MALARIA CHEMOSUPPRESSION IN PREGNANCY .2. ITS EFFECT ON MATERNAL HEMOGLOBIN LEVELS, PLACENTAL MALARIA AND BIRTH-WEIGHT

The malaria prophylactic effects of chloroquine (CQ), proguanil (PROG) , anti chloroquine-proguanil combination (CQ+PROG) during pregnancy on maternal haemoglobin levels (Hb), placental malaria, and birth weight were assessed in Muheza, Tanzania. Within 2 months of prophylaxis, se vere anaemia in primigravidae (PG) was reduced from 21% (22 cases) to 13% (13 cases). There was no positive effect in multigravidae (MG). Su stained increases in the mean Hb occurred in PG of the PROG and CQ+PRO G groups. The mean Hb of PG of the CQ group decreased after an initial increase, possibly due to the selection of more and highly chloroquin e-resistant strain(s). The mean birth weight of PG was highest in the CQ+PROG (2.89 kg) and least in the CQ group (2.71 kg). The CQ group ha d the highest low birth weight rate (LBW). The prevalence of placental malaria was highest in the CQ (28%) and lowest in the PROG group (12% ). For all the prophylactic effects, PROG and CQ+PROG did not differ s ignificantly. Thence, the deployment of CQ+PROG for prophylaxis would be unnecessary. Proguanil is a suitable alternative to chloroquine pro phylaxis. Due to possible emergence of proguanil resistance, deploymen t of this drug should incorporate constant monitoring for resistance a nd the eventual prophylaxis efficacy. The search for other effective m alaria control measures should continue.