MORTALITY AND MORBIDITY FROM MALARIA AFTER STOPPING MALARIA CHEMOPROPHYLAXIS

Gambian children who had received malaria chemoprophylaxis for a varia ble period of time during their first 5 years of life were followed to determine whether they experienced a rebound in mortality or in morbi dity from malaria during the period after chemoprophylaxis was stopped . The risk of dying between the ages of 5 years, when chemoprophylaxis was stopped, and 10 years was no higher among children who had receiv ed chemoprophylaxis with Maloprim(R) (pyrimethamine plus dapsone) for some period during their first 5 years of life than among children who had received placebo (21 vs. 24 deaths) and the beneficial effect of chemoprophylaxis on mortality observed during the first 5 years of lif e was sustained. The incidence of clinical attacks of malaria during t he year after medication was stopped was significantly higher among ch ildren who had previously received Maloprim(R) for several years than among children who had previously received placebo. However, at the en d of this year, there was no significant difference in spleen rate, pa rasite rate or packed cell volume between the 2 groups of children. Th us, stopping chemoprophylaxis after a period of several years increase d the risk of clinical malaria but did not result in a rebound in mort ality in Gambian children. However, the number of deaths recorded was small, so a modest effect on mortality cannot be excluded.