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Glucose-6-phosphate dehydrogenase deficiency, chlorproguanil-dapsone with artesunate and post-treatment haemolysis in African children treated for uncomplicated malaria

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dc.contributor.author Van Malderen, C.
dc.contributor.author Van geertruyden, J. P.
dc.contributor.author Machevo, S.
dc.contributor.author Gonzalez, R.
dc.contributor.author Bassat, Q.
dc.contributor.author Talisuna, A.
dc.contributor.author Yeka, A.
dc.contributor.author Nabasumba, C.
dc.contributor.author Piola, P.
dc.contributor.author Daniel, A.
dc.contributor.author Turyakira, E.
dc.contributor.author Forret, P.
dc.contributor.author Van Overmeir, C.
dc.contributor.author van Loen, H.
dc.contributor.author Robert, A.
dc.contributor.author D'Alessandro, U.
dc.date.accessioned 2012-05-08T13:48:51Z
dc.date.available 2012-05-08T13:48:51Z
dc.date.issued 2012
dc.identifier.issn 1475-2875
dc.identifier.doi http://dx.doi.org/10.1186/1475-2875-11-139
dc.identifier.other ITG-B1B
dc.identifier.other ITG-B12B
dc.identifier.other ITG-B13B
dc.identifier.other ITG-C14B
dc.identifier.other ITG-BLA
dc.identifier.other MULTI
dc.identifier.other DBM
dc.identifier.other U-MALAR
dc.identifier.other DCS
dc.identifier.other U-CTU
dc.identifier.other JIF
dc.identifier.other DOI
dc.identifier.other CPDF
dc.identifier.other Abstract
dc.identifier.other UPD46
dc.identifier.uri http://hdl.handle.net/10390/6995
dc.description.abstract BACKGROUND: Malaria is a leading cause of mortality, particularly in sub-Saharan African children. Prompt and efficacious treatment is important as patients may progress within a few hours to severe and possibly fatal disease. Chlorproguanil-dapsone-artesunate (CDA) was a promising artemisinin-based combination therapy (ACT), but its development was prematurely stopped because of safety concerns secondary to its associated risk of haemolytic anaemia in glucose-6-phosphate dehydrogenase (G6PD)-deficient individuals. The objective of the study was to assess whether CDA treatment and G6PD deficiency are risk factors for a post-treatment haemoglobin drop in African children <5 years of age with uncomplicated malaria. METHODS: This case-control study was performed in the context of a larger multicentre randomized clinical trial comparing safety and efficacy of four different ACT in children with uncomplicated malaria. Children, who after treatment experienced a haemoglobin drop [greater than or equal to]2 g/dl (cases) within the first four days (days 0, 1, 2, and 3), were compared with those without an Hb drop (controls). Cases and controls were matched for study site, sex, age and baseline haemoglobin measurements. Data were analysed using a conditional logistic regression model. RESULTS: G6PD deficiency prevalence, homo- or hemizygous, was 8.5% (10/117) in cases and 6.8% (16/234) in controls (p = 0.56). The risk of a Hb drop [greater than or equal to]2 g/dl was not associated with either G6PD deficiency (adjusted odds ratio (AOR): 0.81; p = 0.76) or CDA treatment (AOR: 1.28; p = 0.37) alone. However, patients having both risk factors tended to have higher odds (AOR: 11.13; p = 0.25) of experiencing a Hb drop [greater than or equal to]2 g/dl within the first four days after treatment, however this finding was not statistically significant, mainly because G6PD deficient patients treated with CDA were very few. In non-G6PD deficient individuals, the proportion of cases was similar between treatment groups while in G6PD-deficient individuals, haemolytic anaemia occurred more frequently in children treated with CDA (56%) than in those treated with other ACT (29%), though the difference was not significant (p = 0.49). CONCLUSION: The use of CDA for treating uncomplicated malaria may increase the risk of haemolytic anaemia in G6PD-deficient children. en
dc.language English en
dc.subject Malaria en
dc.subject Plasmodium falciparum en
dc.subject Vectors en
dc.subject Mosquitoes en
dc.subject Anopheles en
dc.subject Treatment en
dc.subject Artemisinin combination therapies (ACT) en
dc.subject Chlorproguanil en
dc.subject Dapsone en
dc.subject Artesunate en
dc.subject Children en
dc.subject Hemoglobin en
dc.subject Risk factors en
dc.subject G6PD deficiency en
dc.subject Randomized clinical trials en
dc.subject Africa, General en
dc.title Glucose-6-phosphate dehydrogenase deficiency, chlorproguanil-dapsone with artesunate and post-treatment haemolysis in African children treated for uncomplicated malaria en
dc.type Article-E
dc.citation.issue 139 en
dc.citation.jtitle Malaria Journal en
dc.citation.volume 11 en
dc.identifier.pmid http://www.ncbi.nlm.nih.gov/pubmed/22546009
dc.citation.jabbreviation Malar J en


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