Sensitivity of Plasmodium falciparum to amodiaquine and chloroquine in central Africa: a comparative study in vivo and in vitro.

A comparative study in vivo of amodiaquine efficacy (35 mg/kg over 3 d) and chloroquine (25 mg/kg over 3 d) was conducted in 1991 and 1992 in Cameroon and Congo in 123 patients with uncomplicated Plasmodium falciparum malaria. Amodiaquine was more effective than chloroquine, with parasite clearance by day 7 in 79.7% of the patients compared with 59.4%. Sixteen of 32 (50%) P. falciparum isolates tested in vitro were resistant to chloroquine and only 3 of 34 (9%) were resistant to amodiaquine. 5.3% of patients treated with amodiaquine complained of pruritus and 18.7% of nausea, compared with 15.7% and 5% respectively of those treated with chloroquine.

[Management of child fever in the battle against malaria in Brazzaville]. / Prise en charge des fièvres de l'enfant dans le cadre de la lutte contre le paludisme-maladie à Brazzaville.

A cross sectional study on the diagnostic and therapeutic practices of health staff and mothers with regard to fever was carried out in the urban area of Brazzaville from the 12th to the 20th of April 1997. 390 children were included in the sample. Children were aged under five years, had suffered from fever 15 days prior to the survey and were treated at home or in a health centre with the most currently used drugs against malaria, results of the questionnaire indicated that those symptoms best recognised by mothers are fever (85.8%), asthenia (79.9%), chills (21.1%), vomiting (25.1%) and diarrhoea (10.9%). Chloroquine is the most used drug at home (66%) and amodiaquine (34.5%) in health centres. Drugs are mainly supplied by private drugstores (67.9%) and street vendors (19.1%). Management of fever requires proper training of health staff and good communication between health personnel and the target population.

[No variation in chloroquine resistance (Plasmodium falciparum) from 1986 to 1996 in semi-immune children in Brazzaville (Congo)]. / Niveau de chloroquinorésistance inchangée (Plasmodium falciparum) de 1986 à 1996 chez les enfants semi-immuns à Brazzaville (Congo).

A simplified Plasmodium falciparum in vivo test was carried out in Brazzaville (Congo) in April 1996. Chloroquine was prescribed at 25 mg/kg for 3 days in asymptomatic Brazzavillian school children who presented parasitemia > 800 P. falciparum trophozoïtes and lived in a highly endemic district. A massive decrease of parasitemia was observed on day 2. The percentage of resistance (presence of P. falciparum trophozoïte on day 7 in a thick blood film) was 43.5, 28 and 21 respectively (IC: 95%: 29-57, 15-41 & 10-34) at the threshold of 6, 50 and 100 parasites/microliter. In positive children on day 7 the reduction of parasitemia was > 95% and no case of R3 resistance was detected. A comparison with previous studies carried out in 1985, 1986, 1990 and 1993 in the same school using the same methodology proves the long-lasting stabilization of chloroquino-resistance for this semi-immune indigenous population.

[Comparative efficacy of chloroquine and amodiaquine (25 and 35 mg/kg) in school children infected with P. falciparum (Brazzaville, March 1990)]. / Efficacité comparée de la chloroquine et de l'amodiaquine (25 et 35 mg/kg) chez des écoliers porteurs de P. falciparum (Brazzaville, Mars 1990).

The efficacy of 4 therapeutic schedules was compared in March and April 1990 in Brazzaville school children, aged between 6 and 8 years, with parasitaemia of at least 1,000 trophozoites of Plasmodium falciparum per mm3. It was possible to interpret 125 simplified in vivo tests. The results showed that the activity of amodiaquine is still relatively satisfactory. The activity of chloroquine was slightly lower with the schedule of 25 mg/kg but was good at 35 mg/kg. Although these results were obtained in children who were mostly asymptomatic, they show that the use of amino-4-quinolines is still justified, at least in the initial treatment of uncomplicated malaria in semi-immune congolese subjects.

[Management of children's fever at home in a rural area of Boko (Congo-Brazzaville)]. / Prise en charge des fièvres de l'enfant à domicile dans le district rural de Boko (Congo-Brazzaville).

A cross-sectional study on the diagnostic and therapeutic practices of health staff and mothers with regards to carrying for children's fever was carried out from February 27 to March 16, 1995, in the rural district of Boko. The sample was comprised of 630 children aged less than 5 years old, having suffered from fever within the past 15 days and who were treated either at home or in a local health centre with a drug most presently used against malaria. The results compiled from the responses to the questionnaire have shown that the most frequently cited symptoms by mothers are fever (57.8%), asthenia (51.7%), vomiting (10.6%), chills (7.3%) and diarrhea (7.3%). Chloroquine is the most utilised drug at home (61%) and anti-malaria injections are the most frequently used drugs in health centres (51.7%). The medicine is mainly supplied by public drugstores and pharmacies (47.8%) and street vendors (43.2%). Proper management of a fever requires adequate training of health staff and a good level of communication between health workers and their target populations.