[Therapeutic efficacy of amodiaquine against uncomplicated malaria in Madagascar]. / Efficacité thérapeutique de l'amodiaquine dans le traitement du paludisme à Madagascar.

We report the results of a preliminary study carried out in 2004 to assess the therapeutic efficacy of amodiaquine in patients aged 5 years or older in Sainte Marie and Saharevo, in eastern Madagascar. Consenting patients with uncomplicated Plasmodium falciparum malaria were enrolled and followed up for 14 days: 46 were treated with chloroquine (25 mg/kg for 3 days) and 25 with amodiaquine (30 mg/kg for 3 days). No early treatment failure was observed with chloroquine but the overall late treatment failure rate was 17.4% (4.4% late clinical failures and 13% late parasitological failures). Amodiaquine was not associated with any cases of treatment failure through day 14. These preliminary results indicate that compared with chloroquine, amodiaquine is significantly more effective in treating uncomplicated malaria in our study sites. Amodiaquine is therefore recommended in combination with other antimalarial drugs. To generate useful data for decisions about drug use, further studies based on the WHO protocol should assess the clinical efficacy and also the safety of amodiaquine-containing antimalarial drugs in different regions in Madagascar, especially among children under 5 years.

[Rapid diagnostic test for malaria: preliminary study in Madagascar in 2003]. / Utilisation du test de diagnostic rapide du paludisme à Madagascar: étude préliminaire en 2003.

This study was conducted in 2003 as part of the training of laboratory technicians in the use of rapid diagnostic tests (RDTs) for malaria and to evaluate these tests in Madagascar in field conditions for the first time. Two types of RDT were used separately. The dipstick (Optimal-I) that detects circulating pLDH was tested in 168 patients with clinically suspected malaria (fever or recent history of fever) at primary health centers. Microscopy confirmed malaria in 93/168 (55.4%) cases. Monoparasitic P. falciparum infection was identified in 86/93, P. malariae in 3/93, P. vivax in 3/93 and P. ovale in 1/93. A positive Optimal-I test was a highly sensitive indicator of P. falciparum infection with parasitemia exceeding 500 trophozoites/mul (sensitivity of 97.2%; with a specificity of 100%); it also confirmed 6/7 cases of non-P. falciparum malaria. A community malaria survey used the Malaria Hexagon dipstick (detecting P. falciparum-specific HRP2) for 273 patients: 17 (6.2%) RDT tests were positive, and 16 (5.9%) microscopic tests. Although this dipstick did not detect the only case of infection with P. vivax, its specificity was 100% for detection of P. falciparum infection. Installing microscopes and qualified microscopists in the health centers of the one hundred and eleven districts in Madagascar would be extremely difficult, but our results show that RDT is an effective alternative diagnostic tool for daily use as well as for sporadic malaria epidemics. The revised antimalarial treatment policy, involving a drug ten to twenty times more expensive than chloroquine, demonstrates the need to improve malaria diagnosis: presumptive treatment has become prohibitively expensive. RDT can be used to improve malaria case management at the primary heath centers in Madagascar. We discuss the choice of RDTs.