{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T12:08:10Z","timestamp":1791547690563,"version":"4.3.4"},"reference-count":38,"publisher":"American Society of Tropical Medicine and Hygiene","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2017,12,6]]},"abstract":"<jats:p>Afghanistan\u2019s national guidelines recommend primaquine (PQ) for radical treatment of <jats:italic>Plasmodium vivax<\/jats:italic> malaria, but this is rarely implemented because of concerns over potential hemolysis in patients who have G6PD deficiency. Between August 2009 and February 2014, we conducted an open-label, randomized controlled trial of chloroquine (CQ) alone versus chloroquine plus primaquine (0.25 mg base\/kg\/day for 14 days) (CQ+PQ) in patients aged 6 months and older with microscopy confirmed <jats:italic>P. vivax<\/jats:italic> infection. In the CQ+PQ group, G6PD deficiency was excluded by fluorescent spot testing. The primary outcome was <jats:italic>P. vivax<\/jats:italic> recurrence assessed by survival analysis over one year follow-up. Of 593 patients enrolled, 570 attended at or after 14 days of follow-up. <jats:italic>Plasmodium vivax<\/jats:italic> recurrences occurred in 37 (13.1%) of 282 patients in the CQ+PQ arm versus 86 (29.9%) of 288 in the CQ arm (Cox proportional hazard ratio [HR] 0.37, 95% confidence interval [CI] 0.25\u20130.54) (intention-to-treat analysis). Protection against recurrence was greater in the first 6 months of follow-up (HR 0.082; 95% CI 0.029\u20130.23) than later (HR 0.65, 95% CI 0.41\u20131.03). Five of seven patients requiring hospital admission were considered possible cases of PQ-related hemolysis, and PQ was stopped in a further six; however, in none of these cases did hemoglobin fall by \u2265 2 g\/dL or to below 7 g\/dL, and genotyping did not detect any cases of Mediterranean variant G6PD deficiency. PQ 0.25 mg\/kg\/day for 14 days prevents relapse of <jats:italic>P. vivax<\/jats:italic> in Afghanistan. Patient visits during the first week may improve adherence. Implementation will require deployment of point-of-care phenotypic tests for G6PD deficiency.<\/jats:p>","DOI":"10.4269\/ajtmh.17-0290","type":"journal-article","created":{"date-parts":[[2017,10,31]],"date-time":"2017-10-31T07:00:42Z","timestamp":1509433242000},"page":"1782-1787","source":"Crossref","is-referenced-by-count":20,"title":["Chloroquine\u2013Primaquine versus Chloroquine Alone to Treat Vivax Malaria in Afghanistan: An Open Randomized Superiority Trial"],"prefix":"10.4269","volume":"97","author":[{"given":"Ghulam Rahim","family":"Awab","sequence":"first","affiliation":[{"name":"Medical Faculty, Nangarhar University, Jalalabad, Afghanistan;"},{"name":"Ministry of Public Health, Islamic Republic of Afghanistan, Kabul, Afghanistan;"},{"name":"Mahidol-Oxford Tropical Medicine Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mallika","family":"Imwong","sequence":"additional","affiliation":[{"name":"Mahidol-Oxford Tropical Medicine Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand;"},{"name":"Department of Molecular Tropical Medicine and Genetics, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Germana","family":"Bancone","sequence":"additional","affiliation":[{"name":"Shoklo Malaria Research Unit, Mae Sot, Thailand;"},{"name":"Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Atthanee","family":"Jeeyapant","sequence":"additional","affiliation":[{"name":"Mahidol-Oxford Tropical Medicine Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicholas P. J.","family":"Day","sequence":"additional","affiliation":[{"name":"Mahidol-Oxford Tropical Medicine Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand;"},{"name":"Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicholas J.","family":"White","sequence":"additional","affiliation":[{"name":"Mahidol-Oxford Tropical Medicine Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand;"},{"name":"Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charles J.","family":"Woodrow","sequence":"additional","affiliation":[{"name":"Mahidol-Oxford Tropical Medicine Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand;"},{"name":"Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2795","reference":[{"key":"b1","series-title":"Lancet","first-page":"1506","article-title":"Malaria control in Afghanistan: progress and challenges","volume":"365","author":"Kolaczinski","year":"2005"},{"key":"b2","series-title":"Am J Trop Med Hyg","first-page":"72","article-title":"Epidemiology and control of Plasmodium vivax in Afghanistan","volume":"95","author":"Leslie","year":"2016"},{"key":"b3","series-title":"Trop Geogr Med","first-page":"187","article-title":"Swellengrebel lecture. 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