Response of children with Plasmodium falciparum to chloroquine and development of a national malaria treatment policy in Zaire.
In vivo sensitivity of Plasmodium falciparum to chloroquine was evaluated in 4 of 9 regions of Zaire in 1985 to develop a national strategy for treatment of malaria. Children less than 5 years of age were treated with either a single dose of chloroquine base, 10 mg/kg, or a dose of 25 mg/kg given over 3 d. A modified 7-day World Health Organization in vivo test was used with follow-up 2, 3 and 7 d after the start of treatment. 339 children were studied. In Bwamanda 92% of children were aparasitaemic 7 days after chloroquine, 10 mg/kg, but in Kinshasa only 44% were free of parasites after 25 mg/kg chloroquine. The mean drop in parasite density among those who did not clear parasites by day 7 was greater than 98% of the initial value. Although the parasite density decreased markedly, the failure of most subjects to become aparasitaemic indicated a marked decrease in parasite sensitivity since 1983. Only one child of 51 who were initially febrile remained febrile, although 14 (28%) of these had resistant parasites. The decrease in parasitaemia and temperature, even among children with resistant strains, led the Ministry of Health to recommend 25 mg/kg chloroquine as first line treatment for fever/malaria in their national malaria control plan. The plan includes drug sensitivity surveillance and a referral system for patients who do not respond to chloroquine treatment.
Paluku
K M
KM
Childhood Communicable Diseases Program, Ministry of Health, Kinshasa, Zaire.
Breman
J G
JG
Moore
M
M
Ngimbi
N P
NP
Sexton
J D
JD
Roy
J
J
Steketee
R W
RW
Weinman
J M
JM
Kalisa-Ruti
ma-Disu
M
M
D000818:Animals; D002675:Child, Preschool; D002738:Chloroquine / Q000008:administration & dosage / Q000627:therapeutic use*; D015023:Democratic Republic of the Congo; D004351:Drug Resistance; D005260:Female; D006291:Health Policy; D006801:Humans; D008288:Malaria / Q000188:drug therapy* / Q000469:parasitology; D008297:Male; D010963:Plasmodium falciparum / Q000187:drug effects; D011634:Public Health
D002738:Chloroquine