Comparative Haematologic Parameters of Paediatric Uncomplicated Plasmodium falciparum Malaria in Children Treated with Artemether-Lumefantrine and Artesunate-amodiaquine in Jos, North-Central Nigeria.

Abstract

Background: Malaria is still threatening the lives of millions of children particularly the under five years living in malaria endemic countries of the world. Acute malarial episodes cause many pathophysiological changes in the haematological system of man including alterations in erythrocytes, leucocytes and thromobocytes in the peripheral blood. These changes occur before and after treatment with antimalarial drugs and could also be influenced by the type of antimalarial drugs used.

Aim: To determine and compare the changes in haematologic parameters before and after treatment of uncomplicated P. falciparum malaria with artemether-lumefantrine (AL) and artesunate-amodiaquine (AA) in under-five children using 28 day study protocol.

Method: Data on 111 children aged 6 to 60 months who were enrolled into a drug therapeutic efficacy testing (DTET) comparing the efficacy, safety and tolerability of AL (20/120mg) with AA (25mg/67.5mg or 50/135mg) in the treatment of uncomplicated falciparum malaria, were analyzed. This study was over a period of 10 weeks (27/06/2010 - 16/11/2010) at the General Hospital Brakin Ladi,Plateau State, Nigeria. Inclusion criteria were: history of fever in the last 24hrs and /or measured axillary temeperature 37.5 °C, P. falciparum infection with parasitaemia ≥ 1000 to ≤ 250,000 parasites/μL, HIV seronegative status, and a written informed consent from parents/guardians including readiness to comply with the follow-up visits by the parents. The children who met the inclusion criteria were randomized into the two treatment arms and their haematological parameters (haemoglobin(HB)) levels, platelet, neutrophil, lymphocyte counts, and total white cell count (WBC) measured.

Results: Of 649 subjects screened for parasitaemia in the study, 282 (43.5%) were febrile (temperature 37.5°C). Out of 649 subjects, 252 (38.8%) had parasitaemia. Only P.falciparum was identified. Parasite count varied from 1000-200,000 asexual forms/μL. The mean age (months) of study population in the AL and AA arms were 38.9 16.90 and 37.7 16.76 respectively, (p=0.72). Thirty one (55.4%) and 25 (44.6%) were males and females in the AL study arm respectively while 32 (58.2%) and 23 (41.8%) were males and females respectively in the AA study arm, (p=0.77). The mean Packed cell volume (PCV) % pre-treatment (D0) rose from 32.14.7 to 35.7 7 in AL treatment arm and from 32. 5.5 to 35.14.4 in AA treatment levels of 9.83.5 and 10.04.7 to 7.82.2 and 7.72.4, in the AL and AA treatment arms D28 post-treatment (D0) levels of 36.912.5 to 32.88 in the AL treatment arm and from 37.517.0 to 35.0 10.6 in the AA treatment arm respectively, p=0.356. The mean monocytes counts (%) similarly dropped from pre-treatment levels of 11.14.8 to 8.63.4 in the AL treatment arm and from 10.7 4.2 to 8.2 3.7 in the AA treatment arm respectively, p=0.0404. Mean platelete counts also showed a decreasing trends from 545.3215.4 and 280.2151.8 to 268.2106.3 and 258.898.7 in the AL and AA treatment arms respectively at D28, post-treatment, p=0.394. Compared to the PCV, WBC, neutrophil, monocytes and platelete subpopulations of cells, the mean lymphocyte counts demonstrated a progressive increasefrom nadir of 51.415.7 to 58.711.6 in the AL treatment arm and 52.016.6 to 56.611.4 in the AA treatment arm at D28 post-treatment respectively, p=0.630.

Conclusion: Uncomplicated paediatric Plasmodium falciparum malaria induces transient alterations in haematologic parameters before and after antimalarial treatment in Jos, North Central Nigeria. Therefore, malaria infection should be considered as a differential diagnosis in febrile children with alterations in haemologic parameters.