By Adibe, Maxwell Ogochukwu
The use of quinine to treat severe malaria was established before modern trial methods were
developed. Artemisinin derivatives are new antimalarial agent that clears parasites from the
circulation more rapidly than quinine, but their effect on mortality prevention, coma recovery
time, fever clearance, hospital bed-days and haemoglobin level is unclear.
The purpose of this study is to ascertain whether artemisinin derivatives are good alternatives to
quinine in real hospital setting.
We conducted a non-randomized, observational comparison of quinine and artemether therapies
in 96 children with severe malaria. Children between 6 months and 12 years of age presenting
with fever (?37.5"C) and P. fakiparum infection cases with one or more general danger signs of
severe or complicated malaria were included in the study.
There was no significant difference in hospital bed-days among the treatment groups (p = 0.649).
Multivariate regression analysis showed that for 'hospital bed- days', the effect of severity was a
secondary determinant of hospital bed- days, (p=0.009). There was a significant improvement in
haemoglobin level on day 14 (p< 0.0001) within the treatment groups. The number of patients
with mild anaemia increased from 23/61(38%) on day 0 to 20/36(55.56%) on day 14. There was
significant difference in coma recovery at day 3 (p < 0.0001). The comatose patients reduced
from 17/61(28%) at day 0 to 4/61(6.5%) at day 3, although five of them died before day 3. There
was no significant difference when the treatment groups were compared (p = 0.874). There was
no significant difference in mortality prevention for treatment groups: Artemether 4/25(16%)
deaths vs Quinine 7/37(18.9%); OR= 1.2,95% CI 0.121 to 1 1.865.
The findings showed that quinine and artemisinin derivatives were comparable in terms of
mortality prevention, fever and parasite clearance, coma recovery, hospital bed- days reduction,
and improvement in haemoglobin.