Newly transmitted Plasmodium falciparum malaria in the central highland plateaux of Madagascar: assessment of clinical impact in a rural community.

Plasmodium falciparum has recently reappeared in the central highland plateaux of Madagascar. To define its role in the overall malaria pathology occurring during the rainy season, we conducted a clinical and parasitological study among the 2776 consultants of a malaria field health centre which we established in the middle of the transmission area. From January to June 1988 the overall parasite rate was 63.2% and did not vary with age; the overall splenic rate was 46.9%, decreasing in individuals over 15 years of age. After the beginning of the main transmission season, an increase in parasite rates and parasite densities was observed, while febrile illnesses associated with malaria parasitaemia decreased. During the second part of the rainy season the parasite densities started to decrease, while parasite rates and malaria-associated fevers remained at the same level. The frequency of fevers was not related to the malaria parasite density owing to individual and seasonal variations.

Newly transmitted plasmodium falciparum malaria in the central highland plateaux of Madagascar : assessment of clinical impact in a rural community

Plasmodium falciparum has recently reappeared in the central highland plateaux of Madagascar. To define its role in the overall malaria pathology occurring during the rainy season, we conducted a clinical and parasitological study among the 2776 consultants of a malaria field health centre which we established in the middle of the transmission area. From January to June 1988 the overall parasite rate was 63.2% and did not vary with age; the overall splenic rate was 46.9%, decreasing in individuals over 15 years of age. After the beginning of the main transmission season, an increase in parasite rates and parasite densities was observed, while febrile illnesses associated with malaria parasitaemia decreased. During the second part of the rainy season the parasite densities started to decrease, while parasite rates and malaria-associated fevers remained at the same level. The frequency

[The treatment of Plasmodium falciparum malaria in the Malagasy Highland Plateaux. Development of fever and parasite density. Clinical aspects]. / Le traitement du Paludisme à Plasmodium falciparum sur les Hauts Plateaux malgaches. Evolution de la fièvre et des densités parasitaires. Aspects pratiques.

In 1988, the sensitivity to chloroquine was investigated by the standard WHO in vivo test in 91 Plasmodium falciparum-infected individuals from the Highland Plateaux of Madagascar. As compared to the previous years, the level of resistance to chloroquine was increased, R2 resistant strains being present. This study also allows to define a policy for chloroquine therapy of patients. Following the malaria diagnosis by microscopy at DO, a single blood smear on D4 may indicate the parasitological cure for sensitive strains. However, 2 additional blood smears, on D7 and D14, are needed due to the presence of SR1, R1, and R2 strains. In all cases, a thick blood smear is required for microscopic observation, as the thin smear possess an insufficient threshold of sensitivity.