Maloprim malaria prophylaxis in children living in a holoendemic village in north-eastern Tanzania.
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.
Lemnge
M M
MM
National Institute for Medical Research, Amani Centre, Tanzania.
Msangeni
H A
HA
Rønn
A M
AM
Salum
F M
FM
Jakobsen
P H
PH
Mhina
J I
JI
Akida
J A
JA
Bygbjerg
I C
IC
D000890:Anti-Infective Agents / Q000009:adverse effects / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003622:Dapsone / Q000009:adverse effects / Q000627:therapeutic use*; D004311:Double-Blind Method; D004338:Drug Combinations; D004351:Drug Resistance; D005260:Female; D005334:Fever / Q000517:prevention & control; D005500:Follow-Up Studies; D006400:Hematocrit; D006801:Humans; D007223:Infant; D008288:Malaria / Q000097:blood / Q000503:physiopathology / Q000517:prevention & control*; D008297:Male; D018512:Parasitemia / Q000517:prevention & control; D010349:Patient Compliance; D011446:Prospective Studies; D011739:Pyrimethamine / Q000009:adverse effects / Q000627:therapeutic use*; D013163:Splenomegaly / Q000517:prevention & control; D013636:Tanzania; D016896:Treatment Outcome
D000890:Anti-Infective Agents; D004338:Drug Combinations; D003622:Dapsone; D011739:Pyrimethamine