Therapeutic efficacy of Sulfadoxine/Pyrimethamine in the treatment of uncomplicated malaria in children

In Ethiopia like in most other sub Saharan Africa countries malaria remains a major public health problem with P.falciparum accounting for the highest number of deaths. Owing to its effectiveness and low cost treatment with Sulfadoxine/Pyrimethamine (SP) was and is still the recommended first line treatment for uncomplicated P. falciparum malaria. However the rapid emergence of resistance is considered to be the main drawback for the use of this drug in malaria endemic areas. This study is aimed at assessing the extent of resistance to SP by P. falciparum malaria. A cross sectional study was conducted in Oct. 2003 in Jimma town. The study included children under 15 years of age who were infected with P.falciparum malaria and who have fulfilled the inclusion criteria. The patients were treated with the standard regimen of Sulfadoxine/Pyrimethamine. Clinical and parasitological responses to the drug sample were monitored for 14 days. A total of 95 children below 15 years of age were considered for the study out of whom 86 have completed the 14-day follow up with a 9.5% loss to follow up. The age of the children ranged from one to 14 years 60 (63.2%) of them were males and 35 (36.8%) were females with a male to female ratio of 1.71. With regard to age distribution 24 (25.3%)were in the under-five-age category 41(43.2%) in the age group 5-9 and 30 (31.6) were in the age group 10-14. Forty seven (54.7%) children responded successfully both clinically and parasitologically to SP treatment. Twenty-two (25.6%) children had late parasitological failure and 17 (19.7%) had late clinical failure. The mean parasite count at recruitment was 32651 per µl with a range of 2100-190000. The period time for clearance of parasitemia was 2.7 days (± 2.53 SD). This study has shown that the prevalence of resistance to SP is on the increase which may indicate the need for searching for affordable and effective substitutes to SP. (authors)