Dawam J A, Madaki J K A, Gambazai A A, Okpe E S, Lar-ndam N, Onu A, Gyang M
Niger J Med. 2016 Apr-Jun;25(2):119-27.
Malaria carries a high case fatality among patients with sickle cell disease. In Jos University Teaching Hospital, at the time of this study, the use of Proguanil was the acceptable mode of chemoprophylaxis for preventing malaria in these patients. Intermittent Preventive Treatment (IPT) with Sulphadoxine-Pyrimethamine [SP] has shown great potential for reducing the prevalence of malaria and anaemia among pregnant women, infants and travellers. We hypothesised that monthly SP was superior to daily Proguanil in reducing malaria parasitaemia, clinical malaria attacks and sickle cell crises in such patients.
To assess the efficacy and affordability of monthly SP versus daily Proguanil for malaria chemoprophylaxis in patients attending Sickle Cell Clinic at Jos University Teaching Hospital, Plateau State, Nigeria.
One hundred and fifty four patients [114 children and 40 adults] with Sickle Cell Disease in their steady state were randomized to monthly SP or daily Proguanil for malaria chemoprophylaxis. Active detection of malaria parasite in the peripheral blood and packed cell volumes were done at each monthly visit to the clinic over a period of three months. The primary outcome measure was the proportion of patients with malaria parasite in the peripheral blood at the end of 3 months. The secondary outcome measures included episodes of clinical malaria attacks, frequency and type of sickle cell crises and adverse effects of the medication.
Ninety four percent [72/77] of patients in the SP group and 91% [70/77] in the Proguanil group respectively completed three months of follow up. SP reduced the prevalence of malaria parasitaemia by 25% [(14%) 10/72] compared to 6.4% [(30%) 21/70] in the proguanil group. [X2 54; p = 0.01]. Seventeen percent [12/72] of the patients receiving monthly SP had malaria attacks compared to 57% [40/70] on prophylaxis with Proguanil. [X2 =25; p< 0.0003]. Thirty three percent [24/72] of the patients receiving SP had at least an episode of bone pain crises compared to 69% [48/70] of the patients receiving Proguanil. [X2 =17.6; p<0.0001]. SP was 8 times cheaper than Proguanil.
Monthly chemoprophylaxis with SP was more efficacious than daily Proguanil in reducing the prevalence of asymptomatic malaria parasitaemia, clinical malaria attack and sickle cell crises in patients with sickle cell disease. SP was 8 times cheaper than Proguanil. No significant side effect was recorded in both groups. The current practice of routinely prescribing daily Proguanil to SCD patients for malaria chemoprophylaxis needs to be reviewed.
疟疾在镰状细胞病患者中具有较高的病死率。在本研究开展时，乔斯大学教学医院对这类患者预防疟疾采用氯胍作为可接受的化学预防方式。磺胺多辛-乙胺嘧啶[SP]间歇性预防治疗在降低孕妇、婴儿和旅行者疟疾及贫血患病率方面显示出巨大潜力。我们推测，对于这类患者，每月使用SP在降低疟疾寄生虫血症、临床疟疾发作和镰状细胞危象方面优于每日使用氯胍。
评估在尼日利亚高原州乔斯大学教学医院镰状细胞病门诊患者中，每月使用SP与每日使用氯胍进行疟疾化学预防的疗效和成本效益。
154例处于稳定期的镰状细胞病患者[114例儿童和40例成人]被随机分为每月使用SP组或每日使用氯胍组进行疟疾化学预防。在为期三个月的每个月门诊就诊时，对外周血中的疟原虫进行主动检测并测量红细胞压积。主要结局指标是3个月末外周血中有疟原虫的患者比例。次要结局指标包括临床疟疾发作次数、镰状细胞危象的频率和类型以及药物不良反应。
SP组94%[72/77]的患者和氯胍组91%[70/77]的患者分别完成了三个月的随访。与氯胍组6.4%[(30%)21/70]相比，SP组将疟疾寄生虫血症患病率降低了25%[(14%)10/72]。[X2 = 54；p = 0.01]。接受每月SP治疗的患者中有17%[12/72]发生疟疾发作，而接受氯胍预防的患者中这一比例为57%[40/70]。[X2 = 25；p < 0.0003]。接受SP治疗的患者中有33%[24/72]至少发生过一次骨痛危象，而接受氯胍治疗的患者中这一比例为69%[48/70]。[X2 = 17.6；p < 0.0001]。SP的成本比氯胍便宜8倍。
对于镰状细胞病患者，每月使用SP进行化学预防在降低无症状疟疾寄生虫血症患病率、临床疟疾发作和镰状细胞危象方面比每日使用氯胍更有效。SP的成本比氯胍便宜8倍。两组均未记录到明显的副作用。目前对镰状细胞病患者常规每日开氯胍进行疟疾化学预防的做法需要重新审视。
