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doi: 10.1186/s12936-015-0983-x.

Therapeutic efficacy of chloroquine for the treatment of Plasmodium vivax malaria among outpatients at Hossana Health Care Centre, southern Ethiopia

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Therapeutic efficacy of chloroquine for the treatment of Plasmodium vivax malaria among outpatients at Hossana Health Care Centre, southern Ethiopia

Mesfin Assefa et al. Malar J. .

Abstract

Background: Plasmodium vivax accounts for about 44 % of all malaria infection in Ethiopia. Chloroquine (CQ) is the first-line treatment for vivax malaria in Ethiopia. Chloroquine-resistant (CQR) P. vivax has been emerging in different parts of the world to compromise the efficacy of the drug and pose both health and economic impact in the developing world. The current study was aimed at assessing the therapeutic efficacy of CQ for the treatment of vivax malaria among outpatients at Hossana Health Care Centre, southern Ethiopia.

Methods: A one-arm, 28-day follow-up, in vivo therapeutic efficacy study was conducted from 5 April to 25 June, 2014. Sixty-three patients aged between four and 59 years were enrolled with microscopically confirmed P. vivax infection. All patients were treated with CQ 25 mg/kg for 3 days. Recurrence of parasitaemia and clinical conditions of patients were assessed on days 1, 2, 3, 7, 14, 21, and 28 during the 28-day follow-up period. Haemoglobin (Hb) level was determined on day 0, day 28 and on day of recurrence of parasitaemia by using portable spectrophotometer.

Results: Of the total 63 patients included in the study, 60 (95.2 %) completed their 28-day follow-up; three patients were excluded from the study: one patient due to vomiting of the second dose of drug, one patient due to Plasmodium falciparum infection and one patient lost to follow-up during the study. During enrolment, 35 (53.3 %) had a history of fever and 28 (46.7 %) had documented fever. The geometric mean of parasite density on day of enrolment was 3472 parasites/μl. Among these, two patients had recurrent parasitaemia within the 28-day follow-up. CQ was found to be efficacious in 96.7 % of the study participants except two treatment failures detected. The failure might be due to late parasitological failure among these two patients who had recurrent parasitaemia within the 28-day follow-up.

Conclusion: The current study revealed that CQ showed a high rate of efficacy (96.7 %) among the study participants even though some reports from previous studies elsewhere in Ethiopia showed an increase in CQR P. vivax. Thus, CQR molecular markers and regular monitoring of the pattern of resistance to CQ is needed for rapid and effective control measures of possible spread of drug resistance in the study area.

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Figures

Fig. 1
Fig. 1
Map of the study area
Fig. 2
Fig. 2
Flow chart of patients’ enrolment and follow up for CQ therapeutic efficacy study at Hossana Health Care Centre Southern Ethiopia from April to June, 2014
Fig. 3
Fig. 3
Parasite clearance following CQ treatment of Plasmodium vivax infected malaria patients at Hossana Health Care Centre Southern Ethiopia from April to June, 2014
Fig. 4
Fig. 4
Fever clearance following CQ treatment of Plasmodium vivax infected malaria patients at Hossana Health Care Centre Southern Ethiopia from April to June, 2014

References

    1. WHO . World malaria report. Geneva: World Health Organization; 2013.
    1. Federal Ministry of Health . National malaria guidelines. Ethiopia: Addiss Ababa; 2012.
    1. WHO . Monitoring antimalarial drug resistance. Geneva: World Health Organization; 2001.
    1. DACA . Standard treatment guidelines for health centers. Ethiopia: Addiss Ababa; 2010.
    1. Tulu AN, Roger H, Webbeg, Strong JA, Schellenberg, Bradley DJ. Failure of chloroquine treatment for malaria in the highlands of Ethiopia. Trans R Soc Trop Med. 1996;90:556–557. doi: 10.1016/S0035-9203(96)90322-3. - DOI - PubMed

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