In vivo and in vitro assessment of the sensitivity of Plasmodium falciparum to chloroquine in four districts of Tanga region, Tanzania

Kilimali, V.A.E.B.; Mkufya, A.R.

doi:10.1016/0035-9203(85)90070-7

Cited by 15 publications

(7 citation statements)

References 6 publications

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“…Results from the in vivo sensitivity study suggest presence of a high level of resistance to pyrimethamine/sulfadoxine as previously indicated from studies in this area, 17,18 although the parasitologic findings alone cannot exclude that some of the cases were due to re-infections. The PCR genotyping techniques have previously been shown to be particularly useful in differentiating recrudescences from re-infections in areas of comparatively low endemicity.…”

Section: Discussionmentioning

confidence: 48%

Distinguishing Plasmodium falciparum treatment failures from re-infections by using polymerase chain reaction genotyping in a holoendemic area in northeastern Tanzania.

Magesa¹,

Mdira²,

Färnert³

et al. 2001

The American Journal of Tropical Medicine and Hygiene

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Abstract. An in vivo drug sensitivity study was conducted in Magoda village in northeastern Tanzania to evaluate the usefulness of polymerase chain reaction (PCR)-based genotyping of Plasmodium falciparum parasites to distinguish between re-infection and treatment failure. The study tested P. falciparum susceptibility to a combination of sulfadoxine/pyrimethamine (Fansidar; F. Hoffmann La Roche, Basel, Switzerland). Blood samples were collected before treatment and on days 7, 14, or 28 post-treatment in 51 asymptomatic children, of which 26 could not clear parasitemia within seven days post-treatment. Among the remaining 25 children who had no detectable parasites on day 7, only five remained parasite negative up to day 28. Primary and recrudescent P. falciparum parasites were analyzed by PCR using family specific primers for merozoite surface protein-1 (MSP-1), MSP-2, and glutamate-rich protein (GLURP). All samples contained multiple P. falciparum infections. For all children with recrudescent P. falciparum, common alleles were detected in both the primary and recrudescent samples. However, in no child were the exact same alleles detected in both samples, indicating that probably at least some of the recrudescing parasites originated from new infections. The study demonstrates the general usefulness of PCR genotyping technique in distinguishing re-infections from true recrudescences following therapeutic drug treatment.

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Section: Discussionmentioning

confidence: 48%

Distinguishing Plasmodium falciparum treatment failures from re-infections by using polymerase chain reaction genotyping in a holoendemic area in northeastern Tanzania.

Magesa¹,

Mdira²,

Färnert³

et al. 2001

The American Journal of Tropical Medicine and Hygiene

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“…In 1985, the median in vivo resistance to chloroquine in school children documented by Kilimali and Mkufya was 20%. 31 Mutabingwa and others later reported a resistance rate of 80% in infants, 58% in children 1-5 years old, and 50% in children 6-10 years old. 32 Similar results were reported by Rønn in 1997, who showed a resistance rate of 70% in children less than five years of age.…”

Section: Resultsmentioning

confidence: 95%

Malaria Control at the District Level in Africa: The Case of the Muheza District in Northeastern Tanzania

Alilio

Kitua²,

Njunwa³

et al. 2004

The American Journal of Tropical Medicine and Hygiene

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An assessment was done in Tanzania to determine the extent to which the primary health care services have contributed to reducing the burden of malaria since the system was initiated in the 1980s. Seven descriptive processes and outcome indicators of effectiveness were used: changes of malaria transmission and incidence over time; use of facility-based care services for malaria; patients' access to professional advice; the trend of treatment failure over time of sulfadoxine-pyrimethamine and chloroquine; survival rates of severe cases at the district hospital; a district malaria control strategy; number of malaria specific training for care providers; and the number of activities carried out on mosquito control measures. The data were collected from 1996 to 2003 in the Muheza district northeastern Tanzania. It covered household interviews with a stratified sample of 1,250 respondents, and in-depth interviews with all 175 health care providers in the 35 health facilities within the district. All six members of the district health management team were also interviewed. Additional data came from dispensary and hospital records, and published literature. The results show an unchanged malaria disease burden. The average number of clinical malaria episodes per child less than five years of age remained between 3 and 3.5 episodes per year in the district since the 1960s. The comparison of cases expected in the population less than five years old with those seen in the district health facilities shows a coverage rate of 33%. Furthermore, between 1990 and 2003, little training on malaria was provided to health staff. The findings imply a limited effectiveness of district health services on malaria control, suggesting a weak process of translating national malaria goals to activities at the district level.

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“…Children aged <10 years old were given either one or two tablet(s) of Maloprim ® to under-fives and those aged 5–9 years, respectively and followed-up weekly to determine their general condition and malaria infection status [40]. Because of increasing resistance to chloroquine (CQ) in Muheza district which was then the government policy as first line treatment of uncomplicated malaria [42], patients who developed parasitaemia during follow-up under this trial were treated with either sulphadoxine/pyrimethamine (SP) or amodiaquine (AQ) [40]. …”

Section: Methodsmentioning

confidence: 99%

Declining burden of malaria over two decades in a rural community of Muheza district, north-eastern Tanzania

Ishengoma

Mmbando

Segeja

et al. 2013

Malar J

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BackgroundThe recently reported declining burden of malaria in some African countries has been attributed to scaling-up of different interventions although in some areas, these changes started before implementation of major interventions. This study assessed the long-term trends of malaria burden for 20 years (1992–2012) in Magoda and for 15 years in Mpapayu village of Muheza district, north-eastern Tanzania, in relation to different interventions as well as changing national malaria control policies.MethodsRepeated cross-sectional surveys recruited individuals aged 0 – 19 years from the two villages whereby blood smears were collected for detection of malaria parasites by microscopy. Prevalence of Plasmodium falciparum infections and other indices of malaria burden (prevalence of anaemia, splenomegaly and gametocytes) were compared across the years and between the study villages. Major interventions deployed including a mobile clinic, bed nets and other research activities, and changes in national malaria control policies were also marked.ResultsIn Magoda, the prevalence of P. falciparum infections initially decreased between 1992 and 1996 (from 83.5 to 62.0%), stabilized between 1996 and 1997, and further declined to 34.4% in 2004. A temporary increase between 2004 and 2008 was followed by a progressive decline to 7.2% in 2012, which is more than 10-fold decrease since 1992. In Mpapayu (from 1998), the highest prevalence was 81.5% in 1999 and it decreased to 25% in 2004. After a slight increase in 2008, a steady decline followed, reaching <5% from 2011 onwards. Bed net usage was high in both villages from 1999 to 2004 (≥88%) but it decreased between 2008 and 2012 (range, 28% - 68%). After adjusting for the effects of bed nets, age, fever and year of study, the risk of P. falciparum infections decreased significantly by ≥97% in both villages between 1999 and 2012 (p < 0.001). The prevalence of splenomegaly (>40% to <1%) and gametocytes (23% to <1%) also decreased in both villages.Discussion and conclusionsA remarkable decline in the burden of malaria occurred between 1992 and 2012 and the initial decline (1992 – 2004) was most likely due to deployment of interventions, such as bed nets, and better services through research activities. Apart from changes of drug policies, the steady decline observed from 2008 occurred when bed net coverage was low suggesting that other factors contributed to the most recent pattern. These results suggest that continued monitoring is required to determine causes of the changing malaria epidemiology and also to monitor the progress towards maintaining low malaria transmission and reaching related millennium development goals.

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In vivo and in vitro assessment of the sensitivity of Plasmodium falciparum to chloroquine in four districts of Tanga region, Tanzania

Cited by 15 publications

References 6 publications

Distinguishing Plasmodium falciparum treatment failures from re-infections by using polymerase chain reaction genotyping in a holoendemic area in northeastern Tanzania.

Distinguishing Plasmodium falciparum treatment failures from re-infections by using polymerase chain reaction genotyping in a holoendemic area in northeastern Tanzania.

Malaria Control at the District Level in Africa: The Case of the Muheza District in Northeastern Tanzania

Declining burden of malaria over two decades in a rural community of Muheza district, north-eastern Tanzania

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