Thirty-four cohort studies on traditional antimalarials have been retrieved from a comprehensive literature search (see Chapter 19). Five of them examined Ayurvedic preparations used in India. Others investigated traditional remedies in Uganda, Tanzania, and Madagascar. The Chinese herb Artemisia annua, the source of artemisinin and its derivatives, was studied in the Democratic Republic of Congo. These studies provide indications not only on therapeutic and secondary effects but also on the potential to reverse resistance to chloroquine and the feasibility of plant cultivation and preparation.
The interpretation of results focused on the improvement of clinical symptoms (fever, headache, etc.) and parasite clearance. Lack of parasite clearance was interpreted as a failure; this should be questioned in view of local epidemiology: when rapid reinfection is the rule (especially in areas of stable transmission), parasite clearance is not necessarily a desirable outcome. This is so because in areas where complete eradication of malaria is not achievable in the near future, a low parasitaemia may contribute to maintaining immunity, prevent severe forms of the disease, and is often tolerated without any clinical symptoms (Bell, 1995).
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