(244) Comparative Effect of Four Antimalarial Treatments on Haematocrit in Children in Southwest, Nigeria.

Background: Anaemia in malaria has both central (dyserythropoiesis) and peripheral causes (phagocytosis of both infected and uninfected erythrocytes and haemolysis). Some antimalarial drugs also cause intravascular hemolysis leading to anemia. However, it is often difficult to disentangle the anemia effect of malaria from its treatments.

Objectives: The aim of this study was carried out to compare the change in hematocrit following four antimalarial treatments.

Methods: Data were extracted from 313 case record forms of children that met the eligibility criteria aged 3-119 months enrolled in antimalarial clinical trials in Southwest Nigeria between 1998 and 2014. Change in haematocrit levels from baseline through 28 days follow-up period were compared among children treated with artemether-lumefantrine (82), atovaquone-proguanil (41), artesunate-amodiaquine (156) and chloroquine (34).
Repeated measures analysis was done by fitting a general linear model (GLM).

Results: The median age of the study population was 25 months and 54% were males. The mean differences (95% CI) in haematocrit from baseline were 4.7% (95% CI = 3.6, 5.8), 4.4% (95% CI = 2.7, 6.0), 3.8% (95% CI = 3.0, 4.7) and 2.4% (95% CI = 0.5, 4.4), for artemether-lumefantrine, atovaquone-proguanil and artesunate-amodiaquine and chloroquine, respectively. Using the general linear model, repeated measure analysis showed significant differences in the mean haematocrit level over the 28-day follow-up among the four treatment groups (p < 0.05).

Conclusions: All children experienced increased haematocrit after treatment, with artemether-lumefantrine appearing to result in a greater increase in haematocrit than other antimalarial drugs. Children who are more susceptible to haemolyze during and after malarial infection such as Sickle Cell Disease and G6PD deficiency patients might benefit more from using the artemether-lumefantrine combination than the other antimalarial drugs in the Nigerian market.