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THERAPEUTIC EFFICACY OF SULFADOXINE-PYRIMETHAMINE AND AMODIAQUINE AMONG CHILDREN WITH UNCOMPLICATED PLASMODIUM FALCIPARUM MALARIA IN ZANZIBAR, TANZANIA

The efficacy of sulfadoxine-pyrimethamine (SP) and amodiaquine (AQ) was assessed at Kivunge and Micheweni in Zanzibar, Tanzania, in 2001. The main objective was to obtain baseline data after observations of high levels of chloroquine treatment failures. Children (6–59 months) were randomized to receive either drug. At Kivunge, SP and AQ were given to 64 and 63 cases, while for Micheweni, 61 and 70 cases were treated. Main findings were overall high rates (> 90%) of adequate clinical response (ACR) with AQ. A lower ACR was seen in the SP group at Kivunge (87.1%) compared with Micheweni (94.8%). Furthermore, in the ACR group, 16.7% AQ parasitological resistance (RI–RIII) was encountered at Kivunge. Most of the cases of SP parasitological resistance (14.5%; RI/RII) were seen at Micheweni. Notwithstanding this, the overall treatment failure was only 9.2% with SP and 5.5% with AQ. The Zanzibar Ministry of Health has since reviewed its antimalarial drug policy.

Received October 14, 2004. Accepted for publication May 3, 2005.

Acknowledgments: We would like to thank all parents/guardians for allowing their children to participate in the study. We are particularly grateful for the logistical support provided by WHO offices in Dar es Salaam and Zanzibar, Kivunge Cottage Hospital, Chake Chake, Wete, and Micheweni Hospital authorities and their staff. Before undertaking the study, permission was sought from the Ministry of Health in both Zanzibar and Pemba. Dr. Julius Massaga and Mr. Mathias Kamugisha of NIMR Amani Centre are thanked for useful discussions on the manuscript and for assistance with data analysis.

Financial support: This study was supported by the World Health Organization (African Region Office).

^* Address correspondence to Martha M. Lemnge, Amani Medical Research Centre, P.O. Box 4, Amani, Tanga, Tanzania. E-mail: mlemnge{at}amani.mimcom.net; mlemnge{at}hotmail.com

Authors’ addresses: Martha M. Lemnge, Ezekiel K. Malecela, and Edward Sambu, National Institute for Medical Research, Amani Medical Research Centre, P.O. Box 4, Amani, Tanga, Tanzania. Abdullah S. Ali, Ministry of Health and Social Welfare, Zanzibar Malaria Control Programme, Zanzibar, Tanzania. Rahma Abdulla, Kivunge Cottage Hospital, Kivunge, Zanzibar, Tanzania. Mohamed S. Juma, Chake Chake Hospital, Chake Chake, Pemba, Tanzania. Khatibu Fakih, Wete Hospital, Wete, Pemba, Tanzania. Khafidh H. Abdulla, Malaria Control Unit, Chake Chake, Pemba, Tanzania. Ritha J. Njau, WHO Country Office, Dar es Salaam, Tanzania.

Reprint requests: Martha M. Lemnge, Amani Medical Research Centre, P.O. Box 4, Amani, Tanga, Tanzania, Telephone: 255 27 26 40303, Fax: 255 27 26 43869, E-mail: mlemnge{at}amani.mimcom.net; mlemnge{at}hotmail.com.