Proguanil as malaria chemoprophylaxis in sickle cell anaemia: the controversies, problems and the future: A narrative of literature

Abstract

Aim: In Nigeria, proguanil is the recommended drug for malaria chemoprophylaxis in persons with sickle cell anaemia (SCA); however, over the   years, studies have given controversial reports on the effectiveness of proguanil as chemoprophylaxis. This paper highlights the controversies and  the problems of continuous chemoprophylaxis with proguanil; and the need to explore more effective malarial chemoprevention method:  Intermittent Preventive Treatment (IPT). This is a narrative review of studies on the efficacy of malaria chemoprophylaxis in persons with SCA  focusing on proguanil and IPT.
Method: A total of seven (7) studies on the efficacy of IPT and malaria chemoprophylaxis using proguanil in SCA were found using the following  search engines: Google Scholar, Pub Med, MEDLINE, Med Scape and Cochrane review databases.
Result: Malaria chemoprophylaxis seems to be more useful in young children than in adults. Proguanil is less efficacious in reducing malaria  induced morbidity and mortality in SCA, compare to IPT using sulphadoxine/pyrimethamine (SP) or mefloquine/artesunate (MQAS).
Conclusion: Age may bean important determinant of efficacyof malaria chemoprophylaxis in the reduction of malaria induced morbidity (parasite  density , clinical malaria, severe anaemia, and vasoocclusive crises) in persons with SCA; being more useful in young children than in adults. There  may be a need to set separate policies on malaria chemoprevention for adults and children. It is paramount to consider a change of the current policy on malaria chemoprophylaxis in children with SCA from proguanil to IPT using SP,  QAS or other efficacious drugs for the present and the  future.