ABSTRACT
En depit des efforts deployes a travers plusieurs initiatives internationales; le paludisme constitue toujours un veritable probleme de sante publique. La prise en charge des cas de la maladie s'est compliquee avec l'emergence et l'extension des resistances de plasmodium Falciparum aux antipaludiques usuels. Parmi les strategies de lutte; outre la prise en charge des cas; la prevention reste l'element majeur. La moustiquaire impregnee d'insecticides est une composante de la strategie de lutte antivectorielle. La chloroquine; utilisee il y a quelques annees dans la chimioprophylaxie chez la femme enceinte a ete abandonnee du fait de niveaux de resistance devenus trop eleves. Elle est desormais remplacee par l'association sulfadoxine-pyrimethamine en traitement preventif intermittent (TPI).Cependant; il est urgent aujourd'hui de trouver une alternative a cet antipaludique; en raison de taux de resistances de Plasmodium Falciparum en augmentation. Aussi; avons-nous juge opportun de mettre en ouvre une etude comparee de l'efficacite et de la tolerance de l'association sulfalene-pyrimethamine ou metakelfin (MK) et de l'association sulfadoxine-pyrimethamine (SP); molecule de reference dans le TPI de la femme en ceinte. L'etude; multicentrique; randomisee; comparative; s'est deroulee simultanement au Cameroun; en Cote d'Ivoire et au Senegal durant la seconde semestre de l'annee 2005. La methodologie OMS d'etude de l'efficacite des antipaludiques a ete utilisee. Au total; 444 patients ont ete inclus dans cette etude. L'efficacite des deux medicaments etaient comparable; avec des taux de reponses cliniques et parasitologiques adequat respectifs de 92pour l'association sulfalene-pyrimethamine et 92;1pour l'association sulfadoxine-pyrimethamine apres correction PCR. La tolerance dans les deux groupes de traitement etait egalement comparable. L'association sulfalene-pyrimethamine pourrait etre utilisee dans le TPI chez les femmes enceinte; ce qui pourrait diminuer la pression exercee sur l'association sulfadoxine-pyrimethamine
Subject(s)
Drug Therapy, Combination , Drug Tolerance , Malaria , Pregnant WomenABSTRACT
Despite all the effort expended in the context of diverse international programmes; malaria still represents a massive public health problem. The treatment of patients has been complicated by the emergence and spread of Plasmodium Falciparum resistant to the regular antimalarial drugs. Thus research has focused on the identification of more effective but safe treatment modalities; notably drug combination. In this context; we have investigated the efficacy and safety of a novel combination; namely sulfalene/ pyrimethamine plus amodiaquine; by comparing it to amodiaquine plus artesunate (a combination recently adopted as first-line treatment in many countries). The randomized; multicentre; comparative study was conducted simultaneously in Cameroon and Cote d'Ivoire in the first six months of 2005. WHO methods for the evaluation of the efficacy of antimalarial drugs was used and a total of 467 patients were included. The two regime comparably effective with a clinical and parasitologic response rate of 97for sulfalene/pyrimethamine plus amodiaquine compared with 98.1for artesunate plus amodiaquine after PCR correction. Tolerance was also comparable in both groups
Subject(s)
Comparative Effectiveness Research , Drug Therapy , Drug Tolerance , Malaria/prevention & control , Pregnant WomenABSTRACT
A study in vivo of Plasmodium falciparum sensitivity to chloroquine was carried out from April 1997 to February 2000 at Yamoussoukro, Kossou and Bouaké in the central region of Côte d'Ivoire. This study was included in the national Plasmodium falciparum-sensitivity program. One hundred and sixteen subjects consulting for suspected malaria were included according to the WHO's standard of 14 days. Chloroquine was administered on a dosage of 25 mg/kg, spread over three days. Among 108 subjects who finished the treatment, 26.9% (29/108) had therapeutic failure to chloroquine (23 precocious therapeutic failure and 6 late therapeutic failure). Chloroquine was more efficacious in Yamoussoukro (87.5% of clinical appropriate response) and Bouaké (82.5%) than in Kossou (61.7%). Parasitic reduction on subjects with therapeutic failure was higher than 85%. The risk of therapeutic failure is not linked to age of patient. Before a revaluation of this situation, chloroquine should always be recommended as a first-line treatment for uncomplicated malaria for the local populations.
Subject(s)
Antimalarials/therapeutic use , Chloroquine/therapeutic use , Malaria, Falciparum/drug therapy , Malaria, Falciparum/parasitology , Age Factors , Child, Preschool , Cote d'Ivoire/epidemiology , Drug Administration Schedule , Hospitalization , Humans , Infant , Malaria, Falciparum/epidemiology , Parasitic Sensitivity Tests , Patient Selection , Population Surveillance , Severity of Illness Index , Treatment OutcomeABSTRACT
The therapeutic management of malaria in endemic regions is now hampered not only by the limited number of antimalarial agents, but also by the appearance of chemoresistant plasmodial strains and by the sometimes severe adverse effects related to the use of some of these drugs. Between January and July 1993, 100 patients presenting with symptomatic Plasmodium falciparum malaria were randomised to receive amodiaquine or chloroquine at the dose of 30 mg/kg for 3 days. The objective of this study was to compare the efficacy and safety of these two 4-aminoquinolines in the treatment of uncomplicated malaria. The parasite clearance was 4.87 (+/- 0.33) days in the amodiaquine group and 5.55 (+/- 0.31) days in the chloroquine group. All subjects in both groups were afebrile by D7. Cutaneous adverse effects, such as pruritus, were reported with both amodiaquine (3.2%) and chloroquine (6.8%). Amodiaquine was found to be significantly more effective than chloroquine in terms of parasite clearance on D7. The therapeutic failure rate was 0% for amodiaquine versus 16.3% for chloroquine. At a time when chemoresistance of Plasmodium falciparum, especially chloroquine-resistance, has spread to malarial endemic zones, amodiaquine should be very widely indicated in the treatment of simple malaria due to its excellent efficacy and good safety.
Subject(s)
Amodiaquine/therapeutic use , Chloroquine/therapeutic use , Malaria, Falciparum/drug therapy , Adolescent , Amodiaquine/adverse effects , Child , Child, Preschool , Chloroquine/adverse effects , Drug Resistance , Female , Humans , Infant , MaleABSTRACT
The authors reviewed the evolution of Plasmodium falciparum chloroquine resistance in greater Abidjan for the year 1990. They used the classical course of treatment consisting of 25 mg per kg of bodyweight distributed on three days. Parasitaemia and body temperature controls were carried out on day O, day 2 and day 7. The study, which involved 547 children averaging 38.3 months of age disclosed an early in vivo resistance in the range of 18.20% as against 29.6% in 1988.
Subject(s)
Malaria, Falciparum/drug therapy , Malaria, Falciparum/epidemiology , Population Surveillance , Body Temperature , Body Weight , Child, Preschool , Chloroquine/administration & dosage , Chloroquine/therapeutic use , Clinical Protocols , Drug Administration Schedule , Drug Resistance , Fever/diagnosis , Fever/etiology , Humans , Infant , Malaria, Falciparum/complications , Malaria, Falciparum/parasitologyABSTRACT
A coprological study realized with 217 HIV adult subjects has allowed to evaluate the frequency of the cryptosporidiosis during this affection in Abidjan. Cryptosporidium sp. has been found in 8.7% of the subjects. Otherwise 78.9% of the patients had a chronic diarrhoea. 89.4% showed an abdominal pain and were dehydrated 94.7% had lost weight and 21% had nausea or vomiting.
Subject(s)
Cryptosporidiosis/complications , HIV Infections/complications , Acquired Immunodeficiency Syndrome/complications , Acquired Immunodeficiency Syndrome/epidemiology , Adult , Cote d'Ivoire/epidemiology , Cryptosporidiosis/diagnosis , Cryptosporidiosis/epidemiology , HIV Infections/epidemiology , HumansABSTRACT
Coprological survey involving 250 ivorian children with diarrhoea was done to evaluate the incidence of cryptosporidiosis. Crypstosporidium sp. was found in 10.4% of subjects. 76.9, 57.7 and 19.2% Cryptosporidium positive children had profuse diarrhoea, fever and pulmonary symptoms respectively. In Ivory Coast, children diarrhoeas due to cryptosporidiosis are quantitatively important.
Subject(s)
Cryptosporidiosis/epidemiology , Cote d'Ivoire/epidemiology , Cryptosporidiosis/diagnosis , Humans , InfantABSTRACT
In vivo tests of Plasmodium falciparum chloroquine sensitivity were conducted in October and November, 1988 with 81 children aged 5 to 9 in several districts of Abidjan, Ivory Coast. The WHO standard scheme covering 7 days on basis of 25 mg per kilo spread over 3 days resulted in a therapeutic failure in 29.6 per cent cases. Nevertheless, a drop in overall parasitemia by over 80 per cent was noted from Day-0 to Day-2 in 70 per cent of visible resistance. Only in vivo tests conducted at a later stage with identification of chloroquine in the blood stream, with together in vitro studies will make it possible to know the actual level of resistance of Plasmodium falciparum strains to chloroquine.
Subject(s)
Chloroquine/therapeutic use , Malaria/drug therapy , Plasmodium falciparum/drug effects , Animals , Child , Child, Preschool , Chloroquine/pharmacology , Cote d'Ivoire/epidemiology , Female , Humans , Malaria/epidemiology , Male , Microbial Sensitivity TestsABSTRACT
The authors study parasites of the six most commonly consumed species of fishes in Côte-d'Ivoire. Analysis of gills, alimentary canal and blood of 188 fishes reveal the presence of extremely diverse families of parasites.
