Quinine should no longer be the drug of choice for treating severe malaria, according to an updated systematic review by Cochrane researchers. It is now evident that the antimalarial drug artesunate, which is derived from herbs used in Chinese medicine, is more effective at preventing death in patients with severe malaria.
Rising status of women, increased risk of smoking
Millions of women in developing countries risk disease and early death in the coming decades as the tobacco industry exploits their rising economic and political status, according to a new study, published today in the Bulletin of the World Health Organization which analyses women’s empowerment and smoking rates in 74 countries.
Women’s empowerment is measured by the United Nations Development Programme using data such as female representation in parliament, voting rights and comparisons of male-to-female income in each country.
The study shows that men are currently five times more likely to smoke than women in countries with lower measures of female empowerment, such as China, Indonesia, Pakistan, Saudi Arabia and Uganda. In countries with relatively high female empowerment, such as Australia, Canada, Norway, Sweden and the United States of America, this gap has been closed: women smoke almost as much as men do.
“This study highlights the need to act quickly to curb smoking among women, particularly in developing countries.” says Dr Douglas Bettcher, Director of the Tobacco Free Initiative at WHO.
“The tobacco epidemic is still in its early stages in many countries but is expected to worsen. Strong tobacco control measures such as bans on tobacco advertising are needed to prevent the tobacco industry from targeting women.”
“We must pay more attention to the ways in which the tobacco industry is capitalizing on societal changes to target women, such as marketing cigarettes to women as a symbol of emancipation,” says study co-author, Sara C Hitchman who conducted the study with Dr Geoffrey T Fong from the International Tobacco Control Policy Evaluation Project at the University of Waterloo in Ontario, Canada. “Women’s empowerment must continue, but does the bad necessarily have to follow the good?”.
The Tobacco Free Initiative at WHO encourages countries to prevent the spread of the tobacco epidemic by implementing policies outlined in the WHO Framework Convention on Tobacco Control. These include public awareness campaigns, packaging and promotion regulations and tax measures to reduce demand for tobacco products.
Severe malaria occurs when the disease affects the function of vital organs. It is associated with rarer cerebral malaria, which affects the brain and can lead to long-term disability. More than a million people die each year from severe malaria, the majority in Sub-Saharan Africa. Artesunate was recommended as the preferred treatment for adults with severe malaria by the World Health Organization (WHO) in 2006, but there was insufficient evidence at the time to recommend a change from the standard treatment of quinine in children.
The researchers updated the review of artesunate by adding a new large multicentre trial of African children published in the Lancet in 2010 to the existing 8 trials. The review now includes a total of 1664 adults and 5765 children, from a variety of settings across Africa and Asia. According to the results, taking artesunate reduces the risk of death by 39% in adults and 24% in children compared to quinine. In adults, deaths caused by severe malaria were reduced from 241 per 1000 with quinine to 147 with artesunate. In children, deaths were reduced from 108 per 1000 with quinine to 83 with artesunate.
“There is now enough evidence to be confident of these results in adults and children,” said Peter Olumese of the WHO’s Global Malaria Programme. “Intravenous artesunate is now being recommended as the treatment of choice for adults and children with severe malaria anywhere in the world.”
Although more children given artesunate suffered neurological problems compared to those given quinine, these were largely resolved within a month of treatment, and were outweighed by the increase in survival rates. “The balance of benefits and harms is in favour of treatment with artesunate,” said David Sinclair of the Liverpool School of Tropical Medicine in Liverpool, UK, who led the review team.