Many countries in Africa are now confronted with the dilemma of shifting drug policies for uncomplicated falciparum malaria from chloroquine, which has become largely ineffective, to a new first-line drug and amodiaquine is one of the possible options. A multicentre, open-label randomized controlled trial of amodiaquine 30 mg/kg vs chloroquine 25 mg/kg over 3 days was performed in Senegal, Cameroon, Gabon, and Burkina Faso between 1996 and 1998 and patients were followed-up for 14 days. Sensitivity of isolates in vitro and whole blood levels of chloroquine and amodiaquine were also measured. The primary efficacy parameter was parasitological clearance on day 14 (parasitological success). The secondary efficacy parameter was absence of signs/symptoms of malaria on day 14 (clinical success). Among the 364 patients randomized and receiving the assigned treatment (chloroquine n = 185, amodiaquine n = 179), 137 and 139, respectively, reached the primary endpoint. Amodiaquine proved significantly more effective than chloroquine. The summary odds ratio (95% CI) was 7.79 (4.54-13.35) for parasitological success, and 6.3 (3.4-11.68) for clinical success. Sensitivity in vitro and chloroquine blood levels were good predictors of chloroquine failure. Amodiaquine remains effective for treating uncomplicated falciparum malaria in areas of West and Central Africa where chloroquine resistance is prevalent. However, measures should be taken to protect the lifespan of amodiaquine where the drug is introduced for use.
Sum m ary :A battery of sixty-six blood samples from Senegal was analysed by the ParaSight F® test, the ICT Malaria PF® and the Malaria IgG CELISA®. These three assays detect the histidine rich protein 2 antigen of Plasmodium falciparum. Thick smear microscopy was used as the reference method. Sensitivity, specificity, predictive positive and negative values were respectively 89 %, 100 %, 100 %, 88 % for the ICT; 86 %, 93 %, 94 %, 85 % for the paraSight and 88 %, 87 %, 88 %, 87 % for the M alaria IgG CELISA. The three assays failed to detect two positive samples with P. ovale and P. malariae. Assays were also compared with regard to the expense of equipment and reagents and speed and ease of use. The rapid ICT and ParaSight F test can be performed with minimal training and may be specially useful in areas where P. falciparum is the predominant malaria species, in epidemic malaria regions, and where skilled microscopy is not readily available. M alaria remains the most important parasitic disease, causing about 2,000,000 deaths each year, mostly due to P la sm od iu m fa lc ip a r u m . The increase o f drug resistant strains and the increasing clinical importance o f malaria has led to efforts to improve diagnostic methods. M icroscopic examination o f blood smears remains the method o f choice for dia gnosing malaria in most settings, but effective micro scopy requires a quality m icroscope and extensive trai ning. Newer technologies that have been evaluated inclu de hybridization to DNA or RNA (A m broise Thomas, 1990; Franzen e t al., 1984), the polymerase chain reaction PCR (Barker e t al., 1992; Mc Lauglin e t al., 1987) and the QBC malaria assay (Levine, 1989). However Parasite, 1998, 5,[189][190][191][192] assays detecting the P la sm od iu m fa lc ip a r u m histidinerich protein 2 Pf HRP-2 (Howard et al., 1986), a watersoluble protein released from parasitized erythrocytes, are the current major commercial technologies. Related assays include the ParaSight F® test developed by Becton Dickinson, the ICT Malaria P.f.® developed by ICT Diagnostics (Sydney, Australia) and the Malaria IgG CELISA® developed by CelLabs (Sydney, Australia). Pf HRP-2 is identified using m onoclonal antibodies in different formats in these assays. The purpose of the pre sent study was to compare thick smears microscopy to these three companies assays which detect Pf HRP-2. MATERIALS A N D METHODSD u r i n g Novem ber 1996, sixty-six patients with malaria symptoms presenting at the Roi Bau doin out-patient clinic in Guediawaye, a su burb o f Dakar, Senegal were enrolled in the study. The age distribution was 1-65 years. Thirty-five were female and thirty-one w ere m ale; inform ed con sen t was 189 Note de rechercheArticle available at
Introduction The World Health Organization (WHO) recommends the creation of national blood transfusion services. Burkina Faso has a CNTS (Centre national de transfusion sanguine - National Blood Transfusion Center) but it currently covers only 53% of the national blood supply versus 47% produced by independent hospital blood banks. Study design To evaluate blood collection, testing, preparation and prescription practices in the regions of Burkina Faso that are not covered by the CNTS, we conducted a cross-sectional survey. Methodology Data were collected by trained professionals from May to June 2009, at 42 autonomous blood centers not covered by the CNTS. Results Blood collection was supervised in all sites by laboratory technicians without specific training. There was no marketing of community blood donation nor mobile collection. Donation was restricted to replacement (family) donors in 21.4% of sites. Pre-donation screening of donors was performed in 63.4% of sites, but some did not use written questionnaires. Testing for HIV, hepatitis B virus and syphilis was universal, although some sites did not screen for hepatitis C virus. In 83.3% of the sites blood typing was performed without reverse ABO typing. In 97.6% of the sites, nurses acted alone or in conjunction with a physician to order blood transfusions. Conclusion Shortcomings in non-CNTS blood centers argue for the development of a truly national CNTS. Such a national center should coordinate and supervise all blood transfusion activities, and is the essential first step for improving and institutionalizing blood transfusion safety and efficacy in a developing country.
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