Gametocytocidal effect of primaquine in a chemotherapeutic malaria control trial in North Sumatra, Indonesia.

The effect of primaquine as a gametocytocidal drug was investigated in 218 P. falciparum (Pf) malaria cases detected during passive case detection (PCD) from August to December 1985 in two coastal villages of North Sumatra, where chloroquine-resistant and Fansidar-sensitive Pf was prevalent. Sulfonamide + pyrimethamine (SP) in combination with primaquine (Pr) was administered in Kuala Tanjung village and SP alone in Nana Siam village. Parasitologically confirmed Pf cases were followed up to observe the fluctuation of gametocytemia after the treatment. In 87 cases treated with SP alone, no significant change was observed in gametocyte positivity rate (GPR) and density on day 2 and day 7. In 131 cases treated with SP and Pr, no significant change was found on day 2 but significant reduction was observed in GPR and density on day 7. The gametocyte positive cases on day 7 were followed up weekly until gametocytes disappeared. SP alone did not reduce GPR from day 0 to week 2, then afterward GPR began to decline but was still 11.5% at week 5. On the other hand, SP with Pr reduced GPR from 77% on day 0 to 30% on day 7, after which GPR declined further to 7% at week 3. Reduction of parasite rate was observed in Kuala Tanjung after the PCD activities, reflecting a reduction in Pf prevalence rate from 18.6% in August 1985 to 2.9% in January 1986. These data indicate that a single dose of Pr 45 mg with SP was partially effective in reducing gametocytes and reducing malaria prevalence rate when administered through PCD activities.

Chemotherapeutic malaria control operation by single dose of Fansidar plus primaquine in North Sumatra, Indonesia.

Selective age group treatment and village scale chemotherapeutic malaria control operation were carried out in east-coast villages in North Sumatra, Indonesia in 1987/1988. A single dose of Fansidar plus primaquine was adopted as the drug regimen to cut the transmission of malaria at the gametocyte stage. After the treatment on day seven, the gametocyte positive rate was reduced to only 2.7% in 72 Plasmodium falciparum gametocyte carriers. A significant reduction of P. falciparum prevalence in the community was observed after successive selective age group treatment in primary school, however P. vivax prevalence persisted. Village scale active case detection was carried out by one health center staff and two village health volunteers. After eight months P. falciparum prevalence was reduced from 14% to 1%. As the result of the chemotherapeutic control activities covering high-prevalence villages in the coastal area, malaria prevalence in 1988 became very low, as compared with the status in 1985/1986.