ABSTRACT: To compare the efficacies against uncomplicated falciparum malaria of chloroquine (CQ), amodiaquine (AQ), sulfadoxine-pyrimethamine (SP) and combinations of these inexpensive drugs.
We searched Medline, Embase, Cochrane CENTRAL Register of Controlled Trials, BIOSIS, Web of Science, African Index Medicus, DARE, Digital Dissertations and Current Controlled Trials for randomised or quasi-randomised controlled trials conducted between 1991 and June 2004 regardless of language and geography. We also contacted malaria experts, searched reference lists, and contacted individual authors for unreported study characteristics and additional data. Unpublished data were sought and included in the analyses.
Thirteen randomised trials (n = 4248) were identified and the summary relative risks of treatment failure at 28 days were calculated. There was marginal benefit in adding CQ to SP, compared with SP monotherapy (RR = 0.74, 95% CI 0.54-1.02). Combining AQ with SP was associated with a significantly lower risk of treatment failure than SP monotherapy (RR = 0.35, 95% CI 0.15-0.82) and AQ monotherapy (RR = 0.59, 95% CI 0.42-0.83). AQ plus SP was associated with a significantly lower risk of treatment failure than CQ plus SP (RR = 0.42, 95% CI 0.25-0.72). Serious adverse events were rare and did not increase with combination therapy.
Amodiaquine plus SP remains an efficacious, affordable and safe option for treating malaria in certain settings.
Tropical Medicine & International Health 07/2006; 11(6):789-99. · 2.80 Impact Factor
ABSTRACT: Epidemics of malaria have occurred in highland areas of East Africa since the 1980s, but the clinical spectrum of severe malaria in these areas has not been described. Over a 17-month period from 2001 to 2002, we assessed 117 consecutive patients admitted to Kabale Hospital in highland Uganda who met the World Health Organization 2000 criteria for severe malaria. Sixty-six persons (56.4%) were age 5 years or older, and 51 (43.6%) were under 5 years of age. Fever, vomiting, and cough were the most frequent symptoms. Hepatomegaly and splenomegaly were infrequent. Prostration was the most frequent manifestation of severe malaria in children under 5 years of age (45.1%) and persons 5 years or older (65.2%), followed by respiratory distress (29.4%) and severe anemia (19.6%) in children under 5 years, and respiratory distress (15.2%) and impaired consciousness (13.6%) in persons 5 years or older. Strictly defined cerebral malaria was uncommon (3.4%). In a multivariate regression model, children under 5 years were more likely than persons 5 years or older to present with severe anemia (OR 5.2, 95% confidence interval [CI] 1.2-21.9) and respiratory distress (OR 3.5, 95% CI 1.3-11.1) and less likely to present with prostration (OR 0.3, 95% CI 0.1-0.7) and impaired consciousness (OR 0.2, 95% CI 0.0-0.9). In highland Uganda, severe malaria often occurs in persons older than 5 years of age. "Typical" signs like splenomegaly are frequently absent, prostration is the major manifestation, and other manifestations vary in frequency according to age.
The American journal of tropical medicine and hygiene 06/2005; 72(5):561-7. · 2.59 Impact Factor
ABSTRACT: Despite great advances in the management of diarrhoeal diseases, persistent diarrhoea remains a major problem in developing countries due to its syndromic nature. Zinc depletion ranks high among the factors contributing to the detrimental effects of persistent diarrhoea on the human body. This however, has not been investigated in the Ugandan population.
To determine the serum zinc status of children with persistent diarrhoea.
Cross-sectional descriptive study.
Children aged 6-36 months with persistent diarrhoea were enrolled from the diarrhoea management unit of Mulago hospital. Socio-demographic and morbidity data were collected, and laboratory investigations were carried out after recruitment. Healthy children of similar age and sex were recruited to determine reference levels of serum zinc for comparison.
The mean serum zinc level in the children with persistent diarrhoea was 5.83 mol/l while that of children without diarrhoea was 8.99 mol/l with no age or sex difference. The serum zinc concentration of children with persistent diarrhoea was significantly lower than that of children without diarrhoea (p<0.001). The prevalence of zinc deficiency in children with persistent diarrhoea was 47.9%. Of the children with persistent diarrhoea, 64 (66.7%) were stunted, wasted or both. However no significant association was observed between nutritional status and serum zinc levels. Only hypoproteinaemia was significantly associated with serum zinc levels in these children (p=0.03).
There is a high prevalence of zinc deficiency and malnutrition among Ugandan children with persistent diarrhoea.
African health sciences 08/2003; 3(2):54-60.