Six Differences in the Efficacy of Antimalarial Drugs and Related Changes in the Haemoglobin Levels of Children Under Five in Ghana
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Date
2012-07
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University of Ghana
Abstract
Background: One of the consequences of drug resistance to malaria parasites, is poor
haematological recovery (Bloland et al., 1993; Verhoeff et al., 1997; Ekvall et al., 1998). Use of
the right antimalarial is the key to avert this situation. Few studies have explored sex differences
of these drug interventions in pediatric populations. ( Domellöf M et al 2002 and Songül S et al
2009).
Methods: This study is a descriptive study analyzing secondary data collected from a primary
comparative efficacy study of four antimalarials in Ghanaian children under five in 2005. Age,
sex, haemoglobin levels, parasite counts and temperature between sexes were used for the
analysis. Pearson Chi square test, ANOVA and paired t-test were performed between sexes and
day of treatment. Comparison of means, standard deviation, risk difference and mean difference
were done where it applies stating p values of <0.05 as significant and 95% confidence intervals.
Results: The treatment groups were distributed as follows at baseline; Chloroquine (CQ) 36,
Artesunate-Amodiaquine (ART/AMQ) 27, Sulphadoxine-Pyrimethamine (SP) 29, and
Artemether –Lumefantrine (AL) 19. The mean age was highest in the AL group 38.6 months
(SD±9.9). Adequate Clinical and Parasitological Response for evaluable patients was also
highest among females in the AL group 72% (13/18) at day 14 and followed a similar trend at
day 28; 69.23% (9/18).
About 70% (62/94) of all males in all treatment groups were anaemic while 43% (40/94) of all
females were anaemic at baseline. A total of 88.3% in both sexes and treatment groups were still
anaemic by day 7 assessment. Haemoglobin (Hb) levels increased in both sexes and all groups
during and after treatment but the cross comparisons between days were mostly significant
among ACT females. Among the ACT’s, females in AL were always significant comparing Hb’s
levels on any day of treatments but only significant at day 0 and 28 for ART/AMQ (p=0.0188).
Conclusion: No significant difference in efficacy was found between males and females and
between antimalarial treatment groups. This could be attributed to a small sample size used in the
evaluation. Considering the permuted days of comparisons in both ACT groups, females were
found to have a statistically significant haematological recovery than boys with mean ages in
months of 35.1 and 31.5 respectively. Further studies to establish local haematological reference
values, followed by studies to ascertain haematological recovery rates among Ghanaian children
are recommended.
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Thesis (Msc) - University of Ghana, 2012