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Anemia of persistent malarial parasitemia in Nigerian children
1Department of Paediatrics, College of Medicine, University of Nigeria Teaching Hospital, Enugu.
Insights
Persistent malaria parasitemia significantly lowers packed cell volume (PCV) in children. Fansidar showed faster hematological recovery than chloroquine, highlighting high drug resistance in Nigeria.
Area of Science:
- Pediatrics
- Infectious Diseases
- Hematology
Background:
- Persistent malaria parasitemia is a significant health concern in children.
- Malaria infection can lead to anemia, impacting packed cell volume (PCV).
- Understanding the efficacy of antimalarial drugs is crucial for effective treatment.
Purpose of the Study:
- To determine the effect of persistent malaria parasitemia on packed cell volume (PCV) levels in children.
- To compare the efficacy and recovery time of chloroquine and Fansidar in treating malaria.
- To assess the level of parasite resistance to first-line antimalarials in Enugu, Nigeria.
Main Methods:
- Prospective study of 100 children aged 0-60 months over 9 months.
- Blood films for parasite identification and counts; patients randomized to chloroquine or Fansidar.
- Packed cell volume (PCV) levels monitored alongside parasite counts and temperature.
Main Results:
- Fansidar group showed significantly lower parasite counts and higher PCV by day 7.
- Chloroquine group showed significant reduction in parasite count and increase in PCV by day 21.
- A strong negative correlation (r = -0.9512) observed between parasite counts and PCV levels.
- High parasite resistance (RII level) found in 81% of patients.
Conclusions:
- Persistent malaria parasitemia negatively impacts children's packed cell volume.
- Fansidar offers a faster hematological recovery compared to chloroquine.
- High antimalarial drug resistance necessitates re-evaluation of drug policies and further community studies.
Abstract:
One hundred children aged 0-60 months, 63 males and 47 females, were studied prospectively over a period of 9 months to determine the effect of persistent malaria parasitemia on their packed cell volume (PCV) levels. Thick and thin blood films for parasite identification and counts were done. Patients were randomly assigned to two treatment groups: 62 patients received chloroquine, while 38 patients received fansidar. Mean parasite count (2789.2+/-1809.6) and mean temperature (36.83 (0.66 degrees C) in the fansidar group at day 7 were found to be significantly lower than at enrollment (p < 0.05). This also corresponded with significantly higher mean PCV values of 33.85+/-4.72 (p < 0.05). In the chloroquine group it was only by day 21 that a significant reduction in parasite count and associated increase in PCV levels were noted. A negative correlation between mean parasite counts and PCV levels was observed (r = -0.9512). The hematological recovery time for chloroquine was longer at 21 days compared to fansidar which was 7 days. RII level of parasite resistance was found in 81 patients, 32 in the fansidar group, and 49 in the chloroquine group. The level of resistance to the used first-line antimalarials was found to be rather high in Enugu, south-east Nigeria. This calls for more extensive community-based studies and probable changes in drug policies.