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Query: UMLS:C0024530 (malaria)
 44,886 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

To determine the effect of chloroquine chemoprophylaxis during pregnancy on birth weights, a randomized trial was carried out in 1987 and 1988 in Banfora, Burkina Faso (West Africa). Seven hundred forty-five randomly selected women treated with chloroquine sulfate were compared to with 719 controls who received no treatment. In spite of an unquestionable effect of chloroquine in preventing placental infection (4.1% infected placentas in the treated group versus 19.0% in the controls), the mean difference in birth weights between the two groups (6 g) was not significant. The difference in the proportion of low birth weight (LBW) newborn babies in two groups (16.3% versus 16.4%) was also not significant. However, there was a strong relationship between placental infection and birth weight (the mean birth weight difference between infected and uninfected placentas was 113 g, and the proportion of LBW babies was 26.0% in infected placentas versus 14.8% in uninfected placentas). The small difference in birth weights observed between the two groups may be due to the fact that the prevalence rate of placental infection is low and that prophylaxis is effective only on a portion of the subjects in the treated group. It may also indicate that malaria is only one of several risk factors responsible for LBW. The relatively small increase in birth weight, the expected poor acceptance of mass prophylaxis, and the spreading of chloroquine-resistant Plasmodium strains should be considered before extending malaria chemoprophylaxis to all pregnant women. It might be worth considering to limit prophylaxis to primigravidae.
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PMID:Effect of chloroquine chemoprophylaxis during pregnancy on birth weight: results of a randomized trial. 153 79

A number of phases in the history of malaria control in the Southwest Pacific Region can be recognized. During the first phase (1898-1923) it was known that anopheline mosquitoes carried malaria, but as yet the identity of the local vectors had not been established. The incrimination of the vectors in 1923 gave a sound basis for control, which remained largely urban in location except for the distribution of the larvivorous fish Gambusia affinis. The exigencies of the Pacific War and the presence of large numbers of combat troops in malarious areas resulted in the establishment of Mobile Entomological Sections and Malaria Control Units, and the collection and collation of large amounts of entomological, epidemiological and parasitological information. Larval control measures, carried out with very large labour lines and with military precision, were effective. The availability of dichlorodiphenyltrichloroethane (DDT) in 1943 made attack on adult vector mosquitoes also possible; DDT was applied widely in Papua New Guinea and the Solomon Islands by spraying and misting with adulticidal devices in tents and buildings, and by release from aircraft. Atebrin and dimethylphthalate also became available in quantity, for the suppression and treatment of malaria and for personal protection against mosquitoes, respectively. The wartime successes gave hope for peacetime anti-malaria activities carried out within village communities, which to this stage had not been seriously attempted. By three years after the end of the war the World Health Organization, the South Pacific Commission, and local administrative structures had been set up. Extensive investigations into the nature and severity of malaria endemicity were undertaken and recorded. Initially malaria control remained localized and largely urban, and was carried out by conventional antilarval measures, but at the same time new anti-malaria compounds became available for prophylaxis and treatment. Uncertainty still remained as to the usefulness of indoor spraying with DDT against anophelines of the punctulatus group. By 1953 the results of detailed studies in test huts set up for the purpose were known to been couraging, and the decision was made in 1954 to begin in Netherlands New Guinea (West Irian) a pilot project of routine residual spraying with DDT in village houses.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:The history of malaria control in the southwest Pacific region, with particular reference to Papua New Guinea and the Solomon Islands. 156 7

Medical advice for the traveller is of increasing importance since in the past decade in industrialized countries there is a steady increase in numbers of travellers and distance travelled. Self medication was evaluated in 193 travellers to malaria-endemic areas. Diarrhoea, fever and headache were the most frequent symptoms. Antidiarrhoeal agents, analgetics/antipyretics, antibiotics and oral contraceptives were the drugs most often used by travellers. One case of mefloquine-resistant and chloroquine-sensitive Plasmodium falciparum malaria acquired in West Africa was reported, another patient took pyrimethamine/sulfadoxine because of suspected malarial fever. The main reasons for drug consumption in travellers to tropical and subtropical areas are functionally divided into 4 groups: vaccination and prophylaxis, medication during the outward and return journey, illness occurring during stay abroad and long-term medication. This classification should be considered when medical advice is given for travellers and is the basis for choosing the contents of a pocket dispensary for travellers.
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PMID:[Self-medication of 193 travelers in the tropics. Recommendations for clinical counseling of tropical travelers and organization of a tropical travel pharmacy]. 158 72

We have investigated the pattern of acquired immune responses to the major surface protein of Plasmodium falciparum merozoites (gp 190, PfMSP1) in a malaria endemic population in West Africa. A prospective longitudinal study in 3- to 8-year-old children was conducted to examine the relationship between naturally acquired immune responses to PfMSP1 and subsequent susceptibility to malaria infection and clinical disease. A population cross-sectional survey was performed to investigate changes in immune response with age. The prevalence and concentration of antibodies to all regions of the molecule increased with age with the highest prevalence of antibodies being detected against regions of the molecule which are highly conserved between parasite isolates. In vitro lympho-proliferation and interferon-gamma production in response to recombinant proteins representing polymorphic regions of the molecule also increased with age. Interestingly, proliferative responses to some regions of the molecule, including some highly conserved sequences, were highest in young children and decreased markedly with increasing age. Significant associations were observed between antibody and lymphoproliferative responses to proteins from the C terminus of the molecule and resistance to episodes of fever associated with high parasitaemia in partially immune children. In addition, high concentrations of antibodies to a conserved region close to the N terminus of PfMSP1 were also significantly associated with protection.
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PMID:Naturally acquired cellular and humoral immune responses to the major merozoite surface antigen (PfMSP1) of Plasmodium falciparum are associated with reduced malaria morbidity. 162 8

The prevalence of visceral leishmaniasis and malaria in the human population of West Pokot district of Kenya was studied in 1986. A total of 2139 people was proportionately screened for the two diseases according to four age categories (0-4, 5-14, 15-44 and greater than 45 years). Diagnostic methods included the enzyme linked immunosorbent assay (ELISA) and Leishmanin skin test for visceral leishmaniasis, and parasitological examination for malaria. The epidemiological value of the spleen rate was evaluated in relation to visceral leishmaniasis and malaria endemicity. A general decline of infection rates with altitude was observed for both diseases. Visceral leishmaniasis was less prevalent than malaria, with less than 2% active cases in any age group and had the same distribution in both sexes. Malaria infection rate was highest in the younger age groups, declining from 21.5% in the 0-4 year old age group to 5.5% in people more than 45 years old. Malaria affected significantly more males than females. The spleen rate was inappropriate for epidemiological survey of either malaria or visceral leishmaniasis due to an overlap in the distribution of the two diseases.
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PMID:Visceral leishmaniasis and malaria prevalence in West Pokot District, Kenya. 818 49

We have undertaken a systematic search for T cell epitopes within the sequence of the major merozoite surface antigen (GP190) of Plasmodium falciparum. Recombinant polypeptides expressed in E. coli were used to evaluate the reactivity of peripheral blood mononuclear cells (PBMC) from both inhabitants of a rural community of West Africa exposed to P. falciparum transmission and from German patients with diagnosis of acute malaria. Although the proliferative response of the PBMC was in most cases very low, several T cell clones could be established. Deletion analysis of each gp190-derived polypeptide allowed the identification of six different T cell epitopes. Epitopes could be mapped within the dimorphic region of gp190, which also contains the sequences most frequently recognized by sera from adult individuals living in endemic areas.
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PMID:The T cell reactivity against the major merozoite protein of Plasmodium falciparum. 170 43

Plasmodium falciparum malaria poses an increasing risk to travellers to West Africa. The development of chloroquine resistant in West Africa has further compounded the risk. Two cases of falciparum malaria from Sierra Leone are presented. One represents the classic missed case and the other a probable case of chloroquine resistant (RI vide infra) falciparum malaria. These cases highlight the danger of the missed or late diagnosis; the need for chemoprophylaxis, even in emigrants; the threat posed to the international traveller by malaria; and the problem of chloroquine resistant Plasmodium falciparum (CRPF) malaria from West Africa. The position of Plasmodium falciparum malaria in West Africa is reviewed along with the problem caused by chloroquine resistance.
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PMID:West African malaria. 174 27

Between 1985-1987, researchers recruited 419 5-60 year old persons with moderate falciparum malaria to take part in a series of studies in West Pokot, Rusinga Island, Busia, and Bungoma districts in western Kenya to determine malaria parasite sensitivity to chloroquine and amodiaquine. The subject received 25mg/kg of the antimalarial for 3 days. Chloroquine resistance was highest in Busia in May 1986 (51%) followed by Bungoma (45%), Busia in July 1986 (38%), West Pokot (27%), and Rusinga Island (19%). No RIII resistance (failure to decrease parasitemia by at least 75%) occurred in any of the 4 studies. In July 1986, researchers compared the different sensitivity levels of chloroquine and amodiaquine among 119 school children in Busia. None of the children exhibited RIII resistance. None of the falciparum malaria parasites in the 58 children receiving amodiaquine showed RII resistance (failure to clear parasites) compared to 3.3% of those receiving chloroquine. Yet 15.5% of students receiving amodiaquine harbored parasites with RI resistance (recurrence of parasitemia within 7 days), especially delayed RI resistance. Still this percentage was much lower than RI resistance among the students receiving chloroquine (34.4%). Total resistance was significantly much higher in the chloroquine group than the amodiaquine group (p.01). Moreover in vitro studies revealed that the percentages of parasites with minimum inhibitory concentrations (MICs) for chloroquine 114 nM (indicating resistance) varied from 37% in Busia to 68% in Bungoma. Further 20% had MICs for amodiaquine 80 mM (indicating resistance). In conclusion, chloroquine resistant falciparum malaria parasites have established themselves in western Kenya. Despite growing resistance, amodiaquine should still be used in uncomplicated infections, if the health practitioner is able to follow up on the patients.
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PMID:Sensitivity of falciparum malaria to chloroquine and amodiaquine in four districts of western Kenya (1985-1987). 176 12

The director of the hospital in Kapenguria and the Public Health Officer in the district of West-Pokot and a deputy medical director who had worked there before visited Chepkono, a village of some 20 huts spread around with serious signs of erosion. Their mission was to induce friends of Kenya in the Netherlands to donate money for the improvement of the health service, for the construction of clinics, and for educational programs. A small clinic consisting of 1 room decorated with pamphlets against AIDS, malaria, and other diseases was managed by the chief primary health care (PHC) assistant named Joseph. The village chief talked about the progression of school construction and the sanitary project. Joseph spoke about the strange disease that had all the signs of an epidemic affecting all ages with headache, fever, abdominal cramps, and muscle pain. A village elder added that the mouths of the deceased were black. At a hut there were about 10 people, among them a couple of children, probably also affected by the strange disease, sitting quietly watching the doctors. Each of them had lost 1 or more family members. The children were examined by the doctors, and it turned out that they suffered from a common ailment that good nutrition could relieve. Joseph got the assignment to procure milk powder and instant food for the use of the mothers. The doctors' conclusion was that in Chepkono the major ailment was meningitis or neck cramp. The examination would continue in the hospital in Kapenguria. The men were also informed that there was no vaccination against the strange disease. Joseph proved to be a capable PHC assistant knowing medicines and patients. Sanitary measures including toilet hygiene and boiling milk and water were recommended to avoid illness, and the guests departed.
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PMID:[Chepkono, in the heart of a paradise]. 178 9

According to the new strategy of the WHO for malaria prophylaxis, the use of stand-by drugs should be recommended when feasible. Because of its favourable safety/efficacy profile, I recommend Halofantrine to be used as the drug for stand-by treatment with the precautions expressed here.
West Afr J Med
PMID:Expert opinion on presumptive treatment with halofantrine (Halfan). 179 Jan 36


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