| Abstrakt: |
A randomized, double-‘blind’, placebo-controlled trial of weekly Maloprim®(dapsone-pyrimethamine, D-P) for malaria prophylaxis was conducted at Magoda village in north-eastern Tanzania. The effect of D-P on the incidence of clinical malaria, Plasmodium falciparumprevalence and density, splenomegaly, and packed cell volume (PCV) was investigated in a cohort of 249 children (126 receiving D-P and 123 receiving placebo) aged 1–9 years. The case definition of clinical malaria (malaria fever) was measured axillary temp-erature =37·5 °C and/or reported fever, and P. falciparumasexual parasitaemia =5000/µL. Children aged 1–4 years given D-P experienced 1·56 episodes of clinical malaria per year, whereas children on placebo experienced 2·55 episodes (relative rate [RR] = 0·61, 95% confidence interval [CI] 0·47, 0·80). Thus, D-P protective efficacy against clinical malaria, in this age group, was 39% (95% CI 20%, 53%; P= 0·0002). The annual incidence of clinical malaria among children aged 5–9 years was 0·16 episodes in the D-P group and 0·26 episodes in those receiving placebo (RR = 0·58, 95% CI 0·26, 1·28; P= 0·17). Increased malaria transmission and drug resistance, during the course of the trial, resulted in a reduction in the protective efficacy of D-P. Overall, D-P was able to reduce parasite densities and splenomegaly. D-P prophylaxis also resulted in an increase in PCV but this effect diminished towards the end of the trial. D-P exerted a suppressive effect on asexual parasitaemia throughout the trial. |
