Amodiaquine treatment of uncomplicated malaria in children, in an area of chloroquine-resistant Plasmodium falciparum in north-central Nigeria.

The efficacy of amodiaquine against Plasmodium falciparum malaria was assessed in an area of confirmed chloroquine resistance in the cool, north-central plateau of Nigeria, using a 14-day protocol. The patients were all children aged <5 years of age. The drug proved highly efficacious, giving a cure 'rate' of 100% on day 14 and mean fever- and parasite-clearance times of 1.11 and 3.11 days, respectively. It was also well tolerated. Following treatment, packed-cell volumes (PCV) generally increased (65% of patients) but remained constant (12%) or even decreased (23%) in some patients; the overall improvement in PCV was not statistically significant (P >0.05). The results justify the use of amodiaquine to treat P. falciparum malaria in those who have failed treatment with chloroquine and the second-line drugs (e.g. sulfadoxine-pyrimethamine) currently used in Nigeria. As the amodiaquine would be better employed as one part of a combination than on its own, there is a need to identify suitable partner compounds.

Preliminary assessment of the efficacy of mefloquine/-sulphadoxine/ pyrimethamine combination in the treatment of uncomplicated malaria in children in North Eastern Nigeria.

Preliminary assessment of efficacy of mefloquine/-sulphadoxine/pyrimethamine (MSP) combination in the treatment of uncomplicated Plasmodium infections was conducted in-vivo in non-immune and semi-immune children in Damboa, in the North east of Nigeria using a 7-day protocol. Six hundred and forty-six (76.4%) subjects out of 846 screened had positive Plasmodium infections. Seventy-two patients aged 6 months to 11 years were enrolled, of whom 69 (95.8%) completed the study. MSP demonstrated high clinical efficacy, producing 100% cure rate against pure P. falciparum (77.8%), pure P. malariae (18.1%) and mixed P. falciparum and P. malariae (4.2%) infections. GMPDs for P. falciparum, P. malariae and mixed infections were 4,826, 3,680 and 12,573 a sexual stages per microl of whole blood. The mean parasite clearance time (MPCT) was 4.42 days for pure P. falciparum parasitaemia and 4.82 days for P. malariae alone. No parasitologic failure occurred in the patients. Clinical response occurred rapidly; all fever cases cleared within 24 hours. Moreover, significant (P<0.05) PCV improvement occurred in 7 days from an average of 33.8 +/- 4.5% on D0 to 35.5 +/- 3.5% on D7. Besides, this drug was well tolerated by majority of patients. Details of these findings are presented and discussed against the background of increased efforts towards effective malaria treatment and control in Nigeria.

Treatment of malaria in north-eastern and south-eastern Nigeria: a population study of mefloquine, sulphadoxine, pyrimethamine combination (MSP) vs chloroquine (CQ).

In a population-based study involving 4019 patients in 20 peripheral health facilities in Nigeria, the outcome of presumptive malaria treatment with MSP was compared to that of CQ. The study was conducted between January 1995 and January 1996. Patients aged 6 months or more with a clinical diagnosis of malaria based on history of fever and axillary temperature > 37.5 degrees C were either treated with MSP (250 mg mefloquine, 500 mg sulphadoxine, and 25 mg pyrimethamine per tablet) or CQ (150 mg chloroquine base per tablet). The clinical cure rate was assessed by the disappearance of clinical signs and symptoms over a 7-day period. Tolerability was assessed by the incidence of adverse events (adverse drug reaction and intercurrent illness). The result shows that the clinical care rate of suspected malaria was 97.6% with MSP and 85.6% with CQ. The incidence of adverse event was 9.5% with MSP and 9.2% with CQ. The withdrawal rate was 2.0% with MSP and 5.0% with CQ; 3.5% of the patients in the CQ group withdrew due to adverse events compared to 0.47% with MSP. In conclusion it was observed that in addition to superior efficacy of MSP over CQ, fever clearance rate with MSP was comparable to that of CQ. The study also demonstrated that two tablets maximum dose of MSP is safe and effective in a large population of Nigeria malaria patients.

Efficacies of chloroquine, pyrimethamine/sulphadoxine and pyrimethamine/sulphalene against P. falciparum in northeastern Nigeria.

The clinical and parasitologic efficacies of oral chloroquine phosphate, pyrimethamine/sulphadoxine and pyrimethamine/sulphalene in treating Plasmodium falciparum malaria were assessed in selected sites of northeastern Nigeria (Zone D of the Primary Health Care (PHC) Programme) using a 14-day standard in-vivo protocol during 1988-1990. Of a total of 2056 children under 5 years screened for infection, for chloroquine trials, 1189 (57.8%) were positive for Plasmodium infection. One hundred and seventy (14.3%) of these positive children were enrolled into the study. Clinically, the drug demonstrated high performance in clearing symptoms of infection. However, varying degrees of parasitologic failure, ranging from delayed clearance through recrudescence to asymptomatic Type-II resistance, were encountered. For tests with pyrimethamine/sulphadoxine and pyrimethamine/sulphalene, 517 and 253 children, respectively, were screened. The corresponding infection rates were 71.6% (370 children) and 71.5% (181 children), with 59 and 34 enrollments. Both drugs were highly effective, clinically and parasitologically. These findings and their implications for the success of the PHC programme for malaria control are discussed.

Efficacy of chloroquine in the treatment of malaria in children under five years in Baissa (Gongola State, Nigeria).

The Nigerian Federal Ministry of Health in 1987 instituted a nationwide programme to gather data on the efficacy of chloroquine in treating malaria in children as a basis for the development of a national malaria therapy policy. The programme is part of a comprehensive Combating Childhood Communicable Diseases (CCCD) programme. A simplified WHO in vivo method, involving follow-up observations on day 1 (D1), D2, D7 and D14 following the first day the study began (D0), was used for this study. A total of 769 children were screened, of which 363 (47%) were positive for malaria parasites. Fifty-three children were enrolled for the 14-day follow up, and chloroquine phosphate, 25 mg (base) kg-1, was given in three divided doses on D0, D1 and D2. Parasitological failure occurred in 25% of the children. There were no clinical failures in the study; i.e. no child found with parasitaemia after completing treatment was judged to be clinically ill. Generally the older children had the heavier parasite densities and severer symptoms.