Comparison of chloroquine, pyrimethamine and sulfadoxine, and chlorproguanil and dapsone as treatment for falciparum malaria in pregnant and non-pregnant women, Kakamega District, Kenya.
OBJECTIVE
To compare treatment and protection against falciparum malaria in pregnant and non-pregnant women with three drug regimens.


METHODS
Prospective intervention study with six weeks' follow up. Patients received one of three drug regimens in order of entry.


METHODS
Primary care hospital and secondary girls' school in rural western Kenya.


METHODS
158 of 988 pregnant women (89 primigravid and 69 multigravid) in the third trimester and 105 of 1488 non-pregnant schoolgirls of reproductive age were parasitaemic (more than 500 asexual forms/microliter. These women were divided into three treatment groups by gravid state.


METHODS
Women were treated with chloroquine base 25 mg/kg over three days or pyrimethamine 75 mg and sulfadoxine 1500 mg as a single dose or chlorproguanil 1.2 mg/kg and dapsone 2.4 mg/kg as a single dose.


METHODS
Parasitaemia and haemoglobin concentrations measured at seven day intervals for six weeks.


RESULTS
Primigravid women were more likely to be parasitaemic on follow up than multigravidas or nulligravidas, whose response was about the same. Parasites did not clear by day 7 in primigravidas in six (20%) of 30 who received chloroquine, three (8%) of 35 treated with pyrimethamine and sulfadoxine, and none of 23 treated with chlorproguanil and dapsone. At day 28, 83%, 19%, and 67% of primigravidas in these treatment groups were parasitaemic. Haemoglobin concentrations rose in all women, but improvement was sustained only in women who remained free of parasites.


CONCLUSIONS
Clearance of parasites was better with either pyrimethamine and sulfadoxine or chlorproguanil and dapsone than with chloroquine. Longest protection was obtained with pyrimethamine and sulfadoxine.
St Mary's Hospital, Mumias, Kakamega District, Kenya.
M
M
Keuter
A
A
van Eijk
M
M
Hoogstrate
M
M
Raasveld
M
M
van de Ree
W A
WA
Ngwawe
W M
WM
Watkins
J B
JB
Were
A D
AD
Brandling-Bennett
D000293:Adolescent; D000328:Adult; D000818:Animals; D000962:Antimalarials / Q000627:therapeutic use*; D002738:Chloroquine / Q000008:administration & dosage; D003622:Dapsone / Q000008:administration & dosage; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D008288:Malaria / Q000097:blood / Q000188:drug therapy*; D010963:Plasmodium falciparum; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000188:drug therapy*; D002727:Proguanil / Q000008:administration & dosage; D011446:Prospective Studies; D011739:Pyrimethamine / Q000008:administration & dosage; D013413:Sulfadoxine / Q000008:administration & dosage
D000962:Antimalarials; D013413:Sulfadoxine; D002738:Chloroquine; D003622:Dapsone; D002727:Proguanil; D011739:Pyrimethamine