IN-VITRO SENSITIVITY OF PLASMODIUM FALCIPARUM TO CHLOROQUINE, HALOFANTRINE, MEFLOQUINE AND QUININE IN MADAGASCAR

Objective: To determine how sensitive Plasmodium falciparum is to the major antimalarialdrugs in Madagascar.Design: Assessment of Plasmodium falciparum isolates sensitivity to antimalarials, byuse of the in-vitro radioisotope method.Setting: Ankazobe and Saharevo in the foothill areas; and Toamasina and Tolagnaroin the coastal areas (between January 1998 and November 1999).Subjects: Primary Plasmodium falciparum isolates from patients with uncomplicatedmalaria attack.Results: Between January 1998 and November 1999, of the 293 in-vitro tests done withat least one antimalarial, 70% (205/293) were interpretable. As there was no significantdifference between results from the four study sites, the data have been expressed asa whole. All of the successfully tested isolates were sensitive to halofantrine (n = 56)and to quinine (n = 199), 5.8% (12/205) of the isolates were resistant to chloroquineand 2% (4/199) to mefloquine. The geometric mean IC50 was 0.3 µg/L for halofantrine(95% CI = 0.1 - 0.4 µg/L); 9.4 µg/L for chloroquine (95% CI = 7.3 - 10.8 µg/L); 3.8µg/L for mefloquine (95% CI = 3.3 - 4.3 µg/L); and 26.8 µg/L for quinine (95% CI= 24.3 - 29.4 µg/L). The low positive correlation found between halofantrine andchloroquine IC50s (n=56; r = 0.41, P = 0.002) suggests a risk of cross-resistance betweenthese two drugs.Conclusion: The degree and frequency of chloroquine resistance in-vitro is stationaryin Madagascar compared to previous results during the last decade. The in-vitrosensitivity of P. falciparum to quinine, mefloquine and halofantrine encourages the useof these drugs as alternative in case of chloroquine treatment failure. Nevertheless, itis important to maintain and to extend malaria and drug sensitivity surveillance inMadagascar

In-virto sensitivity of plasmodium falciparum to chloroquine, halofantrine, Mefloquine in Madagascar

Objective: To determine how sensitive Plasmodium falciparum is to the major antimalarial drugs in Madagascar. Design: Assessment of Plasmodium falciparum isolates sensitivity to antimalarials, by use of the in-vitro radioisotope method. Setting: Ankazobe and Saharevo in the foothill areas; and Toamasina and Tolagnaro in the coastal areas (between January 1998 and November 1999). Subjects: Primary Plasmodium falciparum isolates from patients with uncomplicated malaria attack. Results: Between January 1998 and November 1999, of the 293 in-vitro tests done with at least one antimalarial, 70% (205/293) were interpretable. As there was no significant difference between results from the four study sites, the data have been expressed as a whole. All of the successfully tested isolates were sensitive to halofantrine (n = 56) and to quinine (n = 199), 5.8% (12/205) of the isolates were resistant to chloroquine and 2% (4/199) to mefloquine. The geometric mean IC50 was 0.3 µg/L for halofantrine (95% CI = 0.1 - 0.4 µg/L); 9.4 µg/L for chloroquine (95% CI = 7.3 - 10.8 µg/L); 3.8 µg/L for mefloquine (95% CI = 3.3 - 4.3 µg/L); and 26.8 µg/L for quinine (95% CI = 24.3 - 29.4 µg/L). The low positive correlation found between halofantrine and chloroquine IC50s (n=56; r = 0.41, P = 0.002) suggests a risk of cross-resistance between these two drugs. Conclusion: The degree and frequency of chloroquine resistance in-vitro is stationary in Madagascar compared to previous results during the last decade. The in-vitro sensitivity of P. falciparum to quinine, mefloquine and halofantrine encourages the use of these drugs as alternative in case of chloroquine treatment failure. Nevertheless, it is important to maintain and to extend malaria and drug sensitivity surveillance in Madagascar. (East African Medical Journal: 2002 79(5): 237-241)

Factors associated with anaemia among preschool- age children in underprivileged neighbourhoods in Antananarivo, Madagascar.

Anaemia occurs in children when the haemoglobin level in the blood is less than the normal (11 g/dL), the consequence is the decrease of oxygen quantity in the tissues. It is a prevalent public health problem in many low-income countries, including Madagascar, and data on risk factors are lacking. We used existing data collected within the pathophysiology of environmental enteric dysfunction (EED) in Madagascar and the Central African Republic project (AFRIBIOTA project) conducted in underprivileged neighbourhoods of Antananarivo to investigate the factors associated with anaemia in children 24 to 59 months of age. Children included in the AFRIBIOTA project in Antananarivo for whom data on haemoglobin and ferritin concentrations were available were included in the study. Logistic regression modelling was performed to identify factors associated with anaemia. Of the 414 children included in this data analysis, 24.4% were found to suffer from anaemia. We found that older children (adjusted OR: 0.95; 95% CI: 0.93-0.98) were less likely to have anaemia. Those with iron deficiency (adjusted OR: 6.1; 95% CI: 3.4-11.1) and those with a high level of faecal calprotectin (adjusted OR: 2.5; 95% CI: 1.4-4.4) were more likely to have anaemia than controls. To reduce anaemia in the children in this underprivileged area, more emphasis should be given to national strategies that improve children's dietary quality and micronutrient intake. Furthermore, existing measures should be broadened to include measures to reduce infectious disease burden