Predictors of the failure of treatment with chloroquine in children with acute, uncomplicated, Plasmodium falciparum malaria, in an area with high and increasing incidences of chloroquine resistance

• Published in: Annals of tropical medicine and parasitology 2005-09, Vol.99 (6), p.535-544
• Main Authors: Sowunmi, A., Fateye, B. A., Adedeji, A. A., Fehintola, F. A., Gbotosho, G. O., Happi, T. C., Tambo, E., Oduola, A. M. J.
• Format: Article
• Language: English
• Subjects: Acute Disease; Antimalarials - therapeutic use; Biological and medical sciences; Child; Child, Preschool; Chloroquine - therapeutic use; Drug Resistance; Endemic Diseases; Female; Human protozoal diseases; Humans; Infectious diseases; Malaria; Malaria, Falciparum - blood; Malaria, Falciparum - drug therapy; Malaria, Falciparum - epidemiology; Male; Medical sciences; Nigeria - epidemiology; Parasitemia - drug therapy; Parasitemia - epidemiology; Parasitic diseases; Plasmodium falciparum; Protozoal diseases; Risk Factors; Sex Factors; Time Factors; Treatment Failure
• ISSN: 0003-4983; 1364-8594
• DOI: 10.1179/136485905X51382

Resistance to chloroquine (CQ) in Plasmodium falciparum has reached unacceptably high levels in many endemic countries. The pre-treatment factors that identify the children who are at risk of treatment failure after being given CQ were evaluated in 385 children with acute, uncomplicated, Plasmodium falciparum malaria. These children each took part in one of six antimalarial drug trials conducted, between July 1996 and July 2004, in a hyper-endemic area of south-western Nigeria. Following treatment with CQ, 149 (39%) of the children failed treatment by day 7 or 14. In a multivariate analysis, an age of 7 years [giving an adjusted odds ratio (AOR) of 2.17, with a 95% confidence interval (CI) of 1.19-3.85; P=0.01], an asexual parasitaemia of 100,000/μl (AOR = 2.17; CI = 1.08-4.35; P=0.03), the presence of gametocytaemia (AOR = 2.08; CI = 1.14-3.85; P=0.02) and enrolment >4 years after commencement of the study (i.e. after 2000; AOR = 2.13; CI = 1.3-4.0; P=0.003) were found to be independent predictors at presentation of the subsequent failure of treatment with CQ. Compared with the other children, those who failed to clear their parasitaemias within 3 days and those who still had fever 1-2 days after commencing treatment were more likely to be treatment failures. Together, these findings may have implications for malaria-control efforts in all areas of sub-Saharan Africa where treatment of malaria depends almost entirely on antimalarial monotherapy.