Maloprim malaria prophylaxis in children living in a holoendemic village in north-eastern Tanzania.

Abstract

A randomized, double-'blind', placebo-controlled trial of weekly Maloprim (dapsone-pyrimethamine, D-P) for malaria prophylaxis was conducted at Magoda village in north-eastern Tanzania. The effect of D-P on the incidence of clinical malaria, Plasmodium falciparum prevalence and density, splenomegaly, and packed cell volume (PCV) was investigated in a cohort of 249 children (126 receiving D-P and 123 receiving placebo) aged 1-9 years. The case definition of clinical malaria (malaria fever) was measured axillary temperature > or = 37.5 degrees C and/or reported fever, and P. falciparum asexual parasitaemia > or = 5000/microL. Children aged 1-4 years given D-P experienced 1.56 episodes of clinical malaria per year, whereas children on placebo experienced 2.55 episodes (relative rate [RR] = 0.61, 95% confidence interval [CI] 0.47, 0.80). Thus, D-P protective efficacy against clinical malaria, in this age group, was 39% (95% CI 20%, 53%; P = 0.0002). The annual incidence of clinical malaria among children aged 5-9 years was 0.16 episodes in the D-P group and 0.26 episodes in those receiving placebo (RR = 0.58, 95% CI 0.26, 1.28; P = 0.17). Increased malaria transmission and drug resistance, during the course of the trial, resulted in a reduction in the protective efficacy of D-P. Overall, D-P was able to reduce parasite densities and splenomegaly. D-P prophylaxis also resulted in an increase in PCV but this effect diminished towards the end of the trial. D-P exerted a suppressive effect on asexual parasitaemia throughout the trial.

• Authors: M M Lemnge, H A Msangeni, A M Rønn, F M Salum, P H Jakobsen, J I Mhina, J A Akida, I C Bygbjerg
• Journal: Transactions of the Royal Society of Tropical Medicine and Hygiene (Trans R Soc Trop Med Hyg) 1997 Jan-Feb Vol. 91 Issue 1 Pg. 68-73 ISSN: 0035-9203 [Print] England
• PMID: 9093633 (Publication Type: Clinical Trial, Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)

Chemical References

• Anti-Infective Agents
• Drug Combinations
• Dapsone
• Pyrimethamine

Topics

• Anti-Infective Agents (adverse effects, therapeutic use)
• Child
• Child, Preschool
• Cohort Studies
• Dapsone (adverse effects, therapeutic use)
• Double-Blind Method
• Drug Combinations
• Drug Resistance
• Female
• Fever (prevention & control)
• Follow-Up Studies
• Hematocrit
• Humans
• Infant
• Malaria (blood, physiopathology, prevention & control)
• Male
• Parasitemia (prevention & control)
• Patient Compliance
• Prospective Studies
• Pyrimethamine (adverse effects, therapeutic use)
• Splenomegaly (prevention & control)
• Tanzania
• Treatment Outcome