Mefloquine therapy for Plasmodium falciparum malaria in children under 5 years of age in Malawi: in vivo/in vitro efficacy and correlation of drug concentration with parasitological outcome

The in vivo and in vitro response of Plasmodium falciparum to a single oral dose of mefloquine (25 mg/kg body weight (M25) or 15 mg/kg (M15] was studied in children under 5 years of age in Malawi. Of the children who received mefloquine, 35% vomited at least once, and 10% did not tolerate the drug because of vomiting. The therapy failure rates for the M25 group on day 7, 14, and 28 were 15%, 18%, and 42%, respectively, and these did not differ significantly from those for the M15 group (4%, 18%, and 59%). In contrast, 34 in vitro microtests (17 per group) showed schizont inhibition at less than or equal to 32 pmol mefloquine per test well. On day 7, the concentration of mefloquine in samples of blood was significantly lower in both the M25 and M15 groups for children who were parasitaemic on day 7 than in samples from those who were aparasitaemic. A positive blood smear on day 7 was strongly associated with a mefloquine concentration of less than 500 ng/ml blood on day 2 or day 7 (P less than 0.0003). Vomiting was associated with a low mefloquine concentration on day 2 but not day 7. These results suggest that mefloquine is effective against P. falciparum in Malawi but that for young children the therapy appears to be complicated by frequent vomiting

Oral rehydration therapy in Malawi: impact on the severity of disease and on hospital admissions; treatment practices; and recurrent costs

In the first 2 years following refresher training of paediatric staff in oral rehydration therapy (ORT) and the establishment of an oral rehydration unit at the Kamuzu Central Hospital; Lilongwe; Malawi; there was a 50 percent decrease in the number of children admitted to the paediatric ward with the diagnosis of diarrhoeal diseases; a 56 percent decrease in the use of intravenous fluid to rehydrate such children; a threefold increase in the use of oral rehydration salts (ORS) exclusively to rehydrate children with mild or moderate dehydration; and a 39 percent decrease in the number of paediatric deaths associated with diarrhoeal diseases. Over the same period; there was a 32 percent decrease in recurrent hospital costs attributable to paediatric diarrhoeal diseases. As use of ORT continues to increase in Malawi; where diarrhoeal diseases account for 9 percent of paediatric hospital admissions; there should be considerable decreases in mortality from such diseases and concomitant increases in cost savings attributable to them

In vivo efficacy of chloroquine treatment for Plasmodium falciparum in Malawian children under five years of age

In 1984 the government of Malawi instituted a program to reduce malaria mortality and morbidity in children less than 5 years of age as a part of the Combatting Childhood Communicable Diseases (CCCD) program. To define the appropriate malaria therapy regimen; investigators used a quality assurance design in a simplified 7-day in vivo drug response study with follow-up observations on day 2 (D2) ; D3; and D7 after the initial day of the study (D0). The efficacy of oral chloroquine was assessed in 224 children who were enrolled at 6 sites; 2 in each of the 3 administrative regions of Malawi. Parasitological failure; defined as failure of parasitemia to decrease by 75 percent of the value by D3 or presence of any detectable parasitemia on D7; ranged from 41 percent -65 percent following administration of chloroquine 25 mg (base)/kg. However; only 8 percent of children who were parasitemic on D7 were febrile or judged to be ill. Considering these therapeutic results and the higher cost and limited availability of alternative therapies; chloroquine 25 mg/kg therapy was adopted as the primary therapy for malaria

Oral rehydration therapy in Malawi: impact on hospital admissions; hospital treatment practices and severity of disease

After the first two years after refresher training of pediatric staff in oral rehydration therapy [ORT] and the establishment of an oral rehydration unit at Kamuzu Central Hospital [KCH]; Lilongwe; there was a 50 percent decrease in the number of children admitted to the pediatric ward with the diagnosis of diarrheal disease; a 56 percent decrease in the use of intravenous fluid for rehydration of children hospitalized with diarrheal disease and a 70 percent increase in the use of oral rehydration salts [ORS] exclusively to rehydrate children with mild or moderate dehydration