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Chloroquine-resistant Plasmodium falciparum among children in Calabar, south eastern Nigeria
O E Antia-Obong1, A A Alaribe, M U Young
1Department of Paediatrics, University of Calabar Teaching Hospital, Nigeria.
Insights
Chloroquine resistance in Plasmodium falciparum malaria is worsening in children in Calabar, Nigeria. Treatment failure rates increased significantly, indicating a need for updated malaria treatment policies.
Area of Science:
- Medical Research
- Tropical Medicine
- Parasitology
Background:
- Plasmodium falciparum malaria remains a significant health concern, particularly in children.
- Chloroquine has historically been a first-line antimalarial, but resistance is a growing problem.
- Previous studies in Calabar indicated rising chloroquine resistance.
Purpose of the Study:
- To evaluate the efficacy of chloroquine treatment in children with Plasmodium falciparum malaria.
- To assess the current prevalence of chloroquine resistance in Calabar.
- To compare resistance levels with previous findings from 1989.
Main Methods:
- A study involving 69 children (6-60 months) with confirmed Plasmodium falciparum malaria.
- Treatment administered included chloroquine phosphate suppositories and chloroquine sulphate syrup.
- Evaluation of treatment response followed the World Health Organization (WHO) 14-day in vivo field test.
Main Results:
- Overall parasitological cure rate was 34.8%, with treatment failure in 65.2% of cases.
- The prevalence of chloroquine resistant Plasmodium falciparum (CRPF) was significantly higher than reported in 1989 (65.2% vs. 53.6%).
- The proportion of RII (Resistant, Intermediate) cases increased significantly from 21.4% in 1989 to 46.4% in the current study.
Conclusions:
- Chloroquine resistance in Plasmodium falciparum malaria has worsened in Calabar, Nigeria.
- The increase in RII cases suggests a more severe form of resistance.
- Continuous surveillance of antimalarial drug efficacy is crucial for developing effective malaria treatment policies.
Abstract:
Sixty-nine children aged between 6 and 60 months with parasitologically proven Plasmodium falciparum malaria were treated with chloroquine (2.5 mg/kg) in the Children's Emergency Room of the University of Calabar Teaching Hospital (UCTH) in 1993. Thirty subjects (mean age 27.8 months) and 39 (mean age 29.5 months) received chloroquine phosphate suppository (Pharma Deko) and chloroquine sulphate syrup (May & Baker), respectively. The World Health Organization (WHO) 14-day in vivo field test was used in evaluating the response to treatment. In both treatment groups the responses were similar. Overall, parasitological cure occurred in 24 subjects (34.8%) and in the remaining 45 subjects (65.2%) treatment failed (chloroquine resistance). This level of chloroquine resistant Plasmodium falciparum (CRPF) is higher than 53.6% reported in this centre in 1989. Furthermore, in the present study the proportion of RII (46.4%) is significantly higher than 21.4% (P < 0.02) obtained in 1989. Our findings show a worsening of CRPF in Calabar with RII being the main contributor. This observation indicates the need for continued surveillance of the response of P. falciparum to chloroquine and alternative antimalarials as a means of evolving an effective treatment policy for malaria.