Presumptive treatment with sulphadoxine-pyrimethamine versus weekly chloroquine for malaria prophylaxis in children with sickle cell anaemia in Uganda: a randomized controlled trialReportar como inadecuado




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Malaria Journal

, 8:237

First Online: 24 October 2009Received: 23 June 2009Accepted: 24 October 2009

Abstract

BackgroundMalaria carries high case fatality among children with sickle cell anaemia. In Uganda, chloroquine is used for prophylaxis in these children despite unacceptably high levels of resistance. Intermittent presumptive treatment with sulphadoxine-pyrimethamine SP has shown great potential for reducing prevalence of malaria and anaemia among pregnant women and infants.

ObjectiveTo compare the efficacy of monthly SP presumptive treatment, versus weekly chloroquine for malaria prophylaxis in children attending the Sickle Cell Clinic, Mulago Hospital.

MethodsTwo hundred and forty two children with sickle cell anaemia were randomized to presumptive treatment with SP or weekly chloroquine for malaria prophylaxis. Active detection of malaria was made at each weekly visit to the clinic over one month. The primary outcome measure was the proportion of children with one malaria episode at one month follow-up. The secondary outcome measures included malaria-related admissions and adverse effects of the drugs.

ResultsNinety-three percent 114-122 of the children in the chloroquine group and 94% 113-120 in the SP group completed one month follow up. SP reduced prevalence of malaria by 50% compared to chloroquine OR = 0.50, 95% CI 0.26-0.97; p = 0.042. Six percent 7-122 of the children receiving weekly chloroquine had malaria related admissions compared to 2.5% 3-120 on presumptive treatment with SP. No serious drug effects were reported in both treatment groups

ConclusionPresumptive treatment with SP was more efficacious than weekly chloroquine in reducing prevalence of malaria in children with sickle cell anaemia. Continued use of chloroquine for malaria chemoprophylaxis in children with sickle cell anaemia in Uganda does not seem to be justified.

Clinical Trials RegistrationClinicalTrials.gov Identifier: NCTOO124267

Electronic supplementary materialThe online version of this article doi:10.1186-1475-2875-8-237 contains supplementary material, which is available to authorized users.

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Autor: Victoria Nakibuuka - Grace Ndeezi - Deborah Nakiboneka - Christopher M Ndugwa - James K Tumwine

Fuente: https://link.springer.com/







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