title: Sickle-cell disease and malaria: evaluation of seasonal intermittent preventive treatment with sulfadoxine-pyrimethamine in Senegalese patients-a randomized placebo-controlled trial.
abstract: Sickle-cell disease (SCD) patients are at high risk of developing malaria which is a major contributor to morbidity and mortality in this disease. In Senegal, malaria transmission is high during rainy season, between July and October, and it was noted that sickle-cell crisis are frequent during this period. Then we carried out a double-blind randomized controlled trial to compare the impact of monthly sulfadoxine-pyrimethamine (SP) during the high-transmission season versus placebo on malaria incidence and morbidity of sickle-cell anemia. Sixty (60) SCD patients were randomized either to receive three intermittent preventive treatment (ITP) with SP or placebo using the random permutation table with nine elements. The drug was administrated as follows: sulfadoxine 25 mg/kg and pyrimethamine 1.25 mg/kg and this treatment was given once during the following months: September, October, and November. Overall four episodes of malaria disease were diagnosed, all these cases in the placebo arm. Thus, overall prevalence was 6.6% and there was no other case of malaria in the SP arm during the study period. Parasitological diagnosis confirmed the presence of Plasmodium falciparum in all four cases. No patient death was encountered during the study. SP treatment was well tolerated as only one patient (1.6%) in the SP arm reported pruritus. A significant reduction of patients' complaints (p = 002) and blood requirements (p = 0.001) was noted in the SP group; whereas, no impact was observed on vaso-occlusive crisis and hospitalization occurrence. Malaria prophylaxis by monthly intake of SP during the transmission period of the parasite reduced the prevalence of malaria and was safe in SCD patients leaving in malaria endemic area.
authors.affiliation: Department of Clinical Hematology, University Cheikh Anta Diop, BP 5002, Dakar-Fann, Senegal. saliou.diop@ucad.edu.sn
authors.forename: Saliou
authors.initials: S
authors.lastname: Diop
authors.forename: Fabienne
authors.initials: F
authors.lastname: Soudré
authors.forename: Moussa
authors.initials: M
authors.lastname: Seck
authors.forename: Youssou Bamar
authors.initials: YB
authors.lastname: Guèye
authors.forename: Tandakha Ndiaye
authors.initials: TN
authors.lastname: Diéye
authors.forename: Awa Oumar Touré
authors.initials: AO
authors.lastname: Fall
authors.forename: Abibatou
authors.initials: A
authors.lastname: Sall
authors.forename: Doudou
authors.initials: D
authors.lastname: Thiam
authors.forename: Lamine
authors.initials: L
authors.lastname: Diakhaté
mesh_terms: D000293:Adolescent; D000328:Adult; D000755:Anemia, Sickle Cell / Q000150:complications* / Q000188:drug therapy* / Q000453:epidemiology; D000962:Antimalarials / Q000009:adverse effects / Q000627:therapeutic use; D004311:Double-Blind Method; D004338:Drug Combinations; D005260:Female; D006801:Humans; D015994:Incidence; D008288:Malaria / Q000453:epidemiology / Q000209:etiology* / Q000517:prevention & control* / Q000635:transmission; D008297:Male; D010507:Periodicity; D010919:Placebos; D011739:Pyrimethamine / Q000009:adverse effects / Q000627:therapeutic use*; D012621:Seasons; D012675:Senegal / Q000453:epidemiology; D013413:Sulfadoxine / Q000009:adverse effects / Q000627:therapeutic use*; D055815:Young Adult
chemical_list: D000962:Antimalarials; D004338:Drug Combinations; D010919:Placebos; C001205:fanasil, pyrimethamine drug combination; D013413:Sulfadoxine; D011739:Pyrimethamine