Age, temperature, and parasitaemia predict chloroquine treatment failure and anaemia in children with uncomplicated Plasmodium falciparum malaria

• Published in: Transactions of the Royal Society of Tropical Medicine and Hygiene Vol. 97; no. 4; pp. 422 - 428
• Main Authors: Hamer, D.H., MacLeod, W.B., Addo-Yobo, E., Duggan, C.P., Estrella, B., Fawzi, W.W., Konde-Lule, J.K., Mwanakasale, V., Premji, Z.G., Sempértegui, F., Ssengooba, F.P., Yeboah-Antwi, K., Simon, J.L.
• Format: Journal Article
• Language: English
• Published: Oxford Elsevier Ltd 01.07.2003; Royal Society of Tropical Medicine and Hygiene; Elsevier
• Subjects: Africa; Age Factors; anaemia; Anemia - parasitology; Anemias. Hemoglobinopathies; Antimalarials - therapeutic use; Biological and medical sciences; Body Temperature; Child, Preschool; chloroquine; Chloroquine - therapeutic use; Diseases of red blood cells; Drug Resistance; Ecuador; Female; Hematologic and hematopoietic diseases; Human protozoal diseases; Humans; Infant; Infectious diseases; Logistic Models; Malaria; Malaria, Falciparum - complications; Malaria, Falciparum - drug therapy; Male; Medical sciences; Parasitemia - drug therapy; Parasitic diseases; Plasmodium falciparum; Prognosis; Prospective Studies; Protozoal diseases; Risk Factors; Treatment Failure; South America; Ecuador; America; Africa; chloroquine; Plasmodium falciparum; Ecuador; anaemia; treatment failure; Africa; malaria; Antimalarial; Protozoal disease; Chloroquine; Hemopathy; Tropical medicine; Antirheumatic agent; Parasitemia; Child; Age; Failure; Human; Protozoa; Apicomplexa; Malaria; Anemia; Body temperature; Prediction; Parasitosis; Infection; Treatment; Parasiticide
• ISSN: 0035-9203; 1878-3503
• DOI: 10.1016/S0035-9203(03)90076-9

The prevalence of chloroquine-resistant Plasmodium falciparum malaria has been increasing in sub-Saharan Africa and parts of South America over the last 2 decades, and has been associated with increased anaemia-associated morbidity and higher mortality rates. Prospectively collected clinical and parasitological data from a multicentre study of 788 children aged 6–59 months with uncomplicated P. falciparum malaria were analysed in order to identify risk factors for chloroquine treatment failure and to assess its impact on anaemia after therapy. The proportion of chloroquine treatment failures (combined early and late treatment failures) was higher in the central-eastern African countries (Tanzania, 53%; Uganda, 80%; Zambia, 57%) and Ecuador (54%) than in Ghana (36%). Using logistic regression, predictors of early treatment failure included younger age, higher baseline temperature, and greater levels of parasitaemia. We conclude that younger age, higher initial temperature, and higher baseline parasitaemia predict early treatment failure and a higher probability of worsening anaemia between admission and days 7 or 14 post-treatment.