ABSTRACT
Background: Malaria infection during pregnancy is a major public health problem. Due to increasing resistance to Chloroquine and Sulphadoxine/Pyrimethamine; the Ugandan national policy on malaria treatment was changed in 2005 to Artemisinin-based combination therapy (ACT) as the first-line treatment for uncomplicated malaria. The policy recommends assessment of safety and efficacy of alternative drugs for treatment of uncomplicated malaria. We compared the efficacy and safety of Artemether- Lumefantrine (Coartemr) and Chlorproguanil-Dapsone (Lapdapr) in the management of uncomplicated malaria in pregnancy. Methodology: We enrolled 110 pregnant women in the second and third trimester of pregnancy who presented to Mulago hospital; Uganda; with uncomplicated malaria. The study design was an open-label randomized clinical trial. Partici- pants were randomized to receive either Artemether-Lumefantrine (Coartemr 20mg/120mg) orally or Chlorproguanil-Dapsone (Lapdapr) orally for 3 consecutive days. Primary endpoints were clinical and parasitological response assessed on days 0; 1; 2; 4; 7; 14 and 28. Adverse effects; clinical response (treatment failure) and parasitological response were compared. Analysis was by intention to treat. Results: Of the 100 women who completed the study; there was no statistically significant difference in clinical and parasitological response by Day 4. The mean fever clearance time 3.0 days with Lapdapr versus 2.5 days with Coartemr was comparable. Likewise; mean parasite clearance time of 2.4 and 2.2 days for Lapdapr and Coartemr respectively was comparable. The adverse effects were comparable between the two groups. Conclusion: Artemether- Lumefantrine and Chlorproguanil-Dapsone have high and comparable cure rates and similar safety profiles when used for treatment of uncomplicated malaria in pregnancy
Subject(s)
Antimalarials , Drug Resistance , Malaria/complications , Randomized Controlled Trials as TopicABSTRACT
This is life-threatening malaria requiring urgent and special treatment. Who is at risk of severe malaria: In highly endemic areas severe forms of malaria occur in young children over 6 months up to 5 years with the greatest deaths in those between 1 and 3 years of age. It is less common in older chidren and adults because of the acquisition of prtial immunity. This immunity decreases transiently in pregnant women especially primigraviade; in those who have lived away from an endemic area for several years; and as a result of immunesuppresive treatment or conditions. These people may suffere severe malaria. In areas of lower endemicity; severe malaria occurs in both adults and children. Non-immune travellers / tourists and migrant workers are also vulnerable to severe malaria. Severe malaria occurs almost invariably as a result of delay in treating an uncomplicated attack; because of misdiagnosis or for other reasons; but occasionally may develop very rapidly
Subject(s)
MalariaABSTRACT
To determine the major complications of malaria in children presenting to the Acute Care Unit; Mulago Hospital; Kampala; Uganda. METHODS: 148 charts of children admitted to the Acute Care Unit; with laboratory confirmed malaria were retrospectively reviewed; documenting clinical complications; haemoglobin estimation; level of parasitemia and treatment given. Thirty five children (24) had no documented complication and were excluded from the analysis. RESULTS: The median age for the 113 children analysed was 1.5 years (3 months - 12 yrs.) Eighty percent of the children were 3 years of age. The major clinical complications were severe anaemia in 58.4(66/113); febrile convulsions in 31.8(36/113); and cerebral malaria in 29.2(33/113) of the children. The median age for presentation were 11 months (3 months-6yrs) for severe anaemia; 1.3 years (4 months - 6 yrs) for febrile convulsions and 2 yrs (5 months - 12 years) for cerebral malaria. The children with severe anemia (Hb6g/dl) had a mean hemoglobin of 5.0g/dl (range 2.8-6.0g/dl). The level of parasitemia was highest in those children over 4 years; however; this was not statistically significant due to the small numbers. The treatment with chloroquine was documented in 57.5of the episodes; guinine in 43.1and both in 6.5. Chloroquine alone was used more frequently in those children less than 1 year and quinine in those over 2 years. This is related to the almost exclusive use of quinine in cerebral malaria patients. Conclusion: Malaria occurred most frequently in children under 3 years of age. The main complication in this group of Ugandan children was severe anemia. Age was the major predictor of each complication as well as treatment given. Malaria in children needs to be aggressively managed to avoid these complications
Subject(s)
AnemiaABSTRACT
Chloroquine is the first line drug for the treatment of falciparum malaria in Uganda. Currently there are reports of increasing drug resistance. It is therefore important to keep on monitoring drug sensitivity as one of the activities of Malaria Control Programme. From February too March; 1996; the sensitivity of plasmodium falciparum to chloroquine and sulfadoxide/pyrimethamine was assessed in Jinja District; (Eastern Uganda). Children aged six to sixty months were enrolled into the study if they had purely plasmodium falciparum parasitemia between 500 and 250;000 parasites per microliter of blood and temperature above 37.5oC. Results were analysed for 52 patients in the chloroquine group and 35 in the sulfadoxine pyrimethamine group. Both clinical response and parasitological response were considered. Treatment failure rate for chloroquine was 11.6and 5.7for sulfadoxine/pyrimethamine. The parasitological failure rate for chloroquine was higher than the clinical failure (36.5). Chloroquine is still useful in treating malaria in Jinja District. However; the possibility of recrudescence must always be born in mind and a second line drug should be available for relapses and possible treatment failures