ArticleBMJ global health2019
How delayed and non-adherent treatment contribute to onward transmission of malaria: a modelling study.
Article in BMJ global health, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 21 papers, 3 of them syntheses that pooled it.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
21 citing papers in PubMed, 3 syntheses or guidelines pooled it.
- Determinants of delay in treatment-seeking among malaria patients attending health facilities in Ethiopia from 2010 to 2024: a systematic review and meta-analysis.Malaria journal · 2026Pooled it
- Delays in seeking healthcare and its determinants among malaria patients in Ethiopia: A systematic review and meta-analysis.PloS one · 2025Pooled it
- Asymptomatic recrudescence after artemether-lumefantrine treatment for uncomplicated falciparum malaria: a systematic review and meta-analysis.Malaria journal · 2020Pooled it
- Impact of proactive malaria community case management (proCCM) on parasite prevalence and incidence from 2021 to 2023: a randomised controlled trial in Chadiza District, Eastern Province, Zambia.BMJ global health · 2025Trial
- Re-emergence of malaria in Karen State, Myanmar: has the battle of Burma been lost?Malaria journal · 2026Observational
- Understanding barriers to effective malaria diagnosis and treatment: A mixed-methods study in Uganda, Nigeria, and Ivory Coast.PLOS global public health · 2026Article
- Drivers of delay in reported malaria care-seeking in Myanmar and Thailand.Malaria journal · 2025Article
- Malaria healthcare service utilization before, during, and 1 year into the COVID-19 pandemic in 20 sub-Saharan African countries using Generalized Estimating Equation.Malaria journal · 2025Article
- Estimating rates of treatment delay for malaria fevers among children in Sub-Saharan Africa 2006-2022.Nature communications · 2025Article
- Malaria care-seeking among febrile patients in Myanmar and Thailand: an accelerated failure time analysis.Research square · 2025Article
- Increasing the resolution of malaria early warning systems for use by local health actors.Malaria journal · 2025Article
- Adapting malaria indicator surveys to investigate treatment adherence: a pilot study on Bioko Island, Equatorial Guinea.Malaria journal · 2024Article
- Treatment-seeking behaviours of malaria patients versus non-malaria febrile patients along China-Myanmar border.Malaria journal · 2023Article
- The uncertain role of substandard and falsified medicines in the emergence and spread of antimicrobial resistance.Nature communications · 2023Review
- Evaluating recurrent episodes of malaria incidence in Timika, Indonesia, through a Markovian multiple-state model.Infectious Disease Modelling · 2022Article
- Determinants of Patients' Adherence to Malaria Treatment in the Democratic Republic of the Congo.Tropical medicine and infectious disease · 2022Article
- Article
- Financing malaria.PLOS global public health · 2022Review
- Gametocyte carriage after seasonal malaria chemoprevention in Plasmodium falciparum infected asymptomatic children.Malaria journal · 2021Article
- COVID-19 and malaria: A symptom screening challenge for malaria endemic countries.International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases · 2020Article
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Authors and funding
9 authors.
Funding
Abstract
introductionArtemether-lumefantrine (AL) is the most widely-recommended treatment for uncomplicated
methodsWe extend a within-host model of
resultsUsing survey data from seven African countries to determine the time taken to acquire antimalarials following fever increased our estimates of mean total infectivity of a malaria episode by up to 1.5-fold, compared with patients treated after 24 hours. Realistic adherence behaviour, based on data from a monitored cohort in Tanzania, increased the contribution to transmission by 2.2 to 2.4-fold, compared with a perfectly-adherent cohort. This was driven largely by increased rates of treatment failure leading to chronic infection, rather than prolonged gametocytaemia in patients who have slower, but still successful, clearance of parasites after imperfect adherence to treatment. Our model estimated that the mean infectivity of untreated infections was 29-51 times higher than that of treated infections (assuming perfect drug adherence), underlining the importance of improving treatment coverage.
conclusionUsing mathematical modelling, we quantify how delayed treatment and non-adherent treatment can increase transmission compared with prompt effective treatment. We also highlight that transmission from the large proportion of infections which never receive treatment is substantially higher than those treated.
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Registered trials
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