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Thema: Malariaprophylaxe in Gambia

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6/1 von 107    DIMDI: GLOBAL Health (AZ72) © CAB

ND:	AZ20103217070
AU:	Bojang KA; Milligan PJM; Conway DJ; Sisay-Joof F; Jallow M; Nwakanma DC; Abubakr I; Njie F; Greenwood B
TI:	Prevention of the recurrence of anaemia in Gambian children following discharge from hospital.
SO:	PLos One (June); p. e11227 /2008/
PU:	Public Library of Sciences (PLoS); San Francisco; USA http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0011227
LA:	English
ISSN:	1932-6203
CS:	Medical Research Council Laboratories, Banjul, Gambia.
	mailto:kbojang@mrc.gm
DT:	Journal article
RN:	33 ref.
SC:	HH405 ... Pesticides and Drugs; Control, (New March 2000); VV130 ... Nutrition related Disorders and Therapeutic Nutrition; VV220 ... Protozoan, Helminth and Arthropod Parasites of Humans, (New March 2000)
SH:	Pesticides and Drugs; Control, (New March 2000); Nutrition related Disorders and Therapeutic Nutrition; Protozoan, Helminth and Arthropod Parasites of Humans, (New March 2000)
CT:	anaemia; antimalarials; antiprotozoal agents; chemoprophylaxis; children; disease prevention; efficacy; food supplements; haemoglobin; human diseases; iron; malaria; mortality; pyrimethamine; randomized controlled trials; relapse; safety; sulfadoxine
CT:	man; Plasmodium falciparum
CT:	Gambia
BTERM:	West Africa; Africa South of Sahara; Africa; Least Developed Countries; Developing Countries; ACP Countries; Commonwealth of Nations; Anglophone Africa; Homo; Hominidae; Primates; mammals; vertebrates; Chordata; animals; eukaryotes; Plasmodium; Plasmodiidae; Haemospororida; Apicomplexa; Protozoa; invertebrates
UT:	anemia; death rate; hemoglobin; recurrence of disease; relapses; sulphadoxine; The Gambia
CR:	7439-89-6; 58-14-0; 2447-57-6
AB:	Background: In malaria endemic countries, children who have experienced an episode of severe anaemia are at increased risk of a recurrence of anaemia. There is a need to find ways of protecting these at risk children from malaria and chemoprevention offers a potential way of achieving this objective. Methods: During the 2003 and 2004 malaria transmission seasons, 1200 Gambian children with moderate or severe anaemia (Hb concentration <7 g/dL) were randomised to receive either monthly sulfadoxine-pyrimethamine (SP) or placebo until the end of the malaria transmission season in which they were enrolled, in a double-blind trial. All study subjects were treated with oral iron for 28 days and morbidity was monitored through surveillance at health centres. The primary endpoint was the proportion of children with moderate or severe anaemia at the end of the transmission season. Secondary endpoints included the incidence of clinical episodes of malaria during the surveillance period, outpatient attendances, the prevalence of parasitaemia and splenomegaly, nutritional status at the end of the malaria transmission season and compliance with the treatment regimen. Results: The proportions of children with a Hb concentration of <7 g/dL at the end of the malaria transmission season were similar in the two study groups, 14/464 (3.0%) in children who received at least one dose of SP and 16/471 (3.4%) in those who received placebo, prevalence ratio 0.89 (0.44,1.8) P=0.742. The protective efficacy of SP against episodes of clinical malaria was 53% (95% CI 37%, 65%). Treatment with SP was safe and well tolerated; no serious adverse events related to SP administration were observed. Mortality following discharge from hospital was low among children who received SP or placebo (6 in the SP group and 9 in the placebo group respectively). Conclusions: Intermittent treatment with SP did not reduce the proportion of previously anaemic children with moderate or severe anaemia at the end of the malaria season, although it prevented malaria. The combination of appropriate antimalarial treatment plus one month of iron supplementation and good access to healthcare during follow-up proved effective in restoring haemoglobin to an acceptable level in the Gambian setting.
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