FIRST LINE ANTI-MALARIAL DRUG (CHLOROQUINE) EFFICACY STUDY FOR THE TREATMENT OF PLASMODIUM VIVAX.

Background: Malaria is well known parasitic disease and is a significant public health concern in Afghanistan. P. vivax, although usually considered to be benign, causes repeated debilitating relapses, rare life threatening complications, and low-birth-weight (LBW) infants of infected mothers. Antimalarial drug resistance poses a considerable challenge to malaria control, and is a major cause of malaria morbidity and mortality. In Afghanistan, P. vivax is transmitted between the months of May and October, but also some rare cases till end of Dec and accounts for around 97.8% of malaria cases. In Afghanistan malaria is the result more than 97% of plasmodium vivax and rarely plasmodium falciparum parasites, with focal and seasonal transmission and is a major health and wealth-threatening burden, now it is mostly confined to eastern region. Case management is major cornerstone of current control program and national treatment guideline recommends chloroquine as first line treatment regimens for vivax malaria respectively (eventually in combination with Primaquine for radical cure). Methods: This surveillance study was one-arm (descriptive) evaluation of clinical and parasitological responses to directly observed treatment with Chloroquine for P. vivax malaria of all male and female, non-pregnant female and children over six month. Treated on site with Chloroquine for P.vivax malaria and monitored for 28 days from Sep, 2016 to Feb, 2017 in eight location in eastern region (Nangarhar and Laghman provinces). All cases were followed up on days 0, 2, 7, 14, 21 and 28 for evaluation of post treatment clinical and parasitological responses. On the basis of the results of these assessments, the patients will be classified as having therapeutic failure (early or late) or an adequate response. The proportion of patients experiencing therapeutic failure during the follow-up period were used to estimate the efficacy of the study drug(s). Results 192 Laboratory confirmed malaria patients (192 PV) were enrolled across eight health facilities of two provinces in the eastern part of the country. Baseline clinical and laboratory characteristics were at benign Pattern for inclusion in trial. Curative efficacy was highly perfect, with an adequate clinical and parasitological response (ACPR) of 99.5% (191/192 treatment success) on day-28. Early therapeutic response of all patients treated with CQ the parasitological response was pleasant and better (within 48hours), mean different in temperature D2 vs D0 =1.2C?, p<0.0001. Parasitaemia: at day2 7/133 patients (5%) remained +ve (p-value<0.0001 Gametocytes were found in 58% PV at day-0 and rapidly cleared with treatment as only 0.9% cases remained with gametocytes on day-2. Only 1/192 (0.5%) recurrence cases found on day 28. Post treatment Hb recovery was also reassuring and there was significant improvement in Hb recovery (Day-28 vs. D-0 = 13.4 vs. 12.50 (p-value <0.0006) 4 Drugs Safety: drug is well tolerated, no serious adverse event (SAE) or adverse event (AE) reported. Conclusions: The descriptive report of clinical outcomes of the study suggests good and high therapeutic efficacy of Chloroquine for vivax malaria treatment in Afghanistan as well as Primaquine for radical treatment. Due to its high efficacy, easy availability and broad use, we recommend to keep continue its administration in Afghanistan first line treatment of PV, but it is crucial to regularly monitor it?s efficacy through clinical, laboratory (in-vitro) and genetic studies for molecular markers analysis.