Table 2 Characteristics of malaria publications from Malawi between 1984 and 1993

1

Khoromana et al. [23]; year of study, 1984

CQ

To assess the appropriate CQ dosage to be used in the Combating Childhood Communicable Diseases program in Malawi

224 children under five presenting at the six outpatient facilities

Modified WHO 7-day in vivo test (1984)

Two CQ dosages of 10 mg/kg and 25 mg/kg were administered

Parasite reduction and clinical response

84% of children given the 10 mg/kg dosage had detectable parasites on day 7, while 57% of 25 mg/kg dosage had a detectable parasite density

Considering the study results and the higher cost and limited availability of alternative therapies, CQ 25 mg/kg therapy was adopted as the primary therapy for malaria

2

Heymann et al. [24]; year of study, 1985

CQ, AQ, SP or Fansidar

To test alternative drugs in children under five

Children under five (39 receiving CQ, 39 at 10 mg/kg AQ, 36 at 25 mg/kg AQ, and 34 at 25 mg/kg SP)

WHO (1984) modified 7-day in vivo test and 21-day follow-up for recrudescence

A comparative trial of AQ in doses of 10 and 25 mg/kg, SP at 25 mg/kg, and CQ at 25 mg/kg

Parasite clearance by day 7; recrudescence at day 21 for AQ 25 mg/kg and SP 25 mg/kg

Parasite clearance of 59% in 25 mg/kg CQ dose, 90% in 10 mg/kg AQ dosage, 97% in 25 mg/kg AQ dosage, and 100% clearance in 25 mg/kg dosage; 34% of recrudescence in the 25 mg/kg AQ group and no recrudescence in the SP group (the results were significant; P = 0.01)

The results suggested that, in Malawi, AQ and SP are superior to CQ in producing prompt parasite clearance among young children, and that SP alone is superior to the 4-aminoquinolines in sustaining P. falciparum clearance

3

Heymann et al. [26]; year of study, 1988

CQ

Experimental study to evaluate the protective efficacy of CQ on P. falciparum

334 pregnant women in four antenatal clinics

P. falciparum infection rates were measured before and after a 4-week period of CQ prophylaxis

P. falciparum parasites in thick smear

48% had P. falciparum infection before prophylaxis and 37% had the infection after prophylaxis, making the protective efficacy of CQ at 23%

Research needs to be further conducted to define more cost-effective interventions, including more effective drugs, and health education programmes to improve compliance among pregnant women

4

Bloland et al. [25]; year of study, 1990

CQ and SP

Evaluation of drug efficacy for both short-term parasitological and clinical response to therapy and the long-term implications of the persistent parasitemia

153 children under five attending the outpatient department

Modified WHO in vivo test (1973)

28-days follow-up period on two groups; 124 given CQ and 37 SP

Parasitological resistance

82.3% on parasitological resistance occurred in the CQ group, while 70% in SP group exhibited a parasitological response

Children treated with SP maintained clinical improvement and improved haemoglobin concentration during the follow-up period than those treated with CQ; therefore, CQ was no longer considered as an adequately effective therapy of clinical treatment of malaria in very young children