic>\n <\/jats:styled-content>\n , four had\n P. falciparum<\/jats:italic>\n and two had mixed infections. Eleven participants had intermediate G6PD activity (\u2265\u200930%\u201370% activity). At 6\u2009months there were no recurrences in the 7\u2010day primaquine arm (\n n<\/jats:italic>\n \u2009=\u200914) and the risk of\n \n P. vivax<\/jats:italic>\n <\/jats:styled-content>\n recurrence in the standard primaquine arm (\n n<\/jats:italic>\n \u2009=\u200913) was 9.1% (95% CI: 1.3\u201349.2). No participants vomited study drugs, and gastrointestinal symptoms were infrequent. Three participants experienced a\u2009\u2265\u200925% haemoglobin drop between baseline and Day 2, all of whom had baseline values >\u200915\u2009g\/dL. No presentations of haemoglobinuria, severe anaemia, serious adverse events, or deaths occurred during the study period.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n In this small study, the 7\u2010day low\u2010dose primaquine regimen was well tolerated, including among individuals with intermediate G6PD activity. Although the small sample size limits conclusions about efficacy, the findings support the feasibility and safety of this regimen in Nepal, offering potential programmatic advantages for radical cure delivery in a setting close to elimination.<\/jats:p>\n <\/jats:sec>\n \n Trial Registration<\/jats:title>\n \n Clinicaltrials.gov<\/jats:ext-link>\n : NCT04079621\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1111\/tmi.70145","type":"journal-article","created":{"date-parts":[[2026,4,25]],"date-time":"2026-04-25T08:07:47Z","timestamp":1777104467000},"page":"1028-1034","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Short\u2010Course Low\u2010Dose Primaquine for Radical Cure in\n G6PD<\/scp>\n \u2010Normal Patients in the Pre\u2010Elimination Context of Nepal"],"prefix":"10.1111","volume":"31","author":[{"given":"Prakash","family":"Ghimire","sequence":"first","affiliation":[{"name":"Central Department of Microbiology Tribhuvan University Kirtipur Kathmandu Nepal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gokarna","family":"Dahal","sequence":"additional","affiliation":[{"name":"National Malaria Program, Epidemiology and Disease Control Division, Department of Health Services Ministry of Health & Population, Government of Nepal Kathmandu Nepal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nabaraj","family":"Adhikari","sequence":"additional","affiliation":[{"name":"Central Department of Microbiology Tribhuvan University Kirtipur Kathmandu Nepal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Komal Raj","family":"Rijal","sequence":"additional","affiliation":[{"name":"Central Department of Microbiology Tribhuvan University Kirtipur Kathmandu Nepal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5874-2547","authenticated-orcid":false,"given":"Sanjib","family":"Adhikari","sequence":"additional","affiliation":[{"name":"Central Department of Microbiology Tribhuvan University Kirtipur Kathmandu Nepal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Megha Raj","family":"Banjara","sequence":"additional","affiliation":[{"name":"Central Department of Microbiology Tribhuvan University Kirtipur Kathmandu Nepal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hellen","family":"Mnjala","sequence":"additional","affiliation":[{"name":"Global and Tropical Health Division, Menzies School of Health Research Charles Darwin University Darwin Northern Territory Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Grant","family":"Lee","sequence":"additional","affiliation":[{"name":"Global and Tropical Health Division, Menzies School of Health Research Charles Darwin University Darwin Northern Territory Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sophie","family":"Weston","sequence":"additional","affiliation":[{"name":"Global and Tropical Health Division, Menzies School of Health Research Charles Darwin University Darwin Northern Territory Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Angela","family":"Rumaseb","sequence":"additional","affiliation":[{"name":"Global and Tropical Health Division, Menzies School of Health Research Charles Darwin University Darwin Northern Territory Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anjana","family":"Rai","sequence":"additional","affiliation":[{"name":"Global and Tropical Health Division, Menzies School of Health Research Charles Darwin University Darwin Northern Territory Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5734-0845","authenticated-orcid":false,"given":"Benedikt","family":"Ley","sequence":"additional","affiliation":[{"name":"Global and Tropical Health Division, Menzies School of Health Research Charles Darwin University Darwin Northern Territory Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohammad Sharif","family":"Hossain","sequence":"additional","affiliation":[{"name":"Infectious Disease Division International Centre for Diarrhoeal Disease Research Dhaka Bangladesh"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julie A.","family":"Simpson","sequence":"additional","affiliation":[{"name":"Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health University of Melbourne Melbourne Victoria Australia"},{"name":"Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine University of Oxford Oxford UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Megha","family":"Rajasekhar","sequence":"additional","affiliation":[{"name":"Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health University of Melbourne Melbourne Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bipin","family":"Adhikari","sequence":"additional","affiliation":[{"name":"Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine University of Oxford Oxford UK"},{"name":"Mahidol Oxford Tropical Medicine Research Unit Bangkok Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ric N.","family":"Price","sequence":"additional","affiliation":[{"name":"Global and Tropical Health Division, Menzies School of Health Research Charles Darwin University Darwin Northern Territory Australia"},{"name":"Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine University of Oxford Oxford UK"},{"name":"Mahidol Oxford Tropical Medicine Research Unit Bangkok Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bibek K.","family":"Lal","sequence":"additional","affiliation":[{"name":"Family Welfare Division, Department of Health Services Ministry of Health & Population, Government of Nepal Kathmandu Nepal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kamala","family":"Thriemer","sequence":"additional","affiliation":[{"name":"Global and Tropical Health Division, Menzies School of Health Research Charles Darwin University Darwin Northern Territory Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,4,25]]},"reference":[{"key":"e_1_2_12_2_1","unstructured":"Epidemiology and Disease Control Division MoH Nepal \u201cNational Malaria Strategic Plan 2025\u20132030 \u201dKathmandu Nepal 2024."},{"key":"e_1_2_12_3_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.1002299"},{"key":"e_1_2_12_4_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12936-023-04725-w"},{"key":"e_1_2_12_5_1","unstructured":"WHO \u201cWHO Guidelines for Malaria \u201d25 November 2022 V5.4 Geneva 2022."},{"key":"e_1_2_12_6_1","unstructured":"National Center for Parasitology EaMCC \u201cNational Treatment Guidelines for Malaria in Cambodia \u201d(Health Mo ed.) 2022."},{"key":"e_1_2_12_7_1","unstructured":"Center of Malariology PaE \u201cLao PDR National Guidelines for the Treatment of Malaria \u201d(PDR MoHL ed.) 2022."},{"key":"e_1_2_12_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1473-3099(23)00430-9"},{"key":"e_1_2_12_9_1","unstructured":"WHO \u201cWHO Guidelines for Malaria \u201d30 November 2024 V8.2 Geneva 2024."},{"key":"e_1_2_12_10_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjgh-2023-012675"},{"key":"e_1_2_12_11_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.1003393"},{"key":"e_1_2_12_12_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13063-022-06364-z"},{"key":"e_1_2_12_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1473-3099(21)00358-3"},{"key":"e_1_2_12_14_1","doi-asserted-by":"publisher","DOI":"10.1093\/infdis\/jiz052"},{"key":"e_1_2_12_15_1","doi-asserted-by":"publisher","DOI":"10.3390\/tropicalmed10020046"},{"key":"e_1_2_12_16_1","doi-asserted-by":"publisher","DOI":"10.1093\/infdis\/jiz126"},{"key":"e_1_2_12_17_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12936-020-03359-6"},{"key":"e_1_2_12_18_1","unstructured":"Nepal EaDCDDoHS \u201cNational Malaria Treatment Protocol 2019 \u201d2019."},{"key":"e_1_2_12_19_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12916-022-02365-6"},{"key":"e_1_2_12_20_1","doi-asserted-by":"publisher","DOI":"10.4269\/ajtmh.18-0373"},{"key":"e_1_2_12_21_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(23)01553-2"}],"container-title":["Tropical Medicine & International Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/tmi.70145","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/tmi.70145","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/tmi.70145","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T17:12:39Z","timestamp":1785777159000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/tmi.70145"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,25]]},"references-count":20,"journal-issue":{"issue":"8","published-print":{"date-parts":[[2026,8]]}},"alternative-id":["10.1111\/tmi.70145"],"URL":"https:\/\/doi.org\/10.1111\/tmi.70145","archive":["Portico"],"relation":{},"ISSN":["1360-2276","1365-3156"],"issn-type":[{"value":"1360-2276","type":"print"},{"value":"1365-3156","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,25]]},"assertion":[{"value":"2025-09-04","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-04-08","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-04-25","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}