CHLOROQUINE TREATMENT FOR UNCOMPLICATED CHILDHOOD MALARIA IN AN AREA WITH DRUG-RESISTANCE - EARLY TREATMENT FAILURE AGGRAVATES ANEMIA

Childhood anaemia is a major public health problem in malaria holoende mic areas. We assessed the effects of antimalarial treatment in an are a with drug-resistant falciparum malaria on haemoglobin levels in smal l children by applying the 1996 World Health Organization in vivo meth od for the evaluation of standard chloroquine treatment at the communi ty level. In Fukayosi village, coastal Tanzania, 117 children aged 5-3 6 months with clinical malaria episodes were treated with chloroquine syrup (25 mg/kg). Early treatment failure (ETF) occurred in 20% and la te treatment failure (LTF) in 22% of cases. Age >1 year and malnutriti on were protective factors against ETF. The evidence that chloroquine treatment could not prevent an exacerbation of anaemia was (i) the fac t that the fall in haemoglobin level after 72 h was significantly grea ter in ETF than in children with LTF and an adequate clinical response , and (ii) the absence of any haematological improvement at follow-up in children receiving chloroquine alone, even in true treatment succes ses. In contrast, pyrimethamine/sulfadoxine administered to treatment failures improved the haemoglobin level significantly >21 d after trea tment started (mean difference 14 g/L, 95% confidence interval 2.1-27) . We conclude that, when chloroquine treatment of childhood malaria is associated with a 20% ETF rate, the haemoglobin response is unsatisfa ctory and there is a need to change the recommended first-line treatme nt.