Evaluation de la chloroquino-resistance apres deux annees d'arret de la chimioprophylaxie chez les enfants de 0-9 ans dans un village d'endemie palustre au Mali

RESUMO

This study was carried out in the village of Faladie; Mali located in the malaria-endemic Kati region; two years after routine use of chloroquine prophylaxis was discontinued in children 0 to 9 years old. The main purpose of this study was to assess changes in chloroquine resistance. Two cross-sectional surveys in association with WHO in vivo chloroquine sensitivity testing were conducted; i.e.; one in September 2000 and one in December 2002. Findings in 2000 showed that 77.5of m o t h e rs administered ch l o roquine prophylaxis to their ch i l d ren in compliance with physician ord e rs. The plasmodic index was 62. The ove rall level of para s i t o l ogic resistance (based on the 1996 WHO in vivo tests) was 80. The ove rall therapeutic fa il ure rate was 17.5. Findings in 2002 demonstrated a plasmodic index of 28; an ove rall para s i t o l ogic resistance rate of 45(based on WHO in vivo tests); and an overall therapeutic failure rate of 15. The diminution of resistance in 2002 may be due to the decrease of drugs pre s s u re and to low ex p o s u re of individuals to mosquitoes at the end of transmission season. Althougt these data indicate a 44drop in hloroquine resistance (P=0.0001); no increase in the clinical effi c a cy of chloroquine was observed (P= 0.05). In view of these results we propose more emphasis on information campaigns to increase public awareness of the need for chemoprophylaxis only for pregnant women; on the promotion of the use of bednets and insecticide-impregnated materials; and on environmental management