In Vivo Chloroquine-Resistant Falciparum Malaria in Western Africa

Neequaye, Janet; Coene, J; Taelman, H; Wéry, M; Greenberg, AlanE.; Minns, Garold; Patchen, Leslie C.; Miller, Kirk D.

doi:10.1016/s0140-6736(86)92286-5

Cited by 42 publications

(16 citation statements)

References 6 publications

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“…The current control strategy in Ghana has case management based on prompt recognition and adequate treatment as its main focus, using chloroquine as the fi rst-line drug [2] . The emergence of chloroquine-resistant parasites in the country, fi rst reported in 1986, and subsequent reports of sulfadoxine/ pyrimethamine (second-line drug) resistance are major 333 obstacles to the control strategy, and adversely affect malaria morbidity, mortality and health care costs [3][4][5] . The spread of antimalarial drug resistance is infl uenced by patterns of drug use among other factors such as the relative risk of drug-resistant parasites transmitting viable gametocytes compared to drug-sensitive parasites, intensity of transmission, and immunity of the human population [6,7] .…”

Section: Introductionmentioning

confidence: 99%

Antimalarial Prescribing Practices: A Challenge to Malaria Control in Ghana

Abuaku

Koram²,

Binka³

2005

Med Princ Pract

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Objective: The study was conducted to determine antimalarial prescribing practices among prescribers in 2 of the 6 sentinel sites established to document antimalarial drug efficacy in Ghana in order to provide some explanation underlying chloroquine treatment failures in the country. Subjects andMethods: The study was descriptive combining both qualitative and quantitative designs. The qualitative design involved in-depth interviews of general prescribers in the Wassa West and Kassena Nankana districts using an interview guide. The quantitative design involved a review of Outpatient Department prescriptions of 100 patients clinically diagnosed as having malaria within the year 2000 in each of the 7 selected health care facilities. Results: The overall number of drugs prescribed per patient encounter was 4.3 in the Wassa West district and 3.0 in the Kassena Nankana district. The number of drugs per patient encounter was 5.4 and 3.7 in private and government health care facilities, respectively. The commonly prescribed antimalarial drug in all the health care facilities visited was chloroquine. However, only 9.8% of prescriptions in private health care facilities contained correct doses of chloroquine compared to 54% in government health care facilities (p = 0.000). Prescriptions containing chloroquine injections were least likely to have correct doses of chloroquine. Conclusion: Thefindings indicate that although chloroquine remained the first-line drug in the treatment of uncomplicated malaria in the two districts, the level of appropriateness of doses prescribed was generally low. Inappropriate doses of chloroquine prescribed were more prevalent in private than government health care facilities, and among prescriptions containing injections.

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Section: Introductionmentioning

confidence: 99%

Antimalarial Prescribing Practices: A Challenge to Malaria Control in Ghana

Abuaku

Koram²,

Binka³

2005

Med Princ Pract

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“…In January 2005, following this recommendation, and in the face of increasing frequencies of CQ-treatment failure, the recommended treatment for the first-line treatment of malaria in Ghana was changed from CQ to an amodiaquine-artesunate combination. Chloroquine resistance in Ghana was first recorded in the mid 1980s (Neequaye, 1986), with several further reports of this problem over the following decade (Ofori-Adjei et al, 1988;Afari et al, 1992;Landgraf et al, 1994). The results of in-vivo studies conducted within three ecological zones in Ghana between 1998 and indicated that about 40% of those treated with CQ failed to show an adequate clinical and parasitological response (K. A.…”

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confidence: 99%

The in-vitro susceptibilities of GhanaianPlasmodium falciparumto antimalarial drugs

Quashie¹,

Duah²,

Abuaku³

et al. 2007

Annals of Tropical Medicine & Parasitology

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In Ghana in 2004 (when choroquine was still the nationally recommended drug for the first-line treatment of malaria), the sensitivities, to chloroquine, amodiaquine, quinine, mefloquine, artesunate and halofantrine, of 60 Plasmodium falciparum isolates from two ecologically distinct areas of the country were assessed in vitro. The aim was to make available, to policy-makers, the field-based evidence needed to review the national strategy for malaria treatment. Drug susceptibilities were explored using the standardized protocol of the Antimalarial Drug Resistance Network. Although 32 of the P. falciparum isolates evaluated (56.1% of the 57 isolates successfully investigated for their susceptibility to choroquine) showed resistance to chloroquine and two showed slightly reduced sensitivity to amodiaquine, all the isolates were sensitive to mefloquine, artesunate, quinine and halofantrine. The median inhibitory concentrations (IC(50)) of chloroquine were positively correlated with those of quinine (r=0.4528; P=0.0008) but not those of any of the other drugs investigated. The IC(50) of amodiaquine and artesunate were also positively correlated (r=0.3703; P=0.0067). These results provide evidence of the presence, in Ghana, of P. falciparum isolates that are highly resistant to chloroquine but generally sensitive to most of the other antimalarial drugs commonly used in the country. Partly in consequence of these observations, the recommended first-line treatment for malaria in Ghana was changed to an amodiaquine-artesunate combination in January 2005.

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“…The increasing risk from Plasmodium jalciparum in West Africa has been documented by Phillips-Howard et al (3), who showed that the number of reported cases rose from 147 in 1977 to 409 in 1986, and that over the same time period, the proportion of all reported cases of malaria caused by Plasmodiumjalciparum rose from one fifth to one third. The increase is partly explained by the development of chloroquine resistant strains in West Africa, something which is well reported in the literature (4)(5)(6)(7)(8)(9)(10). The number of reported cases continues to rise; for the period July 89 -June 90, just over 500 were reported.…”

Section: Introductionmentioning

confidence: 65%