Improving the design and analysis of drug efficacy/effectiveness studies in malaria and in selected neglected tropical diseases (NTDs).

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Infectious tropical diseases place an enormous burden on many human populations. The vast majority of such infections can be successfully treated and/or controlled by drugs so the continued provision of effective drugs is an essential component of medical provision in these settings. Such studies often take place in areas where mobile human populations and poor infrastructure mean that patient follow-up is challenging and often incomplete, and where high re-infection rates often obscure successful treatment outcomes. We argue that current methods of measuring drug efficacy/effectiveness in these settings could clearly be improved in a number of areas. We start by investigating an important paradigm species, falciparum malaria, which is one of the 'big three' infective killers, and then move onto the so-called 'neglected tropical diseases' with initial emphasis on shistosomes (a 'worm' infection spread by contact with water containing the snail intermediate hosts). We also consider how information on drug efficacy/effectiveness can be obtained from studies outside of formal drug clinical trials, such such as intermittent treatment programmes.