BackgroundMalaria prophylaxis is recommended for persons with sickle cell disease (SCD), but the value of this has been questioned. The aim of this study was to find out whether intermittent preventive treatment (IPT) with a fixed-dose combination of mefloquine-artesunate (MQAS) or sulfadoxine-pyrimethamine plus amodiaquine (SPAQ) was more effective than daily proguanil for malaria prevention in subjects with SCD.MethodsPatients with SCD were randomized to receive daily treatment with proguanil or IPT with either MQAS or SPAQ once every 2 months at routine clinic visits. Patients were followed up for 14 months.FindingsA total of 270 patients with SCD were studied, with 90 in each group. Adherence to the IPT regimens was excellent, but 57% of patients took <75% of their daily doses of proguanil. IPT was well tolerated; the most common side effects were vomiting and abdominal pain. Protective efficacy against malaria, compared with daily proguanil, was 61% (95% confidence interval, 3%–84%) for MQAS and 36% (40%–70%) for SPAQ. There were fewer outpatient illness episodes in children who received IPT than those who received proguanil.ConclusionsIPT with MQAS administered to patients with SCD during routine clinic visits was well tolerated and more effective in preventing malaria than daily prophylaxis with proguanil.Clinical Trials RegistrationNCT01319448 and ISRCTN46158146.
Background: Accurate temperature measurement is a critical step in evaluating health or disease especially in children and immmunocompromised subjects; inaccurate measurement may lead to improper diagnosis, wrong treatment or inappropriate intervention. Several methods of temperature measurements exist and comparing these gives room for choosing a near ideal method in terms of speed, safety and accuracy. The study aimed to compare the forehead non touch infra-red thermometer with the axilllary mercury-in-glass method of temperature measurement in the Paediatric age-group. Methods: Study was given ethical approval as part of a larger study. Four hundred and thirty seven children aged 1 to 24 months were studied at the well-baby/immunizationclinic of the University of Ilorin Teaching Hospital over a 6-months period. Both non-touch infrared and theregular mercury-in-glass thermometers were used to take the body temperatures. Data were analysed with SPSS version 21. Pearson correlation was used to determine the relationship between the two methods of temperature measurements, while Bland-Altman method was used to test for level of agreement between them. Results: The mean age and SD was 5.81 ± 4.04 months. Pearson correlation showed a positive correlation between the axillary mercury-in-glass and forehead non-touch infra-red thermometry readings (r = 0.281, p < 0.001). Also, Bland-Altman method revealed a good agreement between both methods of thermometry as 96% of the readings were within the limits of agreement. Mean difference was 0.09˚C (95% confidence interval 0.05 -0.13
Since congenital malaria had previously been thought to be rare, blood film examination for malaria parasites is still sometimes not routinely performed in ill neonates in malaria-endemic regions. Because of increasing published reports of congenital malaria in Nigeria, there is a need to characterize the clinical and laboratory manifestations associated with malaria parasitemia within the first few hours of life. In a 12-month (April 2003-March 2004), multicenter study in Nigeria, thin and thick blood smears made from maternal (finger prick), placental aspirates, cord blood and neonate (heel prick taken within 4 hours of life) were Giemsa-stained and examined by light microscopy for asexual stages of Plasmodium. Parasitemic neonates were closely monitored for clinical and laboratory features of symptomatic malaria. Plasmodium falciparum was found in 5.1% (95/1875) of neonatal heel pricks; mean parasite density was low (mean = 48/?L, range 8?200/?L). Antepartum maternal and placental parasitemia were the most important risk factors for congenital parasitemia (P < 0.001 and P < 0.001). Prolonged labor and prolonged rupture of membranes were also significant factors in the symptomatic neonates. Sixty-one percent (58/95) of parasitemic babies were asymptomatic, while 38.9% (37/95) of them exhibited signs of possible infection. The presence of any symptom was significantly related to parasitemia (P < 0.001). Among the symptomatic parasitemic babies the most common symptoms were, fever (temperature >37.5?;) within the first 24 hours of life (100%) and refusal to suck (10.8%). Anemia at birth (hematocrit <42%) was found in 15.7% (15/95) of parasitemic babies as compared to 9.2% in the non-parasitemic ones. (P = 0.03, OR = 1.84). The mean hematocrit of parasitemic neonates within 4 hours of life was 49.5 ? 6.4 as compared to 52.6 ? 8.2 in non-parasitemic babies (P = 0.001). Furthermore, the mean hematocrit was 44.0 ? 5.5% in the symptomatic parasitemic babies. All symptomatic babies were treated with oral chloroquine with a cure rate of 89.1%. Treatment failures subsequently received oral sulfadoxine-pyrimethamine with good outcome. The febrile newborn should be evaluated for malaria especially if there is a history of prolonged labor or in the presence of maternal malaria infection. Efforts should be intensified to reduce the burden of maternal, placental malaria and therefore congenital malaria.
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