Search

Research studies conducted so far have had little bearing on the National Malaria Eradication Programme implementation for want of operational component. In India there is no dearth of scientific knowledge and technical know-how but dearth of operational research of direct relevance to the programme. The rationale for research under the operational conditions of the NMEP is discussed in this paper.

The present study describes the comparative efficacy of chloroquine and amodiaquine in two different presumptive therapy areas of north eastern India. The study recorded insignificant differences in respect of Mean Parasite Clearance Time (MPCT) of sensitive cases, MPCT and Mean Parasite Recrudescence Time (MPRT) of RI resistant cases and recrudescence rate in chloroquine and amodiaquine therapy areas. It is concluded that amodiaquine is not a superior drug as compared to chloroquine. In the chloroquine resistance area, Plasmodium falciparum developed cross resistance to amodiaquine and this phenomenon appears to be unidirectional. However, amodiaquine may help to slow-down the rate of precipitation of higher grade of resistance.

The present paper describes the relationship of Mean Parasite Clearance Time (MPCT) and Mean Parasite Recrudescence Time (MPRT) in the epidemiology of Plasmodium falciparum. The role of MPCT in grading the resistance of an area has been discussed. Further, MPRT revealed a positive correlationship with the percentage of RI resistant cases, and showed an increase with age. The ratio of MPRT/MPCT is an indicator of stability status of the resistance.

A low dose oral quinine schedule with 1050 mg in two divided doses daily for five days was tried for treatment of Plasmodium falciparum cases in Assam, Meghalaya and Arunachal Pradesh, in areas where resistance to chloroquine was confirmed. The drug schedule was found effective in 76.92 per cent cases. The treatment was also found effective in 45.55 per cent of the known chloroquine resistant P. falciparum cases. The drug in this low dose was well tolerated and clinical response was quick.

A total of 314 cases of Plasmodium falciparum malaria studied during 1980-88 in nine times monitoring revealed three RIII foci i.e. two in Jalpaiguri and one in Purulia districts. The studies showed a parasite clearance of 40 per cent and 32 per cent of P. falciparum cases within seventh day in Purulia and Jalpaiguri districts respectively, with a dosage of 25 mg per kg body weight, spread over three days in divided doses. Increase in transmission potential and prolonged drug pressure with single drug have been noted in association with development of resistance. Malaria parasite clearance time (MPCT) value of sensitive and resistant cases reach parallelism and malaria parasite recrudescence time (MPRT) value starts declining, giving an indication of stabilisation of genetic change in the parasite.

Studies were carried out in some areas of Assam, Nagaland, West Bengal and Mizoram where chloroquine resistant strains of Plasmodium falciparum were present during 1983 and 1984, to see the efficacy of treatment of P. falciparum cases with SLP alone or with quinine sulphate. The findings have indicated that SLP in the dosage of sulfalene (1000 mg) + Pyrimethamine (50 mg) is suitable for treatment of P. falciparum cases not responding to chloroquine therapy in N.E. India. Treatment with sulfalene (1500 mg) + Pyrimethamine (75 mg) has no advantage over the SLP (1000 + 50) mg. Combination of quinine (1000 mg x 3 days) + SLP (1000 + 50) mg is better with 100 per cent cure rate. In Karhi Anglong district (Manja PHC) of Assam response to these drug combination is however less.