Oral Chloroquine in the treatment of cerebral malaria in Ghanaian Children

Abstract

The usefulness of chloroquine as the first line drug for the treatment of acute simple and complicated malaria has been threatened in many Sub-Saharan African countries by the emergency of P. falciparum resistant to chloroquine. In Ghana, anecdotal and published reports suggested that resistance was becoming a major clinical problem, although it remained the first line treatment for simple and complicated malaria including cerebral malaria. This study was undertaken in 1997 to determine the effectiveness of chloroquine in cerebral malaria. Between July and August 1997, 196 children with cerebral malaria were admitted to the Children's Emergency Ward of the Korle Bu Teaching Hospital, Accra. Mortality was 15.3%. Eighty-eight treated initially with chloroquine were studied to Day 7 or longer. Thirty-one of 60 (52%) children tested had parasites in their peripheral blood film at Day 3. In 3 (5%) the parasitaemia was >25% of the Day zero value (R11 resistance) but 2 of these were well. Taking clinical parameters such as fever and worsening coma score into consideration early treatment failure occurred in 10 patients (11.4%) and these had their treatment changed 10 amodiaquine. The results indicate that resistance to chloroquine is demonstrably increasing