Efficacy of chloroquine, sulfadoxine-pyrimethamine and amodiaquine for treatment of uncomplicated Plasmodium falciparum malaria among children under five in Bongor and Koumra, Chad.

We report two 28-day in-vivo antimalarial efficacy studies carried out in the urban centres of Bongor and Koumra, southern Chad. We assess chloroquine (CQ), sulfadoxine-pyrimethamine (SP) and amodiaquine (AQ) to treat Plasmodium falciparum uncomplicated malaria. Methods and outcome classification complied with latest WHO guidelines. Out of the 301 and 318 children aged 6-59 months included in Bongor and Koumra, respectively, 246 (81.7%) and 257 (80.8%) were eligible for analysis. In Bongor and Koumra, the 28-day PCR-adjusted failure rates for CQ were 23.7% (95% CI 14.7-34.8%) and 32.9% (95% CI 22.1-45.1%), respectively, and those for SP were 16.3% (95% CI 9.4-25.5%) and 4.3% (95% CI 1.2-10.5%). AQ failure rates were 6.4% (95% CI 2.1-14.3%) and 2.2% (95% CI 0.3-7.6%). The current use of CQ in Bongor and Koumra is questionable, and a more efficacious treatment is needed. Considering the reduced efficacy of SP in Bongor, AQ seems to be the best option for the time being. Following WHO recommendations that prioritize the use of artemisinin-based combinations, artesunate plus amodiaquine could be a potential first-line treatment. Nevertheless, the efficacy of this combination should be evaluated and the change carefully prepared, implemented and monitored.

Complexity of the malaria vectorial system in Cameroon: contribution of secondary vectors to malaria transmission.

Malaria transmission in Africa is a dynamic and complex system that is so far superficially understood. Further knowledge is required to improve control of the disease. In the present report, we highlight the contribution of the so-called "secondary" malaria vectors to the overall parasite transmission intensity in several sites across Cameroon, through a retrospective analysis of surveys from the Organisation de Coordination pour la lutte Contre les Endémies en Afrique Centrale database. In total, 48,490 female anophelines belonging to 21 different species were collected between October 1998 and March 2003. Anopheles gambiae Giles, Anopheles arabiensis Patton, Anopheles funestus Giles, Anopheles nili (Theobald), and Anopheles moucheti Evans represented 89% of the total anopheline fauna. Beside these major vectors, malaria parasites or their circumsporozoite proteins were found in nine secondary malaria vectors: Anopheles ovengensis Awono-Ambene et al., Anopheles carnevalei Brunhes et al., Anopheles coustani Laveran, Anopheles hancocki Edwards, Anopheles marshallii (Theobald), Anopheles paludis Theobald, Anopheles pharoensis Theobald, Anopheles wellcomei Theobald, and Anopheles ziemanni Grtünberg. The mean infection rate of secondary vectors (1.36%) was significantly (P < 0.001) lower than that of major vectors (3.08%). An. pharoensis and An. ovengensis were repeatedly found infected by Plasmodium falciparum Welch and contributed substantially to the total malaria transmission intensity in some areas where they were abundant. Both species have strong exophilic and/or exophagic habits such that they might elude vector control directed against endophilic and endophagic malaria vectors.