The Importance of the Equivalence Trial Design for Comparison of Rectal Quinine Treatment with Other Quinine Applications

half of infection-related deaths (figure 1): Plasmodium falciparum, Streptococcus pneumoniae, rotavirus, measles virus, and Haemophilus influenzae type b. The value of presenting child mortality data by pathogen-specific cause is well illustrated by examining the relative contribution of P. falciparum to child mortality. Nearly all malaria deaths are due to P. falciparum. Malaria is typically ranked fourth after neonatal disorders, acute respiratory infections, and diarrheal diseases as a major cause of childhood mortality. However, when mortality is broken down according to pathogen-specific cause, P. falciparum is rivaled only by S. pneumoniae as the leading single cause of child mortality. Commercial vaccines are currently available for measles virus, rotavirus, S. pneumoniae, and H. influenzae type b and are being provided to developing countries through the Global Alliance for Vaccines and Immunization and other organizations. Increasing availability of these vaccines may result in an increase in the relative contribution of P. falciparum to child mortality. Issues such as this can only be appreciated when child mortality data are presented by pathogen-specific cause, which also highlights P. falciparum as the major pathogen for which a vaccine is not available. Presenting child mortality estimates by pathogen-specific cause emphasizes the significant impact made by a small number of individual pathogens and could facilitate planning, implementation, and evaluation of preventative interventions and guide funding, training, and research priorities. Although there are major deficiencies in the data available on pathogenspecific causes of child death, available data sources (including vaccine and intervention studies) can be used to derive informative estimates. More complete data on pathogen-specific mortality, particularly in countries with high childhood mortality, are greatly needed.