Sulfadoxine-Pyrimethamine for the Treatment of Falciparum Malaria in Tanzanian Children and Implications for Policy Change

A trial of SP versus CQ was carried out in a holoendemic area as part of the antimalarial drugs efficacy monitoring in Tanzania prior to policy change from chloroquine (CQ) to sulfadoxine-pyrimethamine (SP). The aim was to obtain comparable data as reports from one holoendemic area had shown an SP resistance > 25% past the level for change. Therefore using the WHO in vivo test guidelines, the efficacy of SP versus CQ for the treatment of uncomplicated malaria in children was assessed. Children with fever ≥37.5°C, haemoglobin > 5g/dl, mono infection 2000 – 250000 parasites /μl were recruited in the ratio of 1:2 (CQ: SP) to obtain a sample of 58 for CQ and 120 for SP. SP showed a very high efficacy (98.2% adequate clinical response) in contrast to CQ (37.7%). There were only 1.75% RII responses to SP, in contrast there were 43.7% RIII/II responses to CQ. The decline in parasite density was fast in SP, and the median survival time to parasites clearance was 2 days, 86.7% of the children being aparasitaemic on day3. SP was therefore highly efficacious in this area. The 1.8% clinical and 1.75% parasitological failure rates to SP observed in this area sharply contrasts the 34.0% clinical and 84.4% parasitological failures reported in Muheza emphasizing the need of comparable countrywide data for policy decisions.

Keywords
Malaria, children, chloroquine, sulfadoxine-pyrimethamine, efficacy, policy change.